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. 1998 Jun;78(6):518–523. doi: 10.1136/adc.78.6.518

Development and progression of microalbuminuria in a clinic sample of patients with insulin dependent diabetes mellitus

C Jones 1, G Leese 1, S Kerr 1, K Bestwick 1, D Isherwood 1, J Vora 1, D Hughes 1, C Smith 1
PMCID: PMC1717597  PMID: 9713006

Abstract

The evolution of abnormal albumin excretion and its association with suggested risk factors were studied in 233 children with insulin dependent diabetes mellitus (IDDM) attending a single paediatric diabetic clinic over an eight year period. Yearly albumin:creatinine ratios (ACR; measured in mg/mmol) in early morning urine samples, glycated haemoglobin (HbA1c), and blood pressure were recorded. Thirty four (14.5%) children had a persistently raised ACR (ACR ⩾ 2.5 mg/mmol on at least three consecutive occasions) and 21(9%) had an intermittently raised ACR (ACR ⩾ 2.5 mg/mmol on at least two occasions). Factors associated with a persistently raised ACR compared with normal albuminuria in IDDM included longer duration of diabetes, raised median HbA1c during the first five years after diagnosis, and final age adjusted systolic and diastolic blood pressure represented as standard deviation scores. The onset of persistently raised ACR in 13 of 34 children was before puberty and in 23 of 34 children it was within the first four years of diagnosis. The cross sectional prevalence of raised ACR was 12.9% at one year, 18.3% at five years, and 33% at 10 years after diagnosis. Raised ACR occurs frequently before puberty and in the early stages of childhood diabetes.



