Nothing Special   »   [go: up one dir, main page]
Skip to main content
Springer Nature Link
Log in

Prevalence of hypertension and microalbuminuria in adult type 1 (insulin-dependent) diabetic patients without renal failure in Italy. I. Validation of screening techniques to detect microalbuminuria

The Italian Microalbuminuria Study Group

  • Invited Speakers
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

Abstract

The prevalence of microalbuminuria and arterial hypertension among type 1 (insulin-dependent) diabetic patients is poorly known in Italy. In the preliminary phase of a large outpatient screening programme, we addressed the possibility of using non-time urine samples to predit the chance of detecting albumin excretion rate (AER) in the range of microalbuminuria. We therefore measured urinary albumin and creatinine concentration in timed overnight collections from 641 type 1 diabetic patients with serum creatinine levels lower than 133 μmol/l. AER was strongly and comparably predicted both by urinary albumin concentration (UAlb;r 2=0.754) and by the urinary albumin to creatinine concentration ratio (A/C;r 2=0.773). After exploring several independent cut-off levels for UAlb and A/C, AER in the range 20–200 μg/min (n=91) was found to be predicted with 90% sensitivity and specificity either by UAlb≧20 mg/l or by A/C≧2.0 mg/mmol. UAlb was negatively associated with diuresis, and false negative outcomes were explained by polyuria when screening by this variable. A/C was positively associated with female gender among normoalbuminuric patients, in line with the lower urinary excretion of creatinine in women (7.2±0.25 vs 10.2±0.35 μmol/min,P<0.00001). A significant excess of false positive outcomes in women compared with men was found when screening by any A/C cut-off level equal to or less than 2.5 mg/mmol. Simplified screening techniques seem to remain, however, a practicable option for the detection of microalbuminuria both in epidemiology and in clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Viberti GC, Hill RD, Jarrett RJ, Argyropuolos A, Mahmud U, Keen H, Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet I:1430–1432, 1982

    Google Scholar 

  2. Mathiesen ER, Oxenbøll B, Johansen K, Svendsen PA, Deckert T, Incipient nephropathy in type I (insulin-dependent) diabetes. Diabetologia 26:406–410, 1984

    Google Scholar 

  3. Mogensen CE, Christensen CK, Predicting diabetic nephropathy in insulin-dependent patients. N Engl J Med 311:89–93, 1984

    Google Scholar 

  4. Parving H-H, Oxenbøll B, Svendsen PA, Christiansen JS, Andersen AR, Early detection of patients at risk of developing diabetic nephropathy: a longitudinal study of urinary albumin excretion. Acta Endocrinol 100:550–555, 1982

    Google Scholar 

  5. Marre M, Chatellier G, Leblanc H, Guyene TT, Menard J, Passa P, Prevention of diabetic nephropathy with enalapril in normotensive diabetics with microalbuminuria. BMJ 297:1092–1095, 1988

    Google Scholar 

  6. Cohen D, Dodds R, Viberti GC, Effect of protein restriction in insulin-dependent diabetics at risk of nephropathy. BMJ 294:795–798, 1987

    Google Scholar 

  7. Christensen CK, Mogensen CE, The course of incipient diabetic nephropathy: studies of albumin excretion and blood pressure. Diabetic Med 2:97–102, 1985

    Google Scholar 

  8. Mathiesen ER, Hommel E, Giese J, Parving H-H, Efficacy of captopril in postponing nephropathy in normotensive insulin dependent patients with microalbuminuria. BMJ 303:81–87, 1991

    Google Scholar 

  9. Feldt-Rasmussen B, Mathiesen ER, Jensen T, Lauritzen T, Deckert T, Effect of improved metabolic control on loss of kidney function in type 1 (insulin-dependent) diabetic patients: an update of the Steno studies. Diabetologia 34:164–170, 1991

    Google Scholar 

  10. Krans HMJ, Prota M, Keen H, Diabetes care and research in Europe: the St. Vincent Declaration action programme. Implementation document. G Ital Diabetol 12 [Suppl 2]:22–26, 1992

    Google Scholar 

  11. Microalbuminuria Collaborative Study Group, Microalbuminuria in type 1 diabetic patients: prevalence and clinical characteristics. Diabetes Care 15:495–501, 1992

    Google Scholar 

  12. Nørgaard K, Feldt-Rasmussen B, Borch-Johnsen K, Sælan H, Deckert T, Prevalence of hypertension in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 33:407–410, 1990

    Google Scholar 

  13. Parving H-H, Hommel E, Mathiesen ER, Skøtt P, Edsberg B, Bahnsen M, Lauritzen M, Hougaard P, Lauritzen E, Prevalence of microalbuminuria, arterial hypertension, retinopathy and neuropathy in patients with insulin-dependent diabetes. BMJ 296:156–160, 1988

    Google Scholar 

  14. Gatling W, Knight C, Mullee MA, Hill RD, Microalbuminuria in diabetes: a population study of the prevalence and assessment of three screening tests. Diabetic Med 5:343–347, 1988

    Google Scholar 

  15. Mogensen CE, Chachati A, Christensen CK, Close ER, Deckert T, Hommel E, Kastrup J, Lefebvre P, Mathiesen ER, Feldt-Rasmussen B, Schmitz A, Viberti GC, Microalbuminuria: an early marker of renal involvement in diabetes. Uremia Invest 9:85–95, 1985

