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Prevention of Diabetic Renal Disease with Special Reference to Microalbuminuria

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The Kidney and Hypertension in Diabetes Mellitus

Abstract

In the past year six sets of recommendations on the prevention of diabetic nephropathy, with special reference to microalbuminuria, have been published [1–6]. The background to this activity was the large and increasing number of diabetic patients in whom end-stage renal failure (ESRD) develops and who therefore require dialysis or renal transplantation. Throughout the world about half a million patients are registered as being on renal replacement therapy, and diabetic nephropathy is the cause in nearly one-fifth of them [7]. These data are extrapolated from countries which have registries but in many areas, especially in the densely populated countries of the Far East, accurate information on numbers of patients with ESRD is not yet available. Moreover, the half-million figure probably underestimates the number of diabetic patients with ESRD because selection criteria for renal replacement therapies vary from country to country. Both insulin dependent (IDDM) and non-insulin-diependent (NIDDM) diabetic patients contribute to the increase in ESRD. Prevention of diabetic renal disease, or at least the postponement or slowing down of the disease process, has emerged as a key issue. Our strategy is to develop programmes for all patients with diabetes, focused on early detection of renal disease followed by intervention.

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References

  1. Vibeiti GC, Mogensen CE, Passa P, Bilous R, Mangili R. »St Vincent declaration, 1994: Guidelines for the prevention of diabetic renal failure.« In The Kidney and Hypertension in Diabetes Mellitus, 2nd ed, Mogensen CE, ed. Boston, Dordrecht, London: Kluwer Academic Publishers, 1994; pp 515–527.

    Chapter  Google Scholar 

  2. Anon. Prevention of Diabetes Mellitus: report of a WHO study group. WHO Tech Rep Ser 844. Geneva: WHO, 1994: 55–59.

    Google Scholar 

  3. Jerums G, Cooper M, Gilbert R, O’Brien R, Taft J. Microalbuminuria in diabetes. Med J Aust 1994; 161:265–268.

    PubMed  CAS  Google Scholar 

  4. Consensus development conference on the diagnosis and management of nephropathy in patients with diabetes mellitus. Diabetes Care 1994; 17: 1357–1361.

    Google Scholar 

  5. Bennett PH, Haffner S, Kasiske BL, Keane WF, Mogensen CE, Parving H-H, Steffes MW, Striker GE. Screening and management of microalbuminuria in patients with diabetes mellitus -recommendations to the scientific advisory board of the National Kidney Foundation from an ad hoc committee of the council on diabetes mellitus of the National Kidney Foundation. Am J Kidney Dis 1995; 25: 107–112.

    Article  PubMed  CAS  Google Scholar 

  6. Striker GE. Report on a workshop to develop management recommendations for the prevention of progression in chronic renal disease Bethesda (MA) April 1994. Nephrol Dial Transplant 1995; 10:290–292.

    PubMed  CAS  Google Scholar 

  7. Mogensen CE. Systemic blood pressure and glomerular leakage with particular reference to diabetes and hypertension. J Intern Med 1994; 235: 297–316.

    Article  PubMed  CAS  Google Scholar 

  8. Jarrett RJ, Viberti GC, Argyropoulos A, Hill RD, Mahmud U, Murrells TJ. Microalbuminuria predicts mortality in non-insulin-dependent diabetes. Diabetic Med 1984; 1:17–19.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  10. Yudkin JS, Forrest RD, Jackson CA. Microalbuminuria as a predictor of vascular disease in non-diabetic subjects. Islington diabetes Survey. Lancet 1988; ii: 530–533.

    Article  Google Scholar 

  11. Damsgaard EM, Frøland A, Jørgensen OD, Mogensen CE. Microalbuminuria as a predictor of increased mortality in elderly people. BMJ 1990; 300: 297–300.

    Article  PubMed  CAS  Google Scholar 

  12. Mogensen CE. Microalbuminuria: An important warning sign from the laboratory. J Diabetic Compl 1994; 8: 135–136.

    Article  CAS  Google Scholar 

  13. Feldt-Rasmussen B, Borch-Johnsen K, Deckert T, Jensen G, Jensen JS. Microalbuminuria: An important diagnostic tool. J Diabetic Compl 1994; 8: 137–145.

    Article  CAS  Google Scholar 

  14. Parving H-H, Jensen HÆ, Mogensen CE, Ewin PE. Increased urinary albumin excretion rate in benign essential hypertension. Lancet 1974; i: 1190–1192.

