Effect of duration of type I diabetes on the prevalence of stages of diabetic nephropathy defined by urinary albumin/creatinine ratio


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Effect of duration of type I diabetes on the prevalence of stages of diabetic nephropathy defined by urinary albumin/creatinine ratio

JH Warram, G Gearin, L Laffel and AS Krolewski
Epidemiology and Genetics Section, Joslin Diabetes Center, Boston, MA 02215, USA.

The objective of this study was to determine the prevalence of stages of diabetic nephropathy, defined by the albumin/creatinine ratio (AC ratio) in repeated measurements in random urine samples. Over a 30- month interval, 1613 patients with Type I diabetes (IDDM) (aged 15 to 44 yr, IDDM duration 1 to 39 yr), and 218 healthy control subjects provided multiple urine specimens. AC ratios measured in urine samples taken 5 months apart were highly reproducible (Spearman r = 0.83). A criterion for the boundary between normoalbuminuria and microalbuminuria was obtained by searching for a cutpoint that optimized agreement between serial specimens on individuals. The result was lower in men than women: 17 as compared with 25 micrograms/mg. These two values corresponded to the 95th percentiles of the respective distributions of the AC ratio in healthy control subjects. Also these sex-specific cutpoints, when converted to albumin excretion rates, became almost equal: 30 and 31 micrograms/min. Microalbuminuria appeared early in the course of IDDM (6% of those with only 1 to 3 yr of diabetes) and then increased rapidly during two intervals, the first and third decades, before leveling off at 52%. By that time the cumulative risk of overt proteinuria had risen to 27%. Determinations of the AC ratio in random urine samples are easily obtained and are reliable indices of elevated urinary albumin excretion (microalbuminuria) in IDDM. The pattern of occurrence of microalbuminuria according to duration of IDDM suggests that there may be two subsets of diabetic nephropathy, one appearing early and the other late. Patients with microalbuminuria and 25 yr of postpubertal IDDM have low risk of progression to advanced diabetic nephropathy.

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HOME CURRENT ISSUE ARCHIVES JASN Express ONLINE SUBMISSION AUTHOR INFO
EDITORIAL BOARD SUBSCRIBE FEEDBACK ALERTS HELP

				A. Upadhyay, S.-J. Hwang, G. F. Mitchell, R. S. Vasan, J. A. Vita, P. I. Stantchev, J. B. Meigs, M. G. Larson, D. Levy, E. J. Benjamin, et al. Arterial Stiffness in Mild-to-Moderate CKD J. Am. Soc. Nephrol., September 1, 2009; 20(9): 2044 - 2053. [Abstract] [Full Text] [PDF]

				T. Babazono, I. Nyumura, K. Toya, T. Hayashi, M. Ohta, K. Suzuki, Y. Kiuchi, and Y. Iwamoto Higher Levels of Urinary Albumin Excretion Within the Normal Range Predict Faster Decline in Glomerular Filtration Rate in Diabetic Patients Diabetes Care, August 1, 2009; 32(8): 1518 - 1520. [Abstract] [Full Text] [PDF]

				H. Kramer, D. Reboussin, A. G. Bertoni, S. Marcovina, E. Lipkin, F. L. Greenway III, F. L. Brancati, and the Look Ahead Research Group Obesity and Albuminuria Among Adults With Type 2 Diabetes: The Look AHEAD (Action for Health in Diabetes) Study Diabetes Care, May 1, 2009; 32(5): 851 - 853. [Abstract] [Full Text] [PDF]

				K. Khavandi, A. S. Greenstein, K. Sonoyama, S. Withers, A. Price, R. A. Malik, and A. M. Heagerty Myogenic tone and small artery remodelling: insight into diabetic nephropathy Nephrol. Dial. Transplant., February 1, 2009; 24(2): 361 - 369. [Full Text] [PDF]

				E. C. Witte, H. J. Lambers Heerspink, D. de Zeeuw, S. J.L. Bakker, P. E. de Jong, and R. Gansevoort First Morning Voids Are More Reliable Than Spot Urine Samples to Assess Microalbuminuria J. Am. Soc. Nephrol., February 1, 2009; 20(2): 436 - 443. [Abstract] [Full Text] [PDF]

				P. L. Lutsey, A. V. Diez Roux, D. R. Jacobs Jr, G. L. Burke, J. Harman, S. Shea, and A. R. Folsom Associations of Acculturation and Socioeconomic Status With Subclinical Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis Am J Public Health, November 1, 2008; 98(11): 1963 - 1970. [Abstract] [Full Text] [PDF]

