Journal of the American Society of Nephrology, Vol 7, 2627-2635, Copyright © 1996 by American Society of Nephrology

REGULAR ARTICLES

Renal findings in patients with short-term type 2 diabetes

CK Keller, KH Bergis, D Fliser and E Ritz
Department of Internal Medicine, University of Heldelberg, Germany.

Under semiambulatory conditions, 85 consecutive patients with the diagnosis of Type 2 diabetes of short duration (excluding patients with islet cell antibodies or maturity onset diabetes of the young) were admitted to a self-control training program and were examined in this study. A comprehensive renal assessment was performed, including evaluation of albumin excretion rate (AER), renal hemodynamics, blood pressure (BP) profile, and indicators of genetic risk. AER > or = 30 mg/24 h was found in 13 (15%) of patients; in two of these patients, AER was > or = 300 mg/24 h. By logistic regression, high HbA1, current smoking, and BP parameters were significantly correlated with an increased risk of microalbuminuria (MA). In a multiple linear regression model, accounting for 57% of total variance, HbA1, ERPF, and current smoking were significantly correlated with AER. Median GFR (Cin(inulin clearance) 136 mL/min per 1.73m2; range, 94 to 194) and ERPF (Cpah(para-aminohippuric acid clearance) 733; range, 451 to 1328) were significantly higher in patients than in control subjects (upper 95th percentile, 131 and 706 mL/min per 1.73m2, respectively). In a multiple linear regression model, explaining 27% of total variance, age, AER, gender, and fasting blood glucose were significantly correlated to GFR. According to the criteria of average daytime BP > or = 135/85 mm Hg or 24-h BP > or = 130/80 mm Hg, 60% of patients were hypertensive (HT). Sixty-one percent of all patients (including 50% of the untreated normotensive patients) were "nondippers", i.e., < 15% nighttime decrease of mean arterial pressure. Either HT or nondipping was found in 79% of all patients, so that only 21% had a completely normal blood pressure profile. Ninety-four percent of untreated hypertensive patients had no MA. First-degree relatives of patients with MA compared with patients without MA had more frequent cardiovascular events (69% versus 31%). The risk of MA in diabetic patients with positive family history was amplified by poor glycemic control. MA, but not hypertension, was marginally related to K(m) of Na+/Li+ countertransport. It was concluded that (1) microalbuminuria is found in 15% of patients newly presenting with Type 2 diabetes; (2) a high proportion of patients exhibit hyperfiltration; (3) according to ambulatory BP only, 21% of patients have a completely normal circadian BP profile; (4) a family history of cardiovascular events interacts with glycemic control to increase the risk of MA.

This article has been cited by other articles:

				G. Remuzzi, M. Macia, and P. Ruggenenti Prevention and Treatment of Diabetic Renal Disease in Type 2 Diabetes: The BENEDICT Study J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S90 - S97. [Abstract] [Full Text] [PDF]

				P. De, G. Das, K. Harley, and H. Nair Review: Dual blockade of renin-angiotensin system in diabetic nephropathy: review of literature and local experience The British Journal of Diabetes & Vascular Disease, January 1, 2006; 6(1): 23 - 28. [Abstract] [PDF]

				R. J. Middleton, R. N. Foley, J. Hegarty, C. M. Cheung, P. McElduff, J. M. Gibson, P. A. Kalra, D. J. O'Donoghue, and J. P. New The unrecognized prevalence of chronic kidney disease in diabetes Nephrol. Dial. Transplant., January 1, 2006; 21(1): 88 - 92. [Abstract] [Full Text] [PDF]

				S. R. Orth, T. Schroeder, E. Ritz, and P. Ferrari Effects of smoking on renal function in patients with type 1 and type 2 diabetes mellitus Nephrol. Dial. Transplant., November 1, 2005; 20(11): 2414 - 2419. [Abstract] [Full Text] [PDF]

				T. Shike, T. Gohda, M. Tanimoto, M. Kobayashi, Y. Makita, K. Funabiki, S. Horikoshi, S. Hirose, T. Shirai, and Y. Tomino Chromosomal mapping of a quantitative trait locus for the development of albuminuria in diabetic KK/Ta mice Nephrol. Dial. Transplant., May 1, 2005; 20(5): 879 - 885. [Abstract] [Full Text] [PDF]

				G. Wolf and E. Ritz Diabetic Nephropathy in Type 2 Diabetes Prevention and Patient Management J. Am. Soc. Nephrol., May 1, 2003; 14(5): 1396 - 1405. [Full Text] [PDF]

				B. Baggio, A. Budakovic, M. D. Vestra, A. Saller, M. Bruseghin, and P. Fioretto Effects of Cigarette Smoking on Glomerular Structure and Function in Type 2 Diabetic Patients J. Am. Soc. Nephrol., November 1, 2002; 13(11): 2730 - 2736. [Abstract] [Full Text] [PDF]

				C. B. Good Polypharmacy in Elderly Patients With Diabetes Diabetes Spectr, October 1, 2002; 15(4): 240 - 248. [Abstract] [Full Text] [PDF]

				S. R. Orth Smoking and the Kidney J. Am. Soc. Nephrol., June 1, 2002; 13(6): 1663 - 1672. [Full Text] [PDF]

				K. A. Kohler, W. M. McClellan, D. C. Ziemer, D. G. Kleinbaum, and J. R. Boring Smoking and Microalbuminuria: A case-control study in African-Americans with type 2 diabetes Diabetes Care, January 1, 2002; 25(1): 243 - 245. [Full Text] [PDF]

				E. Ritz, V. Schwenger, M. Zeier, and I. Rychlik Ambulatory blood pressure monitoring: fancy gadgetry or clinically useful exercise? Nephrol. Dial. Transplant., August 1, 2001; 16(8): 1550 - 1554. [Full Text] [PDF]

				W. T. Noonan and R. O. Banks Renal Function and Glucose Transport in Male and Female Mice with Diet-Induced Type II Diabetes Mellitus Experimental Biology and Medicine, December 1, 2000; 225(3): 221 - 230. [Abstract] [Full Text]

				E. Ritz and S. R. Orth Nephropathy in Patients with Type 2 Diabetes Mellitus N. Engl. J. Med., October 7, 1999; 341(15): 1127 - 1133. [Full Text] [PDF]

				M. Bluthner, A. Bruntgens, S. Schmidt, K. Strojek, W. Grzeszczak, and E. Ritz Association of methylenetetrahydrofolate reductase gene polymorphism and diabetic nephropathy in type 2 diabetes Nephrol. Dial. Transplant., January 1, 1999; 14(1): 56 - 57. [PDF]

				D.P. Mikhailidis, J.A. Papadakis, and E.S. Ganotakis Smoking, Diabetes and Hyperlipidaemia The Journal of the Royal Society for the Promotion of Health, April 1, 1998; 118(2): 91 - 93. [Abstract]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673