Logistic regression model for the assessment of microalbuminuria and microproteinuria in insulin-dependent diabetic patients at risk.
Diabetic microalbuminuria, which predisposes to the irreversible macroproteinuria and terminal renal failure, has been shown to be reversible by stringent metabolic control. In this study, using logistic regression, 23 patients with insulin-dependent diabetes mellitus were evaluated. Basing on the reported biochemical changes in patients with diabetes mellitus, the relationship between microalbuminuria and serum biochemistries was assessed. Four biochemical parameters were shown to be significantly related to the amount of microalbuminuria and microproteinuria. The microalbuminuria as assayed by rocket immunoelectrophoresis is closely correlated with the microproteinuria as measured by the Coomassie dye binding method and both have a significant relationship with plasma creatinine, bicarbonate, albumin and globulin as assessed by the Minitab computer program and the Biomedical Data Package--Logistic Regression computer program. The relationship with bicarbonate and creatinine can be due to a decrease in glomerular filtration rate associated with more advanced microproteinuria. The relationship with albumin and globulin is the result of impaired albumin synthesis by the liver in diabetes mellitus. From these data, two simple equations which can provide a relative risk factor with rough quantitative assessment for microproteinuria and microalbuminuria are derived. Thus, from these four parameters available from relatively simple blood biochemistries, assessment can be made of the severity of coexisting diabetic proteinuria. The measurement of the latter is not readily available and is more costly and tedious. This assessment together with the finding of a decrease in albumin, slight increase in creatinine and decrease in bicarbonate associated with the more severe microalbuminuria can be used to alert the diabetologist in implementing tighter metabolic control and other interventional methods before irreversible macroproteinuria develops.
Pun
K K
KK
Department of Medicine, University of Hong Kong.
Ho
P W
PW
Varghese
Z
Z
Moorhead
J F
JF
D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000652:urine*; D001639:Bicarbonates / Q000097:blood; D003404:Creatinine / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D009098:Multiphasic Screening; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D012712:Serum Globulins / Q000378:metabolism
D001639:Bicarbonates; D012709:Serum Albumin; D012712:Serum Globulins; D003404:Creatinine