Sequence of progression of albuminuria and decreased GFR in persons with type 1 diabetes: A cohort study
Sequence of progression of albuminuria and decreased GFR in persons with type 1 diabetes: A cohort study
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DOI：
10.1053/j.ajkd.2007.08.005
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发表时间：
2007-11-01
影响因子：
13.2
通讯作者：
Orchard, Trevor J.
中科院分区：
文献类型：
--
作者：
Costacou, Tina;Ellis, Demetrius;Orchard, Trevor J.
背景：白化尿在预测肾功能丧失方面的敏感性受到质疑。我们确定了肾脏疾病阶段的顺序(微量蛋白尿、大量蛋白尿、低估计肾小球滤过率[EGFR]和终末期肾病[ESRD])，并对那些在低eGFR之前没有白化尿的患者进行了特征描述。研究设计：匹兹堡糖尿病并发症流行病学研究是一项关于儿童期起病的1型糖尿病的前瞻性队列研究。前瞻性随访16年。结果与测量：低EGFR定义为定时采集尿肌酐清除量小于60毫升/分钟/1.73米(2)；微量白蛋白尿，定义为白蛋白排泄率在20-200微克/分钟(30-300毫克/24小时)之间；大量蛋白尿，白蛋白排泄率大于200微克/分钟(300毫克/24小时)；以及终末期肾病，为透析或肾移植。结果：480名ESRD患者中33人(7%)既往有白蛋白尿。480人中有71人(15%)出现低EGFR。71例中66例(93%)有白化尿史，5例(7%)无白化尿史。5例患者发生的EGFR低值分别为：(1)54，(2)58，(3)59，(4)59.7，(5)59.8mL/min/1.73m(2)。5例中有3例(60%；患者1、4和5)随后发展为白化尿。5例患者的最终eGFRs分别为：(1)94，(2)86，(3)60，(4)65，(5)54mL/min/1.73m(2)。限制：未测量GFR和胰岛素敏感性，但进行了估计。无白化尿史的患者发生EGFR降低可能是由于分类错误或一过性EGFR降低所致。结论：无白化尿史的1型糖尿病患者中，EGFR中度降低的情况很少发生。
Background: The sensitivity of alburninuria in predicting loss of kidney function has been questioned. We determined the sequence of kidney disease stages (microalbuminuria, macroalbuminuria, low estimated glomeruiar filtration rate [eGFR], and end-stage renal disease [ESRD]) and characterized those without alburninuria before a low eGFR.Study Design: The Pittsburgh Epidemiology of Diabetes Complications Study is a prospective cohort investigation of childhood-onset type 1 diabetes.Setting & Participants: 480 study participants with eGFR greater than 60 mL/min/1.73 m(2) (mean age, 27 years; diabetes duration, 19 years at study entry) were prospectively followed up for 16 years.Outcomes & Measurements: Low eGFR was defined as creatinine clearance less than 60 mL/min/1.73 m(2) from timed urine collections; microalbuminuria, as albumin excretion rate between 20 to 200 mu g/min (30 to 300 mg/24 h); macroalbuminuria, as albumin excretion rate greater than 200 mu g/min (> 300 mg/24 h); and ESRD, as dialysis or renal transplantation.Results: The 33 of 480 individuals (7%) who developed ESRD had prior albuminuria. 71 of 480 (15%) individuals developed low eGFR. 66 of 71 (93%) had prior/concurrent alburninuria, and 5 of 71 (7%) did not. Incident low eGFR values in the 5 patients were: (1) 54, (2) 58, (3) 59, (4) 59.7, and (5) 59.8 mL/min/1.73 m(2). 3 of 5 (60%; patients 1, 4, and 5) subsequently developed alburninuria. Final eGFRs in the 5 patients were: (1) 94, (2) 86, (3) 60, (4) 65, and (5) 54 mL/min/1.73 m(2), respectively.Limitations: GFR and insulin sensitivity were not measured, but estimated. Incident decreased eGFR in patients without preceding/concurrent alburninuria may be caused by misclassification or a temporary eGFR decrease.Conclusions: Moderately decreased eGFR may occur rarely in patients with type 1 diabetes without preceding alburninuria.