    Google Scholar 

  16. Gatling W, Knight C, Hill RD, Screening for early diabetic nephropathy: which sample to detect microalbuminuria? Diabetic Med 2:451–455, 1985

    Google Scholar 

  17. Cowell CT, Rogers S, Silink M, First morning urinary albumin concentration is a good predictor of 24-hour urinary albumin excretion in children with type 1 (insulin-dependent) diabetes. Diabetologia 29:97–99, 1986

    Google Scholar 

  18. Viberti GC, Vergani D, Detection of potentially reversible diabetic albuminuria: a three-drop agglutination test for urinary albumin at low concentration. Diabetes 31:973–975, 1982

    Google Scholar 

  19. Cohen DL, Close CF, Viberti GC, The variability of overnight urinary albumin excretion in insulin-dependent diabetic and normal subjects. Diabetic Med 4:437–440, 1987

    Google Scholar 

  20. Eshøj O, Feldt-Rasmussen B, Larsen ML, Mogensen EF, Comparison of overnight, morning and 24-hour urine collections in the assessment of diabetic microalbuminuria. Diabetic Med 4:531–533, 1987

    Google Scholar 

  21. Hutchinson AS, O'Reilly DStJ, MacCuish AC, Albumin excretion rate, albumin concentration, and albumin/creatinine ratio compared for screening diabetics for slight albuminuria. Clin Chem 34:2019–2021, 1988

    Google Scholar 

  22. Nathan DM, Rosenbaum C, Protasowicki D, Single-void urine samples can be used to estimate quantitative microalbuminuria. Diabetes Care 10:414–418, 1987

    Google Scholar 

  23. Marshall SM, Screening for microalbuminuria: which measurement? Diabetic Med 8:706–711, 1991

    Google Scholar 

  24. Coonrad BA, Ellis D, Becker DJ, Dorman JS, Drash AL, Kuller LH, Orchard TJ, Assessment of AlbuSure and its usefulness in identifying IDDM subjects at increased risk for developing clinical diabetic nephropathy. Diabetes Care 12:389–393, 1989

    Google Scholar 

  25. Linton AS, Rowe DJF, Ames' Microbumintes evaluated, and its correlation with total protein and albumin concentration in urine. Clin Chem 34:1927–1928, 1988

    Google Scholar 

  26. Kouri TT, Viikari JSA, Mattila KS, Irjala KMA, Microalbuminuria: invalidity of simple concentration-based screening tests for early nephropathy due to urinary volumes of diabetic patients. Diabetes Care 14:591–593, 1991

    Google Scholar 

  27. Ginsberg JM, Chang BS, Matarese RA, Garella S, Use of single voided urine samples to estimate quantitative proteinuria. N Engl J Med 309:1543–1546, 1983

    Google Scholar 

  28. “Todd-Sanford” Clinical diagnosis by laboratory methods, 15th edn. Saunders, Philadelphia, 1974

  29. Watts GF, Morris RW, Khan K, Polak A, Urinary albumin excretion in healthy adult subjects: reference values and some factors affecting their interpretation. Clin Chim Acta 172:191–198, 1988

    Google Scholar 

  30. Chachati A, Frenckell R von, Foidart-Willems J, Godon JP, Lefèbvre PJ, Variability of albumin excretion in insulin-dependent diabetics. Diabetic Med 4:441–445, 1987

    Google Scholar 

  31. Jerums G, Cooper ME, Seeman E, Murray RML, McNeil JJ, Spectrum of proteinuria in type I and type II diabetes. Diabetes Care 10:419–427, 1987

    Google Scholar 

  32. Collins VR, Dowse GK, Finch CF, Zimmet PZ, Linnane AW, Prevalence and risk factors for micro- and macroalbuminuria in diabetic subjects and entire population of Nauru. Diabetes 38:1602–1610, 1989

    Google Scholar 

  33. Mogensen CE, Microalbuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes. N Engl J Med 310:356–360, 1984

    Google Scholar 

  34. Nelson RG, for the Diabetic Renal Disease Study Group, Renal function in non-insulin-dependent diabetes mellitus: purposes and design of the Diabetic Renal Disease Study. Acta Diabetol 28:143–150, 1991

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Medicine, Scientific Institute San Raffaele, University of Milan, Milan, Italy

    R. Mangili

  2. Department of Internal Medicine, University of Genoa, Genoa, Italy

    G. Deferrari

  3. Department of Endocrinology and Metabolic Diseases, Policlinico Umberto I, University “La Sapienza”, Rome, Italy

    U. Di Mario

  4. Department of Clinical Medicine, Ospedale S. Chiara, University of Pisa, Pisa, Italy

    O. Giampietro & R. Navalesi

  5. Institute of Internal Medicine, Policlinico Universitario, University of Padua, Paudua, Italy

    R. Nosadini & G. Crepaldi

  6. Medical Department, ICI Pharmaceuticals, Milan, Italy

    G. Rigamonti

Authors
  1. R. Mangili
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Deferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. Di Mario
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. O. Giampietro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Navalesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Nosadini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Rigamonti
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G. Crepaldi
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

See Appendix

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mangili, R., Deferrari, G., Di Mario, U. et al. Prevalence of hypertension and microalbuminuria in adult type 1 (insulin-dependent) diabetic patients without renal failure in Italy. I. Validation of screening techniques to detect microalbuminuria. Acta Diabetol 29, 156–166 (1992). https://doi.org/10.1007/BF00573481

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00573481

Key words

Search

Navigation