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Selected References

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  1. Almdal T., Nörgaard K., Feldt-Rasmussen B., Deckert T. The predictive value of microalbuminuria in IDDM. A five-year follow-up study. Diabetes Care. 1994 Feb;17(2):120–125. doi: 10.2337/diacare.17.2.120. [DOI] [PubMed] [Google Scholar]
  2. Andersen A. R., Christiansen J. S., Andersen J. K., Kreiner S., Deckert T. Diabetic nephropathy in Type 1 (insulin-dependent) diabetes: an epidemiological study. Diabetologia. 1983 Dec;25(6):496–501. doi: 10.1007/BF00284458. [DOI] [PubMed] [Google Scholar]
  3. Bach L. A., Gilbert R. E., Cooper M. E., Tsalamandris C., Jerums G. Prediction of persistent microalbuminuria in patients with diabetes mellitus. J Diabetes Complications. 1993 Apr-Jun;7(2):67–72. doi: 10.1016/1056-8727(93)90028-w. [DOI] [PubMed] [Google Scholar]
  4. Borch-Johnsen K., Kreiner S. Proteinuria: value as predictor of cardiovascular mortality in insulin dependent diabetes mellitus. Br Med J (Clin Res Ed) 1987 Jun 27;294(6588):1651–1654. doi: 10.1136/bmj.294.6588.1651. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Chase H. P., Garg S. K., Marshall G., Berg C. L., Harris S., Jackson W. E., Hamman R. E. Cigarette smoking increases the risk of albuminuria among subjects with type I diabetes. JAMA. 1991 Feb 6;265(5):614–617. [PubMed] [Google Scholar]
  6. Chiumello G., Bognetti E., Meschi F., Carrà M., Balzano E. Early diagnosis of subclinical complications in insulin dependent diabetic children and adolescents. J Endocrinol Invest. 1989;12(8 Suppl 3):101–104. [PubMed] [Google Scholar]
  7. Cohen D. L., Close C. F., Viberti G. C. The variability of overnight urinary albumin excretion in insulin-dependent diabetic and normal subjects. Diabet Med. 1987 Sep-Oct;4(5):437–440. doi: 10.1111/j.1464-5491.1987.tb00905.x. [DOI] [PubMed] [Google Scholar]
  8. Cook J., Daneman D., Spino M., Sochett E., Perlman K., Balfe J. W. Angiotensin converting enzyme inhibitor therapy to decrease microalbuminuria in normotensive children with insulin-dependent diabetes mellitus. J Pediatr. 1990 Jul;117(1 Pt 1):39–45. doi: 10.1016/s0022-3476(05)82441-2. [DOI] [PubMed] [Google Scholar]
  9. Coonrod B. A., Ellis D., Becker D. J., Bunker C. H., Kelsey S. F., Lloyd C. E., Drash A. L., Kuller L. H., Orchard T. J. Predictors of microalbuminuria in individuals with IDDM. Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Care. 1993 Oct;16(10):1376–1383. doi: 10.2337/diacare.16.10.1376. [DOI] [PubMed] [Google Scholar]
  10. Dahlquist G., Rudberg S. The prevalence of microalbuminuria in diabetic children and adolescents and its relation to puberty. Acta Paediatr Scand. 1987 Sep;76(5):795–800. doi: 10.1111/j.1651-2227.1987.tb10567.x. [DOI] [PubMed] [Google Scholar]
  11. Davies A. G., Postlethwaite R. J., Price D. A., Burn J. L., Houlton C. A., Fielding B. A. Urinary albumin excretion in school children. Arch Dis Child. 1984 Jul;59(7):625–630. doi: 10.1136/adc.59.7.625. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Davies A. G., Price D. A., Postlethwaite R. J., Addison G. M., Burn J. L., Fielding B. A. Renal function in diabetes mellitus. Arch Dis Child. 1985 Apr;60(4):299–304. doi: 10.1136/adc.60.4.299. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Deckert T., Feldt-Rasmussen B., Borch-Johnsen K., Jensen T., Kofoed-Enevoldsen A., Mathiesen E. R. Natural history of diabetic complications: early detection and progression. Diabet Med. 1991;8(Spec No):S33–S37. doi: 10.1111/j.1464-5491.1991.tb02153.x. [DOI] [PubMed] [Google Scholar]
  14. Ellis D., Becker D. J., Daneman D., Lobes L., Jr, Drash A. L. Proteinuria in children with insulin-dependent diabetes: relationship to duration of disease, metabolic control, and retinal changes. J Pediatr. 1983 May;102(5):673–680. doi: 10.1016/s0022-3476(83)80232-7. [DOI] [PubMed] [Google Scholar]
  15. Gatling W., Knight C., Hill R. D. Screening for early diabetic nephropathy: which sample to detect microalbuminuria? Diabet Med. 1985 Nov;2(6):451–455. doi: 10.1111/j.1464-5491.1985.tb00681.x. [DOI] [PubMed] [Google Scholar]
  16. Gibb D. M., Dunger D., Levin M., Shah V., Smith C., Barratt T. M. Early markers of the renal complications of insulin dependent diabetes mellitus. Arch Dis Child. 1989 Jul;64(7):984–991. doi: 10.1136/adc.64.7.984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Jensen J. S., Mathiesen E. R., Nørgaard K., Hommel E., Borch-Johnsen K., Funder J., Brahm J., Parving H. H., Deckert T. Increased blood pressure and erythrocyte sodium/lithium countertransport activity are not inherited in diabetic nephropathy. Diabetologia. 1990 Oct;33(10):619–624. doi: 10.1007/BF00400206. [DOI] [PubMed] [Google Scholar]
  18. Kostraba J. N., Dorman J. S., Orchard T. J., Becker D. J., Ohki Y., Ellis D., Doft B. H., Lobes L. A., LaPorte R. E., Drash A. L. Contribution of diabetes duration before puberty to development of microvascular complications in IDDM subjects. Diabetes Care. 1989 Nov-Dec;12(10):686–693. doi: 10.2337/diacare.12.10.686. [DOI] [PubMed] [Google Scholar]
  19. Krolewski A. S., Warram J. H., Rand L. I., Christlieb A. R., Busick E. J., Kahn C. R. Risk of proliferative diabetic retinopathy in juvenile-onset type I diabetes: a 40-yr follow-up study. Diabetes Care. 1986 Sep-Oct;9(5):443–452. doi: 10.2337/diacare.9.5.443. [DOI] [PubMed] [Google Scholar]
  20. Marshall S. M., Hackett A., Court S., Parkin M., Alberti K. G. Albumin excretion in children and adolescents with insulin-dependent diabetes. Diabetes Res. 1986 Sep;3(7):345–348. [PubMed] [Google Scholar]
