Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus.

نویسندگان

  • Holly J Kramer
  • Quan Dong Nguyen
  • Gary Curhan
  • Chi-Yuan Hsu
چکیده

CONTEXT Kidney disease in type 2 diabetes mellitus (DM) is more heterogeneous than in type 1 DM. Reduced glomerular filtration rate (GFR) among individuals with type 2 DM may not always be due to classic diabetic glomerulosclerosis, which is associated with albuminuria and retinopathy. OBJECTIVE To determine the prevalence of chronic renal insufficiency (CRI), defined as a GFR less than 60 mL/min per 1.73 m2 body surface area (BSA) in the absence of microalbuminuria or macroalbuminuria and diabetic retinopathy among adults with type 2 DM. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of adults aged 40 years or older with type 2 DM in the Third National Health and Nutrition Examination Survey, a probability sample of the total civilian US noninstitutionalized population conducted from 1988-1994. MAIN OUTCOME MEASURES The GFR per 1.73 m2 BSA, calculated with serum creatinine, urea nitrogen, and serum albumin levels using the Modification of Diet in Renal Disease Study prediction equation; albuminuria, assessed using spot urine albumin/creatinine ratio; and presence of retinopathy, determined with fundus photography. RESULTS Overall, 13% (sampled n = 171) of adults with type 2 DM (n = 1197) had CRI with a population estimate of 1.1 million. Among these adults with CRI, diabetic retinopathy was noted in 28% (n = 58), while the frequencies of microalbuminuria and macroalbuminuria were 45% (n = 64) and 19% (n = 47), respectively. Retinopathy and albuminuria (microalbuminuria or macroalbuminuria) were both absent in 30% (n = 51) of adults with type 2 DM and CRI. The population estimate of adults with type 2 DM and CRI in the absence of diabetic retinopathy or albuminuria was approximately 0.3 million. CONCLUSIONS A substantial burden of CRI among persons with type 2 DM in the United States is likely due to renal parenchymal disease other than classic diabetic glomerulosclerosis. Approaches to screening renal disease in the type 2 DM population should incorporate assessment of GFR in addition to monitoring urine albumin excretion and funduscopic changes to ensure that individuals with type 2 DM and CRI not due to diabetic glomerulosclerosis will receive appropriate intervention.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

/ORIGINAL CONTRIBUTION Renal Insufficiency in the Absence of Albuminuria and Retinopathy Among Adults With Type 2 Diabetes Mellitus

END-STAGE RENAL DISEASE (ESRD) in adults with type 2 diabetes mellitus (DM) represents a medical problem with worldwide dimensions. Currently, approximately 40% of all prevalent ESRD cases and almost half of all new cases in the United States are attributed to type 2 DM. Due to the increasing incidence of type 2 DM and the increased survival of these individuals due to improved medical treatmen...

متن کامل

Prevalence of albuminuria and renal insufficiency and associated clinical factors in type 2 diabetes: the Japan Diabetes Clinical Data Management study (JDDM15).

BACKGROUND Microalbuminuria is widely accepted as the first clinical sign of diabetic nephropathy. However, normoalbuminuric type 2 diabetic patients who have renal insufficiency (RI), i.e. low estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2), exist. We explored the prevalence of such patients and associated clinical factors. METHODS We investigated the distribution of patient...

متن کامل

The Clinical Characteristics of Normoalbuminuric Renal Insufficiency in Korean Type 2 Diabetic Patients: A Possible Early Stage Renal Complication

It has been recently reported that a considerable portion of diabetic patients with renal insufficiency show normoalbuminuria. As little is known about normoalbuminuric renal insufficiency in the Asian population, we examined its prevalence and clinical characteristics in Korean type 2 diabetic patients. We studied 562 patients with type 2 diabetes from Seoul National University Hospital. The e...

متن کامل

Prevalence of Retinopathy in Patients with Newly Diagnosed Type 2 Diabetes Mellitus at the Diabetes Center of 5th Azar Hospital in Gorgan

Introduction: Diabetic retinopathy is one of the most important complications of type 1 and 2 diabetes, which is the most important cause of blindness in people aged 20 to 74. This study aimed to determine the prevalence of retinopathy in newly diagnosed type 2 diabetes mellitus at the Diabetes Center of 5th Azar Hospital in Gorgan. Materials and Methods: A total of 260 patients with newly diag...

متن کامل

Oxidized LDL is Correlated with Urine Albumin in Type 2 Diabetes Mellitus: A Case-Control Study

Objective: In patients with diabetes mellitus, increased rate of lipoprotein oxidation and oxidative stress have important role in diabetic angiopathy, including nephropathy. We designed a study for comparing the level of Ox-LDL in diabetic patients with Macro-albuminuria, Micro-albuminuria, versus Normo-albuminuric. Materials and Methods: One hundred and thirty five patients with type 2 dia...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • JAMA

دوره 289 24  شماره 

صفحات  -

تاریخ انتشار 2003