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Up Front MattersBrief Reviews
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Proteinuria in Diabetes: Bystander or Pathway to Cardiorenal Disease?

Janaka Karalliedde and Giancarlo Viberti
JASN December 2010, 21 (12) 2020-2027; DOI: https://doi.org/10.1681/ASN.2010030250
Janaka Karalliedde
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Giancarlo Viberti
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Abstract

The development of albuminuria in diabetics is closely associated with an enhanced risk of renal and cardiovascular disease. However, the role of albuminuria in the pathogenesis of these clinical conditions remains controversial. Whether albuminuria is simply a biomarker or qualifies as a surrogate endpoint for cardiorenal disease has wide-ranging implications from the monitoring and treatment of patients to the design of clinical trials and drug development. We critically review available data to determine whether the association between albuminuria and cardiorenal disease is causative. Current evidence suggests the significance of albuminuria depends on its severity (degree or level) and on the specific clinical outcome under consideration. For diabetic kidney disease, there is convincing epidemiologic and experimental evidence to assign clinical albuminuria status as a surrogate endpoint, but for lower levels of albuminuria (microalbuminuria and normoalbuminuria), the evidence is inconclusive or not available. Albuminuria of any degree is unlikely to be causally related to diabetic cardiovascular disease, but its onset might be useful to identify those subjects at cardiovascular risk and to detect and treat other modifiable risk factors.

  • Copyright © 2010 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 21 (12)
Journal of the American Society of Nephrology
Vol. 21, Issue 12
1 Dec 2010
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Proteinuria in Diabetes: Bystander or Pathway to Cardiorenal Disease?
Janaka Karalliedde, Giancarlo Viberti
JASN Dec 2010, 21 (12) 2020-2027; DOI: 10.1681/ASN.2010030250

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Proteinuria in Diabetes: Bystander or Pathway to Cardiorenal Disease?
Janaka Karalliedde, Giancarlo Viberti
JASN Dec 2010, 21 (12) 2020-2027; DOI: 10.1681/ASN.2010030250
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    • Abstract
    • EPIDEMIOLOGY OF ALBUMINURIA IN DIABETES
    • DEFINITIONS OF ENDPOINTS AND CRITERIA FOR CAUSALITY
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Cited By...

  • Urinary Adiponectin Is an Independent Predictor of Progression to End-Stage Renal Disease in Patients With Type 1 Diabetes and Diabetic Nephropathy
  • Initial Angiotensin Receptor Blockade-Induced Decrease in Albuminuria Is Associated With Long-Term Renal Outcome in Type 2 Diabetic Patients With Microalbuminuria: A post hoc analysis of the IRMA-2 trial
  • Is Treatment of Nephropathy in Type 1 Diabetes Efficacious but Ineffective?
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