| Authors |
Kern EF, Erhard P, Sun W, Genuth S, Weiss MF
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| Submitted By |
Submitted Externally on 10/1/2015 |
| Status |
Published |
| Journal |
American journal of kidney diseases : the official journal of the National Kidney Foundation |
| Year |
2010 |
| Date Published |
5/1/2010 |
| Volume : Pages |
55 : 824 - 34 |
| PubMed Reference |
20138413 |
| Abstract |
Urinary markers were tested as predictors of macroalbuminuria or
microalbuminuria in patients with type 1 diabetes., Nested case-control of
participants in the Diabetes Control and Complications Trial (DCCT)., 87 cases
of microalbuminuria were matched to 174 controls in a 1:2 ratio, while 4 cases
were matched to 4 controls in a 1:1 ratio, resulting in 91 cases and 178
controls for microalbuminuria. 55 cases of macroalbuminuria were matched to 110
controls in a 1:2 ratio. Controls were free of micro-/macroalbuminuria when
their matching case first developed micro-/macroalbuminuria., Urinary
N-acetyl-beta-d-glucosaminidase (NAG), pentosidine, advanced glycation end
product (AGE) fluorescence, and albumin excretion rate (AER)., Incident
microalbuminuria (2 consecutive annual AERs > 40 but < or = 300 mg/d) or
macroalbuminuria (AER > 300 mg/d)., Stored urine samples from DCCT entry and 1-9
years later when macro- or microalbuminuria occurred were measured for the
lysosomal enzyme NAG and the AGE pentosidine and AGE fluorescence. AER and
adjustor variables were obtained from the DCCT., Submicroalbuminuric AER levels
at baseline independently predicted microalbuminuria (adjusted OR, 1.83; P <
0.001) and macroalbuminuria (adjusted OR, 1.82; P < 0.001). Baseline NAG
excretion independently predicted macroalbuminuria (adjusted OR, 2.26; P <
0.001) and microalbuminuria (adjusted OR, 1.86; P < 0.001). Baseline pentosidine
excretion predicted macroalbuminuria (adjusted OR, 6.89; P = 0.002). Baseline
AGE fluorescence predicted microalbuminuria (adjusted OR, 1.68; P = 0.02).
However, adjusted for NAG excretion, pentosidine excretion and AGE fluorescence
lost the predictive association with macroalbuminuria and microalbuminuria,
respectively., Use of angiotensin-converting enzyme inhibitors was not directly
ascertained, although their use was proscribed during the DCCT., Early in type 1
diabetes, repeated measurements of AER and urinary NAG excretion may identify
individuals susceptible to future diabetic nephropathy. Combining the 2 markers
may yield a better predictive model than either one alone. Renal tubule stress
may be more severe, reflecting abnormal renal tubule processing of AGE-modified
proteins, in individuals susceptible to diabetic nephropathy.
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