Predictive value of albuminuria in American Indian youth with or without type 2 diabetes.
OBJECTIVE
To examine the prognostic significance of elevated albuminuria in youth with type 2 diabetes.


METHODS
Cross-sectional and prospective studies were conducted on Pima Indian youth aged 5 to 19 years at baseline who were examined between July 1, 1982, and December 31, 2007. Prevalence and sequential changes in the level of microalbuminuria (30 < or = albumin-to-creatinine ratio [ACR] < 300 mg/g) and macroalbuminuria (ACR > or = 300 mg/g) and incidence of macroalbuminuria were computed according to the presence or absence of type 2 diabetes.


RESULTS
The prevalence of microalbuminuria and macroalbuminuria was 6.5% and 0.6% in the 3856 nondiabetic youth and 18.5% and 2.9% in the 103 youth with diabetes, respectively. One hundred forty-one of 187 (75.4%) nondiabetic youth, but only 1 of 14 (7.1%) diabetic youth with an elevated ACR (> or =30 mg/g) regressed to an undetectable or normal ACR (<30 mg/g) on subsequent examination. In a subset of 2666 youth with a median follow-up of 8.1 years, 36 nondiabetic and 30 diabetic youth with baseline ACRs of <300 mg/g developed macroalbuminuria. For a given ACR, the incidence of macroalbuminuria was 15.9-fold (95% confidence interval: 11.1-22.6) higher in the diabetic than in the nondiabetic youth.


CONCLUSIONS
Elevated albuminuria is infrequent and largely transient in nondiabetic youth, but it is relatively frequent and largely persistent in those with diabetes. Microalbuminuria in youth with type 2 diabetes strongly predicts progression to macroalbuminuria, which supports annual screening for albuminuria.
Kim
Nan Hee
NH
Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA.
Pavkov
Meda E
ME
Knowler
William C
WC
Hanson
Robert L
RL
Weil
E Jennifer
EJ
Curtis
Jeffrey M
JM
Bennett
Peter H
PH
Nelson
Robert G
RG
D000293:Adolescent; D000419:Albuminuria / Q000097:blood / Q000208:ethnology* / Q000652:urine*; D001130:Arizona / Q000208:ethnology; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000208:ethnology* / Q000652:urine*; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000208:ethnology*; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D055815:Young Adult
D001786:Blood Glucose