title: Serum total renin is increased before microalbuminuria in diabetes.
abstract: Serum prorenin is increased in patients with insulin dependent diabetes mellitus (IDDM) with microvascular complications. The present longitudinal study investigated whether increases in serum total renin concentration (TRC, active+prorenin) can predict the development of microalbuminuria in IDDM patients over a 10 year period. TRC and albumin excretion rates (AER) were determined in 78 IDDM patients who were followed longitudinally for 10.4 +/- 0.2 (mean +/- SE) years. Twelve patients had progressively increasing albuminuria (progressors), and these were compared to 66 patients in whom albuminuria did not rise (non-progressors). The two groups had similar duration of diabetes, age, follow-up, glycemic control and blood pressure at the start of the study. Serum TRC was increased in progressors [350 (1.1) mIU/liter, geometric mean (tolerance factor)] compared to non-progressors [189 (1.2)] after 5 to 10 years duration of diabetes, and continued to rise in this group, reaching a mean of 923 mIU/liter (normal range 131 to 170) after 20 years of diabetes. When serial measurements of TRC and AER were compared in individual progressors, a significant increase in TRC was apparent up to five years before the onset of microalbuminuria. Microalbuminuria in patients with IDDM is preceded by a substantial increase in serum TRC, suggesting that serum TRC may predict the subsequent development of incipient nephropathy.
authors.affiliation: Department of Medicine, University of Melbourne, Austin & Repatriation Medical Centere, Heidelberg, Victoria, Australia. terri@austin.unimelb.edu.au
authors.forename: T J
authors.initials: TJ
authors.lastname: Allen
authors.forename: M E
authors.initials: ME
authors.lastname: Cooper
authors.forename: R E
authors.initials: RE
authors.lastname: Gilbert
authors.forename: J
authors.initials: J
authors.lastname: Winikoff
authors.forename: S L
authors.initials: SL
authors.lastname: Skinni
authors.forename: G
authors.initials: G
authors.lastname: Jerums
mesh_terms: D000293:Adolescent; D000328:Adult; D000419:Albuminuria / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000652:urine; D003928:Diabetic Nephropathies / Q000097:blood*; D003930:Diabetic Retinopathy / Q000097:blood*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015592:Immunoradiometric Assay; D008137:Longitudinal Studies; D008297:Male; D011237:Predictive Value of Tests; D012083:Renin / Q000097:blood*; D012680:Sensitivity and Specificity
chemical_list: D012083:Renin