title: Nonalbuminuric renal insufficiency in type 2 diabetes.
abstract: OBJECTIVE
  To determine the prevalence and characteristics of patients with type 2 diabetes who have impaired renal function, defined as a glomerular filtration rate (GFR) <60 ml. min(-1). 1.73 m(-2), and normoalbuminuria.
  
  
  METHODS
  A cross-sectional survey of 301 outpatients attending a single tertiary referral center using the plasma disappearance of isotopic (99m)Tc-diethylene-triamine-penta-acetic acid to measure GFR and at least two measurements of urinary albumin excretion rate (AER) over 24 h to determine albuminuria.
  
  
  RESULTS
  A total of 109 patients (36%) had a GFR <60 ml. min(-1). 1.73 m(-2). The overall prevalence of normo-, micro-, and macroalbuminuria was 43 of 109 (39%), 38 of 109 (35%), and 28 of 109 (26%), respectively. Compared with patients with macroalbuminuria, those with normoalbuminuria were more likely to be older and female. After excluding patients whose normoalbuminuric status was possibly related to the initiation of a renin-angiotensin system (RAS) inhibitor before the start of the study, the prevalence of a GFR <60 ml. min(-1). 1.73 m(-2) and normoalbuminuria was 23%. Temporal changes in GFR in a subset of 34 of 109 (32%) unselected patients with impaired renal function were available for comparison over a 3- to 10-year period. The rates of decline in GFR (ml. min(-1). 1.73 m(-2). year(-1)) of -4.6 +/- 1.0, -2.8 +/- 1.0, and -3.0 +/- 07 were not significantly different for normo- (n = 12), micro- (n = 12), and macroalbuminuric (n = 10) patients, respectively.
  
  
  CONCLUSIONS
  These results suggest that patients with type 2 diabetes can commonly progress to a significant degree of renal impairment while remaining normoalbuminuric.
authors.affiliation: Endocrinology Unit, Austin Health, Heidelberg, Victoria, Australia. r.macisaac@austin.unimelb.edu.au
authors.forename: Richard J
authors.initials: RJ
authors.lastname: MacIsaac
authors.forename: Con
authors.initials: C
authors.lastname: Tsalamandris
authors.forename: Sianna
authors.initials: S
authors.lastname: Panagiotopoulos
authors.forename: Trudy J
authors.initials: TJ
authors.lastname: Smith
authors.forename: Karen J
authors.initials: KJ
authors.lastname: McNeil
authors.forename: George
authors.initials: G
authors.lastname: Jerums
mesh_terms: D017668:Age of Onset; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000652:urine*; D003928:Diabetic Nephropathies / Q000652:urine*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000652:urine*; D008297:Male; D014739:Victoria