				H. J. Lambers Heerspink, A. H. Brantsma, D. de Zeeuw, S. J. L. Bakker, P. E. de Jong, R. T. Gansevoort, and for the PREVEND Study Group Albuminuria Assessed From First-Morning-Void Urine Samples Versus 24-Hour Urine Collections as a Predictor of Cardiovascular Morbidity and Mortality Am. J. Epidemiol., October 15, 2008; 168(8): 897 - 905. [Abstract] [Full Text] [PDF]

				J. P. Forman, N. D.L. Fisher, E. L. Schopick, and G. C. Curhan Higher Levels of Albuminuria within the Normal Range Predict Incident Hypertension J. Am. Soc. Nephrol., October 1, 2008; 19(10): 1983 - 1988. [Abstract] [Full Text] [PDF]

				K. Wanic, G. Placha, J. Dunn, A. Smiles, J. H. Warram, and A. S. Krolewski Exclusion of Polymorphisms in Carnosinase Genes (CNDP1 and CNDP2) as a Cause of Diabetic Nephropathy in Type 1 Diabetes: Results of Large Case-Control and Follow-Up Studies Diabetes, September 1, 2008; 57(9): 2547 - 2551. [Abstract] [Full Text] [PDF]

				J. J. Rogus, G. D. Poznik, M. G. Pezzolesi, A. M. Smiles, J. Dunn, W. Walker, K. Wanic, D. Moczulski, L. Canani, S. Araki, et al. High-Density Single Nucleotide Polymorphism Genome-Wide Linkage Scan for Susceptibility Genes for Diabetic Nephropathy in Type 1 Diabetes: Discordant Sibpair Approach Diabetes, September 1, 2008; 57(9): 2519 - 2526. [Abstract] [Full Text] [PDF]

				J. A Nettleton, M. B Schulze, R. Jiang, N. S Jenny, G. L Burke, and D. R Jacobs Jr A priori-defined dietary patterns and markers of cardiovascular disease risk in the Multi-Ethnic Study of Atherosclerosis (MESA) Am. J. Clinical Nutrition, July 1, 2008; 88(1): 185 - 194. [Abstract] [Full Text] [PDF]

				D. P. K. Ng, S. Nurbaya, S. Choo, D. Koh, K.-s. Chia, and A. S. Krolewski Genetic variation at the SLC12A3 locus is unlikely to explain risk for advanced diabetic nephropathy in Caucasians with type 2 diabetes Nephrol. Dial. Transplant., July 1, 2008; 23(7): 2260 - 2264. [Abstract] [Full Text] [PDF]

				E. T. Rosolowsky, L. H. Ficociello, N. J. Maselli, M. A. Niewczas, A. L. Binns, B. Roshan, J. H. Warram, and A. S. Krolewski High-Normal Serum Uric Acid Is Associated with Impaired Glomerular Filtration Rate in Nonproteinuric Patients with Type 1 Diabetes Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 706 - 713. [Abstract] [Full Text] [PDF]

				S. D. Solomon, J. Lin, C. G. Solomon, K. A. Jablonski, M. M. Rice, M. Steffes, M. Domanski, J. Hsia, B. J. Gersh, J. M. O. Arnold, et al. Influence of Albuminuria on Cardiovascular Risk in Patients With Stable Coronary Artery Disease Circulation, December 4, 2007; 116(23): 2687 - 2693. [Abstract] [Full Text] [PDF]

				M. Ferris, S. L. Hogan, H. Chin, D. A. Shoham, D. S. Gipson, K. Gibson, S. Yilmaz, R. J. Falk, and J. C. Jennette Obesity, Albuminuria, and Urinalysis Findings in US Young Adults from the Add Health Wave III Study Clin. J. Am. Soc. Nephrol., November 1, 2007; 2(6): 1207 - 1214. [Abstract] [Full Text] [PDF]

				T. Nakagawa, M. Segal, B. Croker, and R. J. Johnson A breakthrough in diabetic nephropathy: the role of endothelial dysfunction Nephrol. Dial. Transplant., October 1, 2007; 22(10): 2775 - 2777. [Full Text] [PDF]

				L. H. Ficociello, B. A. Perkins, K. H. Silva, D. M. Finkelstein, H. Ignatowska-Switalska, Z. Gaciong, L. A. Cupples, A. Aschengrau, J. H. Warram, and A. S. Krolewski Determinants of Progression from Microalbuminuria to Proteinuria in Patients Who Have Type 1 Diabetes and Are Treated with Angiotensin-Converting Enzyme Inhibitors Clin. J. Am. Soc. Nephrol., May 1, 2007; 2(3): 461 - 469. [Abstract] [Full Text] [PDF]

				D. P.K. Ng, G. Placha, S. Choo, K.-s. Chia, J. H. Warram, and A. S. Krolewski A Disease Haplotype for Advanced Nephropathy in Type 2 Diabetes at the ACE Locus Diabetes, September 1, 2006; 55(9): 2660 - 2663. [Abstract] [Full Text] [PDF]

				S. I. Hallan, J. Coresh, B. C. Astor, A. Asberg, N. R. Powe, S. Romundstad, H. A. Hallan, S. Lydersen, and J. Holmen International Comparison of the Relationship of Chronic Kidney Disease Prevalence and ESRD Risk J. Am. Soc. Nephrol., August 1, 2006; 17(8): 2275 - 2284. [Abstract] [Full Text] [PDF]

				M. L. Caramori, P. Fioretto, and M. Mauer Enhancing the Predictive Value of Urinary Albumin for Diabetic Nephropathy J. Am. Soc. Nephrol., February 1, 2006; 17(2): 339 - 352. [Abstract] [Full Text] [PDF]

				J. Incerti, T. Zelmanovitz, J. L. Camargo, J. L. Gross, and M. J. de Azevedo Evaluation of tests for microalbuminuria screening in patients with diabetes Nephrol. Dial. Transplant., November 1, 2005; 20(11): 2402 - 2407. [Abstract] [Full Text] [PDF]

				W. M. Mlynarski, G. P. Placha, P. P. Wolkow, J. P. Bochenski, J. H. Warram, and A. S. Krolewski Risk of Diabetic Nephropathy in Type 1 Diabetes Is Associated With Functional Polymorphisms in RANTES Receptor Gene (CCR5): A Sex-Specific Effect Diabetes, November 1, 2005; 54(11): 3331 - 3335. [Abstract] [Full Text] [PDF]

				D.-H. Lee, D. R. Jacobs Jr, M. Gross, and M. Steffes Serum {gamma}-Glutamyltransferase Was Differently Associated with Microalbuminuria by Status of Hypertension or Diabetes: The Coronary Artery Risk Development in Young Adults (CARDIA) Study Clin. Chem., July 1, 2005; 51(7): 1185 - 1191. [Abstract] [Full Text] [PDF]

				H. Kramer, D. R. Jacobs Jr, D. Bild, W. Post, M. F. Saad, R. Detrano, R. Tracy, R. Cooper, and K. Liu Urine Albumin Excretion and Subclinical Cardiovascular Disease Hypertension, July 1, 2005; 46(1): 38 - 43. [Abstract] [Full Text] [PDF]

				Y. Liu, K. P. Burdon, C. D. Langefeld, S. R. Beck, L. E. Wagenknecht, S. S. Rich, D. W. Bowden, and B. I. Freedman T-786C Polymorphism of the Endothelial Nitric Oxide Synthase Gene Is Associated with Albuminuria in the Diabetes Heart Study J. Am. Soc. Nephrol., April 1, 2005; 16(4): 1085 - 1090. [Abstract] [Full Text] [PDF]

				J. Coresh, D. Byrd-Holt, B. C. Astor, J. P. Briggs, P. W. Eggers, D. A. Lacher, and T. H. Hostetter Chronic Kidney Disease Awareness, Prevalence, and Trends among U.S. Adults, 1999 to 2000 J. Am. Soc. Nephrol., January 1, 2005; 16(1): 180 - 188. [Abstract] [Full Text] [PDF]

				A. R. Dyer, P. Greenland, P. Elliott, M. L. Daviglus, G. Claeys, H. Kesteloot, H. Ueshima, J. Stamler, and for the INTERMAP Research Group Evaluation of Measures of Urinary Albumin Excretion in Epidemiologic Studies Am. J. Epidemiol., December 1, 2004; 160(11): 1122 - 1131. [Abstract] [Full Text] [PDF]

				Polyunsaturated Fatty Acid Consumption May Play a Role in the Onset and Regression of Microalbuminuria in Well-Controlled Type 1 and Type 2 Diabetic People: A 7-year, prospective, population-based, observational multicenter study Diabetes Care, June 1, 2004; 27(6): 1454 - 1457. [Full Text] [PDF]

				D. P.K. Ng, W. H. Walker, K.-S. Chia, S. Choo, J. H. Warram, and A. S. Krolewski Scrutiny of the Glutamine-Fructose-6-Phosphate Transaminase 1 (GFPT1) Locus Reveals Conserved Haplotype Block Structure not Associated With Diabetic Nephropathy Diabetes, March 1, 2004; 53(3): 865 - 869. [Abstract] [Full Text] [PDF]

				L. E. Boulware, B. G. Jaar, M. E. Tarver-Carr, F. L. Brancati, and N. R. Powe Screening for Proteinuria in US Adults: A Cost-effectiveness Analysis JAMA, December 17, 2003; 290(23): 3101 - 3114. [Abstract] [Full Text] [PDF]