title: Nonalbumin proteinuria is a simple and practical predictor of the progression of early-stage type 2 diabetic nephropathy.
abstract: OBJECTIVE
  Multiple biomarkers have emerged as a reliable predictor of the progression of diabetic nephropathy. The aim of this study was to pursue a more simple and practical predictor that can be applied in clinical practice.
  
  
  METHODS
  The urine albumin-to-creatinine ratio (ACR), the nonalbumin protein-to-creatinine ratio (NAPCR), and the levels of six biomarkers were measured in 73 patients with type 2 diabetes and estimated glomerular filtration rates (eGFRs)≥60mL/min/1.73m2. The renal outcomes were the annual decline in eGFR and the development of chronic kidney disease (CKD) of stage 3 or greater.
  
  
  RESULTS
  The average rate of eGFR decline over a median of 50months of follow-up was -2.48mL/min/1.73m2/year. After adjusting for nine clinical parameters, only the NAPCR showed a significant association with the annual eGFR decline (adjusted R2=0.139, P=0.042). The NAPCR predicted a higher probability of the development of CKD of stage 3 or greater and was more effective than any of the six urinary biomarkers in this respect (C-index 82.7, sensitivity 92.3, specificity 81.7).
  
  
  CONCLUSIONS
  The NAPCR is a better and more practical predictor of the development and progression of CKD than are other urinary biomarkers in patients with early-stage type 2 diabetic nephropathy.
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea. Electronic address: injkim@pusan.ac.kr.
authors.forename: In Joo
authors.initials: IJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Min Jin
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Yun Kyung
authors.initials: YK
authors.lastname: Jeon
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Bo Hyun
authors.initials: BH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Sang Heon
authors.initials: SH
authors.lastname: Song
authors.affiliation: Internal Medicine Clinic, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Yong Ki
authors.initials: YK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000209:etiology; D015415:Biomarkers / Q000652:urine; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000503:physiopathology / Q000652:urine*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000209:etiology*; D051437:Renal Insufficiency / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000652:urine; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000652:urine; D056910:Republic of Korea / Q000453:epidemiology; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Albuminuria; Chronic kidney disease; Diabetic nephropathy; Nonalbumin proteinuria; Type 2 diabetes mellitus