Urinary albumin excretion rate and glomerular filtration rate in the prediction of diabetic nephropathy; a long-term follow-up study of childhood onset type-1 diabetic patients
Urinary albumin excretion rate and glomerular filtration rate in the prediction of diabetic nephropathy; a long-term follow-up study of childhood onset type-1 diabetic patients
复制标题
DOI：
10.1093/ndt/16.7.1382
复制
发表时间：
2001-07-01
影响因子：
6.1
通讯作者：
Rudberg, S
中科院分区：
文献类型：
--
作者：
Dahlquist, G;Stattin, EL;Rudberg, S
背景糖尿病肾病的早期症状有哪些？肾小球超滤的作用被广泛讨论。我们研究了1型糖尿病微量和大量白蛋白尿的累积发生率、肾小球滤过率（GFR）的预测价值和白蛋白排泄率（AER）的筛查价值。对一组糖尿病儿童进行了平均29 +/-3年的随访。所有75名在一家医院接受治疗的糖尿病病程≥ 8年的儿童前瞻性随访8年，检查GFR、AER。血压和HbAlc。再随访8-10年，对其中60例进行终点随访。7名患者（12%）出现大量白蛋白尿，即持续过夜AER> 200 mg/min，12名（20%）出现持续微量白蛋白尿（AER 15-200 mg/min），17名（28%）出现一过性微量白蛋白尿（连续两次>15 mg：min，在终点时正常化）。一个基线筛查值24小时AER>15 mg/min预测93%的患者持续微量或大量白蛋白尿。阴性预测值为78%。7例大量白蛋白尿患者中有6例和12例微量白蛋白尿患者中有10例的基线GFR高于该方法的正常限值（小于或等于125 ml/min 1.73 m（2））。当调整糖尿病病程时，GFR增加预测大量或微量白蛋白尿（比值比=5.44，P=0.04）。基线GFR增加的阳性预测值为53%。阴性预测值为77%。HbAlc的分层并没有改变GFR增加的影响。在平均糖尿病病程29年时，大量白蛋白尿的累积发生率为12%，然而，另外20%的患者有持续的微量白蛋白尿。24小时AER > 15 mg/min的筛查值是一个强预测因子，而GFR升高是一个较弱但重要的微量和大量白蛋白尿的预测因子。
Background. Predictors of diabetic nephropathy are only partly known. The role of glomerular hyperfiltration is much discussed. We have studied the cumulative incidence of micro and macroalbuminuria and the predictive value of glomerular filtration rate (GFR) and screening value of albumin excretion rate (AER) in type-1 diabetes.Methods. A cohort of diabetic children was followed up at a mean duration of 29 +/-3 years. All 75 children treated in one hospital with diabetes duration greater than or equal to 8 years were prospectively followed for 8 years examining GFR, AER. blood pressure and HbAlc. After another 8-10 years, 60 of them were traced for endpoint follow-up.Results. Seven patients (12%) developed macroalbuminuria, i.e. persistent overnight AER> 200 mg/min, 12 (20%) developed persistent microalbuminuria (AER 15-200 mg/min) and 17 (28%) transient microalbuminuria (>15 mg:min on two consecutive occasions, normalized at endpoint). One baseline screening value of 24-h AER>15 mg/min predicted 93% of patients with persistent micro or macroalbuminuria. The negative predictive value was 78%. Six of seven macroalbuminuric and 10 of 12 microalbuminuric patients had a baseline GFR above the normal limit of the method ( less than or equal to 125 ml/min1.73 m(2)). When adjusted for diabetes duration, increased GFR predicted macro or microalbuminuria (odds ratios=5.44, P=0.04). The positive predictive value for having an increased baseline GFR was 53%. The negative predictive value was 77%. Stratification for HbAlc did not change the effect of an increased GFR.Conclusions. At a mean diabetes duration of 29 years the cumulative incidence of macroalbuminuria was 12%,: however, another 20% had persistent microalbuminuria. A screening value of 24-h AER > 15 mg/min was a strong predictor, whereas increased GFR was a weaker but significant predictor for micro and macroalbuminuria.