title: Proteinuria in type 2 diabetic patients with renal impairment: the changing face of diabetic nephropathy.
abstract: Type 2 diabetic nephropathy (type 2 DN) patients traditionally develop significant proteinuria prior to the development of renal impairment. However, this clinical paradigm, based on observations prior to the widespread usage of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB), has recently been questioned. 2,303 patients enrolled in the Sulodexide Overt Nephropathy Study (OVERT) were analyzed. Prior therapy with ACEi and/or ARB at the time of screening was recorded in 951 patients. 22% of patients had significant renal impairment with a PCR at screening of <500 mg/g. Therapy with ACEi and/or ARB at the time of screening was recorded in 94%, where prior medication data was available. In patients with type 2 DN and advanced renal impairment, levels of proteinuria below that which traditionally defines overt diabetic nephropathy, are found in more than one fifth of patients. We suggest that the high prevalence of ACEi and ARB usage in patients with type 2 DN may be effecting the traditional clinical paradigm of type 2 DN.
authors.affiliation: Melbourne Renal Research Group, 73–75 Pine Street, Reservoir, VIC 3073, Australia. dmpackham@netspace.net.au
authors.forename: David K
authors.initials: DK
authors.lastname: Packham
authors.forename: Sara E
authors.initials: SE
authors.lastname: Ivory
authors.forename: Anne T
authors.initials: AT
authors.lastname: Reutens
authors.forename: Rory
authors.initials: R
authors.lastname: Wolfe
authors.forename: Richard
authors.initials: R
authors.lastname: Rohde
authors.forename: Hiddo
authors.initials: H
authors.lastname: Lambers Heerspink
authors.forename: Jamie P
authors.initials: JP
authors.lastname: Dwyer
authors.forename: Robert C
authors.initials: RC
authors.lastname: Atkins
authors.forename: Julia
authors.initials: J
authors.lastname: Lewis
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000652:urine*; D003928:Diabetic Nephropathies / Q000097:blood* / Q000175:diagnosis / Q000652:urine*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000175:diagnosis / Q000652:urine; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011507:Proteinuria / Q000097:blood* / Q000175:diagnosis / Q000652:urine*
chemical_list: D015415:Biomarkers