  21. Marshall S. M. Screening for microalbuminuria: which measurement? Diabet Med. 1991 Oct;8(8):706–711. doi: 10.1111/j.1464-5491.1991.tb01688.x. [DOI] [PubMed] [Google Scholar]
  22. Mathiesen E. R., Hommel E., Giese J., Parving H. H. Efficacy of captopril in postponing nephropathy in normotensive insulin dependent diabetic patients with microalbuminuria. BMJ. 1991 Jul 13;303(6794):81–87. doi: 10.1136/bmj.303.6794.81. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Mathiesen E. R., Saurbrey N., Hommel E., Parving H. H. Prevalence of microalbuminuria in children with type 1 (insulin-dependent) diabetes mellitus. Diabetologia. 1986 Sep;29(9):640–643. doi: 10.1007/BF00869263. [DOI] [PubMed] [Google Scholar]
  24. Messent J. W., Elliott T. G., Hill R. D., Jarrett R. J., Keen H., Viberti G. C. Prognostic significance of microalbuminuria in insulin-dependent diabetes mellitus: a twenty-three year follow-up study. Kidney Int. 1992 Apr;41(4):836–839. doi: 10.1038/ki.1992.128. [DOI] [PubMed] [Google Scholar]
  25. Mogensen C. E., Christensen C. K. Predicting diabetic nephropathy in insulin-dependent patients. N Engl J Med. 1984 Jul 12;311(2):89–93. doi: 10.1056/NEJM198407123110204. [DOI] [PubMed] [Google Scholar]
  26. Mogensen C. E., Hansen K. W., Osterby R., Damsgaard E. M. Blood pressure elevation versus abnormal albuminuria in the genesis and prediction of renal disease in diabetes. Diabetes Care. 1992 Sep;15(9):1192–1204. doi: 10.2337/diacare.15.9.1192. [DOI] [PubMed] [Google Scholar]
  27. Mogensen C. E., Keane W. F., Bennett P. H., Jerums G., Parving H. H., Passa P., Steffes M. W., Striker G. E., Viberti G. C. Prevention of diabetic renal disease with special reference to microalbuminuria. Lancet. 1995 Oct 21;346(8982):1080–1084. doi: 10.1016/s0140-6736(95)91747-0. [DOI] [PubMed] [Google Scholar]
  28. Mortensen H. B., Marinelli K., Nørgaard K., Main K., Kastrup K. W., Ibsen K. K., Villumsen J., Parving H. H. A nation-wide cross-sectional study of urinary albumin excretion rate, arterial blood pressure and blood glucose control in Danish children with type 1 diabetes mellitus. Danish Study Group of Diabetes in Childhood. Diabet Med. 1990 Dec;7(10):887–897. doi: 10.1111/j.1464-5491.1990.tb01324.x. [DOI] [PubMed] [Google Scholar]
  29. Parving H. H., Hommel E., Damkjaer Nielsen M., Giese J. Effect of captopril on blood pressure and kidney function in normotensive insulin dependent diabetics with nephropathy. BMJ. 1989 Aug 26;299(6698):533–536. doi: 10.1136/bmj.299.6698.533. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Parving H. H., Hommel E., Damkjaer Nielsen M., Giese J. Effect of captopril on blood pressure and kidney function in normotensive insulin dependent diabetics with nephropathy. BMJ. 1989 Aug 26;299(6698):533–536. doi: 10.1136/bmj.299.6698.533. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Rowe D. J., Hayward M., Bagga H., Betts P. Effect of glycaemic control and duration of disease on overnight albumin excretion in diabetic children. Br Med J (Clin Res Ed) 1984 Oct 13;289(6450):957–959. doi: 10.1136/bmj.289.6450.957. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Rudberg S., Ullman E., Dahlquist G. Relationship between early metabolic control and the development of microalbuminuria--a longitudinal study in children with type 1 (insulin-dependent) diabetes mellitus. Diabetologia. 1993 Dec;36(12):1309–1314. doi: 10.1007/BF00400811. [DOI] [PubMed] [Google Scholar]
  33. Seaquist E. R., Goetz F. C., Rich S., Barbosa J. Familial clustering of diabetic kidney disease. Evidence for genetic susceptibility to diabetic nephropathy. N Engl J Med. 1989 May 4;320(18):1161–1165. doi: 10.1056/NEJM198905043201801. [DOI] [PubMed] [Google Scholar]
  34. Shield J. P., Hunt L. P., Baum J. D., Pennock C. A. Screening for diabetic microalbuminuria in routine clinical care: which method? Arch Dis Child. 1995 Jun;72(6):524–525. doi: 10.1136/adc.72.6.524. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Shield J. P., Hunt L. P., Karachaliou F., Karavanaki K., Baum J. D. Is microalbuminuria progressive? Arch Dis Child. 1995 Dec;73(6):512–514. doi: 10.1136/adc.73.6.512. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Viberti G. C., Hill R. D., Jarrett R. J., Argyropoulos A., Mahmud U., Keen H. Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet. 1982 Jun 26;1(8287):1430–1432. doi: 10.1016/s0140-6736(82)92450-3. [DOI] [PubMed] [Google Scholar]
  37. Viberti G. C., Keen H., Wiseman M. J. Raised arterial pressure in parents of proteinuric insulin dependent diabetics. Br Med J (Clin Res Ed) 1987 Aug 29;295(6597):515–517. doi: 10.1136/bmj.295.6597.515. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Viberti G., Mogensen C. E., Groop L. C., Pauls J. F. Effect of captopril on progression to clinical proteinuria in patients with insulin-dependent diabetes mellitus and microalbuminuria. European Microalbuminuria Captopril Study Group. JAMA. 1994 Jan 26;271(4):275–279. [PubMed] [Google Scholar]
  39. Watts G. F., Harris R., Shaw K. M. The determinants of early nephropathy in insulin-dependent diabetes mellitus: a prospective study based on the urinary excretion of albumin. Q J Med. 1991 Apr;79(288):365–378. [PubMed] [Google Scholar]
  40. Yokoyama H., Uchigata Y., Otani T., Tomioka M., Kodama K., Omori Y. Changes of albumin concentrations in the first morning urine according to age and sex in 2990 healthy children and adults. Diabetes Res Clin Pract. 1993 Aug-Sep;21(2-3):167–170. doi: 10.1016/0168-8227(93)90065-d. [DOI] [PubMed] [Google Scholar]

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