title: Diabetic kidney disease: Is there a non-albuminuric phenotype in type 2 diabetic patients?
abstract: BACKGROUND
  Albuminuria was widely considered as the first clinical sign of diabetic kidney disease (DKD), which is why it has traditionally been used as a screening test for DKD. However, increasing evidence has shown that a significant number of type 2 diabetes mellitus (DM) patients have a decreased glomerular filtration rate (GFR) without significant albuminuria, known as non-albuminuric DKD (NA-DKD). The aim of this study was to determine the prevalence and the demographic and clinical characteristics of patients with NA-DKD.
  
  
  METHODS
  This was a 1-year retrospective study that included 146 type 2 diabetic patients with GFR<75mL/min followed-up in a diabetes outpatient department. Patients were divided into two groups according to their ACR status - NA-DKD and albuminuric DKD (A-DKD).
  
  
  RESULTS
  Of the 146 patients included in the study, 53.4% had A-DKD and 46.6% had NA-DKD. According to the multivariable analysis performed, patients with NA-DKD tended to be older (p=0.021), female (p=0.045) and with a lower GFR (p=0.004) than A-DKD patients. There was no difference between the groups in terms of body mass index, metabolic control of DM, duration of DM diagnosis and prevalence of metabolic syndrome.
  
  
  CONCLUSIONS
  The majority of patients with DKD had albuminuria, but a significant proportion had a non-albuminuric phenotype (46.6% in this population). These patients exhibit distinct clinical features that could have screening, therapeutic and prognosis implications.
authors.affiliation: Nephrology Department, Hospital de Santa Cruz, Lisbon, Portugal. Electronic address: ivolaranjinha@gmail.com.
authors.forename: Ivo
authors.initials: I
authors.lastname: Laranjinha
authors.affiliation: Nephrology Department, Hospital de Santa Cruz, Lisbon, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Matias
authors.affiliation: Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Mateus
authors.affiliation: Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, Portugal.
authors.forename: Filipa
authors.initials: F
authors.lastname: Aguiar
authors.affiliation: Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Pereira
authors.affiliation: Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Perneta Santos
authors.affiliation: Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Costa
authors.affiliation: Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Lourenço
authors.affiliation: Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Guia
authors.affiliation: Nephrology Department, Hospital de Santa Cruz, Lisbon, Portugal.
authors.forename: José Diogo
authors.initials: JD
authors.lastname: Barata
authors.affiliation: Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Campos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000145:classification* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012189:Retrospective Studies
keywords: Chronic kidney disease; Diabetes tipo 2; Enfermedad renal crónica; Non-albuminuria; Sin albuminuria; Type 2 diabetes