Prevalence, course and risk factors of diabetic nephropathy in type-2 diabetes mellitus. 2000

M Molnár, and I Wittmann, and J Nagy
Nephrological and Diabetes Centre, 2nd Department of Internal Medicine, Medical University Medical of Pécs, Hungary.

Contrary to the well-known features of diabetic nephropathy (DNP) in type-1 diabetic patients (pts), the prevalence, course and risk factors of DNP in in type-2 diabetic pts are not clear. The aim of the present study was to assess the prevalence of microalbuminuria (MA) and macroalbuminuria (MAA), their relationship with other diabetic complications and with some known cardiovascular risk factors in 200 in type-2 diabetic pts (100 females and 100 males). 68 pts (33%) were normalbuminuric (NA), 55 (27.5%) had MA and 77 (38.5%) had MAA. There was no significant difference among these three groups in age, BMI or the time actually elapsed since the diabetes and hypertension were diagnosed. BMI was high in each group (28.8 +/- 5.29, 28.0 +/- 5.2 and 29.8 +/- 4.6 kg/m2 mean +/- SD). 65% of pts with NA, 77% of those with MA and 81% of pts with MAA had hypertension. MAA pts were more frequently smokers and former smokers, than MA and NA pts (56% vs 32% and 22%). Average GRF values (ml/min/1.73 m2) were 71.9 +/- 26.8 in NA pts, 82.3 +/- 36.8 in MA pts and 56.3 +/- 32 in MAA pts. There was no significant correlation between the urinary albumin excretion (UAE) and glycemic control, serum (se) cholesterol and se HDL cholesterol. At the same time UAE showed a significant positive correlation with se trigliceride (P < 0.01), se uric acid (P < 0.01) and se creatinine (P < 0.01) while a significant negative correlation was found with GFR (P < 0.01). Diabetic non-proliferative retinopathy (RP) was detected even in NA pts (27%) while 51% of MAA pts were without RP. 56% of NA pts, 57% of MA pts and 93% of MAA pts had macroangiopathy. CONCLUSIONS (1) renal function can be impaired even in type-2 diabetic pts with NA and MA, (2) well-known cardiovascular risk factors seem to have a close relation with renal damage in type-2 diabetes (3) renal lesions in type-2 diabetic pts may be caused by diseases other than diabetes (e.g. arteriosclerosis, hypertension) (4) unlike in type-1 diabetes, where the strict glycemic control is the main preventive factor of DNP, in type-2 diabetes, the control of hypertension, hyperlipidemia, obesity, hyperuricemia may have priority.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D003924 Diabetes Mellitus, Type 2 A subclass of DIABETES MELLITUS that is not INSULIN-responsive or dependent (NIDDM). It is characterized initially by INSULIN RESISTANCE and HYPERINSULINEMIA; and eventually by GLUCOSE INTOLERANCE; HYPERGLYCEMIA; and overt diabetes. Type II diabetes mellitus is no longer considered a disease exclusively found in adults. Patients seldom develop KETOSIS but often exhibit OBESITY. Diabetes Mellitus, Adult-Onset,Diabetes Mellitus, Ketosis-Resistant,Diabetes Mellitus, Maturity-Onset,Diabetes Mellitus, Non-Insulin-Dependent,Diabetes Mellitus, Slow-Onset,Diabetes Mellitus, Stable,MODY,Maturity-Onset Diabetes Mellitus,NIDDM,Diabetes Mellitus, Non Insulin Dependent,Diabetes Mellitus, Noninsulin Dependent,Diabetes Mellitus, Noninsulin-Dependent,Diabetes Mellitus, Type II,Maturity-Onset Diabetes,Noninsulin-Dependent Diabetes Mellitus,Type 2 Diabetes,Type 2 Diabetes Mellitus,Adult-Onset Diabetes Mellitus,Diabetes Mellitus, Adult Onset,Diabetes Mellitus, Ketosis Resistant,Diabetes Mellitus, Maturity Onset,Diabetes Mellitus, Slow Onset,Diabetes, Maturity-Onset,Diabetes, Type 2,Ketosis-Resistant Diabetes Mellitus,Maturity Onset Diabetes,Maturity Onset Diabetes Mellitus,Non-Insulin-Dependent Diabetes Mellitus,Noninsulin Dependent Diabetes Mellitus,Slow-Onset Diabetes Mellitus,Stable Diabetes Mellitus
D003928 Diabetic Nephropathies KIDNEY injuries associated with diabetes mellitus and affecting KIDNEY GLOMERULUS; ARTERIOLES; KIDNEY TUBULES; and the interstitium. Clinical signs include persistent PROTEINURIA, from microalbuminuria progressing to ALBUMINURIA of greater than 300 mg/24 h, leading to reduced GLOMERULAR FILTRATION RATE and END-STAGE RENAL DISEASE. Diabetic Glomerulosclerosis,Glomerulosclerosis, Diabetic,Diabetic Kidney Disease,Diabetic Nephropathy,Intracapillary Glomerulosclerosis,Kimmelstiel-Wilson Disease,Kimmelstiel-Wilson Syndrome,Nodular Glomerulosclerosis,Diabetic Kidney Diseases,Glomerulosclerosis, Nodular,Kidney Disease, Diabetic,Kidney Diseases, Diabetic,Kimmelstiel Wilson Disease,Kimmelstiel Wilson Syndrome,Nephropathies, Diabetic,Nephropathy, Diabetic,Syndrome, Kimmelstiel-Wilson
D003930 Diabetic Retinopathy Disease of the RETINA as a complication of DIABETES MELLITUS. It is characterized by the progressive microvascular complications, such as ANEURYSM, interretinal EDEMA, and intraocular PATHOLOGIC NEOVASCULARIZATION. Diabetic Retinopathies,Retinopathies, Diabetic,Retinopathy, Diabetic
D005260 Female Females
D005919 Glomerular Filtration Rate The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to INULIN clearance. Filtration Rate, Glomerular,Filtration Rates, Glomerular,Glomerular Filtration Rates,Rate, Glomerular Filtration,Rates, Glomerular Filtration
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D006814 Hungary A country in Europe, northwest of Romania, south of Slovakia, and east of Austria. The capital is Budapest.
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults

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