How to predict nephropathy in type 1 diabetic patients.
OBJECTIVE
Do exaggerated increases in blood pressure and albuminuria during exercise occur earlier than microalbuminuria and which type of test is most predictive of diabetic nephropathy?


METHODS
A total of 33 insulin-dependent normoalbuminuric men (mean duration of diabetes 14 years; mean age 28 years) and 34 age-matched apparently healthy control subjects were studied. Urinary albumin excretion, heart rate and blood pressure were measured during fixed workload (150 W) and fixed heart rate (155 beats/min) tests. Mean follow-up time was 13.1 +/- 3.2 years. A urinary albumin level in early-morning urine persistently >30 mg/l was considered a sign of diabetic nephropathy.


RESULTS
Sixteen patients reached the endpoints of the study. Eleven had developed microalbuminuria and five macroalbuminuria (persistent levels of urinary albumin >300 mg/l). Of the latter patients, two needed dialysis. Systolic blood pressure and albumin excretion during the fixed heart rate test were higher in diabetic patients who developed signs of nephropathy than in control subjects and diabetic subjects with persistent healthy kidneys. Such differences were not found in the fixed workload test. There were no differences in glycated haemoglobin, blood pressure levels or albumin excretion at baseline between the two diabetic groups.


CONCLUSIONS
To predict the development of diabetic nephropathy it seems important to choose a fixed heart rate test. High levels of systolic blood pressure in such a test were associated with the development of micro- and macroalbuminuria.
Dash
Rabinarayan
R
Department of Rheumatology, University Hospital, SE-221 85 Lund, Sweden.
Torffvit
Ole
O
D000328:Adult; D000419:Albuminuria / Q000175:diagnosis*; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D001795:Blood Pressure Determination; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000628:therapy; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000628:therapy; D018450:Disease Progression; D005080:Exercise Test / Q000379:methods*; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D007677:Kidney Function Tests; D008297:Male; D011379:Prognosis; D018709:Statistics, Nonparametric; D013599:Systole
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin