Stable glomerular filtration rate in normotensive IDDM patients with stable microalbuminuria. A 5-year prospective study.
OBJECTIVE
To investigate the long-term course of glomerular filtration rate (GFR) in IDDM patients with microalbuminuria in order to identify patients with stable or declining kidney function over a 5-year study.


METHODS
Forty normotensive (129 +/- 11/80 +/- 8 mmHg) IDDM patients with persistent microalbuminuria (mean urinary albumin excretion [UAE] 84 mg/24 h [range 30-300]) were followed prospectively for 5 years of clinical examinations that included the measurement of GFR (51Cr-labeled EDTA clearance) at least once a year. The mean GFR at baseline was 120 +/- 18 ml x min-1.1 x 73 m-2.


RESULTS
Using multiple regression analysis, the rate of decline in GFR was independently correlated to onset of diabetic nephropathy (P < 0.001) and systolic blood pressure (sBP) at baseline (P < 0.05). Increase in UAE was correlated to the mean HbA1c during the observation period. Out of 40 patients, 14 progressed to diabetic nephropathy (UAE > 300 mg/24 h). These patients had a significant reduction in GFR (mean -2.2 +/- 3.8 ml x min-1 x year-1; P = 0.05), while GFR remained stable in the remaining 26 patients with nonprogressive microalbuminuria (change in GFR 0.5 +/- 2.1 ml x min-1 x year-1; NS). The difference in the rate of decline of GFR was significant (mean 2.7 ml x min-1 x year-1; P < 0.05).


CONCLUSIONS
Normotensive IDDM patients with nonprogressive microalbuminuria have a stable GFR. Progression of UAE to diabetic nephropathy heralds a progressive loss of kidney function. Efforts should be made to prevent the progression from microalbuminuria to diabetic nephropathy in every IDDM patient with microalbuminuria.
Mathiesen
E R
ER
Steno Diabetes Center, Copenhagen, Denmark.
Feldt-Rasmussen
B
B
Hommel
E
E
Deckert
T
T
Parving
H H
HH
D000328:Adult; D000419:Albuminuria / Q000503:physiopathology* / Q000652:urine; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000503:physiopathology*; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007678:Kidney Glomerulus / Q000503:physiopathology*; D015999:Multivariate Analysis; D011446:Prospective Studies; D013997:Time Factors