    Article  Google Scholar 

  15. Mogensen CE, Vestbo E, Poulsen PL, Christiansen C, Damsgaard EM, Eiskjær H, Frøland A, Hansen KW, Nielsen S, Mau Pedersen M Microalbuminuria and potential confounders. A review and some observations on variability of urinary albumin excretion. Diabetes Care 1995; 18: 572–581.

    PubMed  CAS  Google Scholar 

  16. Mogensen CE. Microalbuminuria as a predictor of clinical diabetic nephropathy. Kidney Int 1987; 31:673–689.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  18. Marshall SM, Alberti KGMM. Screening for early diabetic nephropathy. Ann Clin Biochem 1986; 23:195–197.

    PubMed  Google Scholar 

  19. 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 1986; 29: 97–99.

    Article  PubMed  CAS  Google Scholar 

  20. 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 1988; 34:2019–2021.

    Google Scholar 

  21. Mogensen CE: Management of early nephropathy in diabetic patients. With emphasis on microalbuminuria. Ann Rev Med 1995; 46: 79–94.

    Article  PubMed  CAS  Google Scholar 

  22. Mogensen CE, Poulsen PL, Heinsvig EM. »Abnormal albuminuria in the monitoring of early renal changes in diabetes.« In Concepts for the Ideal Diabetes Clinic. Diabetes Forum Series, Volume IV. Mogensen CE, Standi E, eds. Berlin, New York: Walter de Gruyter, 1993; pp 289–313.

    Google Scholar 

  23. Poulsen PL, Mogensen CE. Evaluation of a new semiquantitative stix for microalbuminuria. Diabetes Care 1995; 18: 732–733.

    PubMed  CAS  Google Scholar 

  24. Anon. Fifth report of the joint national committee on detection, evaluation, and treatment of high blood pressure (JNC V). Arch Intern Med 1993; 153:154–183.

    Google Scholar 

  25. Anon. Guidelines for management of mild hypertension: memorandum from a WHO/ISH meeting. Clin Exp Hypertens 1993; 15: 1363–1395.

    Google Scholar 

  26. The National High Blood Pressure Education Program Working Group. National high blood pressure education program working group report on hypertension. Hypertension 1994; 23: 145–148.

    Article  Google Scholar 

  27. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the systolic hypertension in the elderly program (SHEP). JAMA 1991; 265:3255–3264.

    Article  Google Scholar 

  28. Mogensen CE. Renoprotective role of ACE inhibitors in diabetic nephropathy. Br Heart J 1994; 72: Suppl.: 38–45.

    Article  Google Scholar 

  29. Hansen KW, Mau Pedersen M, Christensen CK, Schmitz A, Christiansen JS, Mogensen CE. Normoalbuminuria ensures no reduction of renal function in type 1 (insulin dependent) diabetic patients. J Intem Med 1992; 232:161–167.

    Article  CAS  Google Scholar 

  30. Schmitz A. Renal function changes in middle-aged and elderly Caucasian Type 2 (non-insulin-dependent) diabetic patients — a review. Diabetologia 1993; 36:985–992.

    Article  PubMed  CAS  Google Scholar 

  31. Tsalamandris C, Allen TJ, Gilbert RE, Sinha A, Panagiotopoulos S, Cooper ME, Jerums G. Progressive decline in renal function in diabetic patients with and without albuminuria. Diabetes 1994; 43:649–655.

    Article  PubMed  CAS  Google Scholar 

  32. Lane PH, Steifes MW, Mauer SM. Glomerular structure in IDDM women with low glomerular filtration rate and normal urinary albumin excretion. Diabetes 1992; 41: 581–586.

    Article  PubMed  CAS  Google Scholar 

  33. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977–986.

    Article  Google Scholar 

  34. Dahl-Jørgensen K, Brinchmann-Hansen O, Bangstad H-J, Hanssen KF. Blood glucose control and microvascular complications — what do we do now? Diabetologia 1994; 37: 1172–1177.

    Article  PubMed  Google Scholar 

  35. Viberti GC, Mogensen CE, Groop L, Pauls JF for the European Microalbuminuria Captopril Study Group. Effect of Captopril on progression to clinical proteinuria in patients with insulin-dependent diabetes mellitus and microalbuminuria. JAMA 1994; 271:275–279.

    Article  PubMed  CAS  Google Scholar 

  36. Mathiesen ER, Hommel E, Hansen HP, Parving H-H. Preservation of normal GFR with long term Captopril treatment in normotensive IDDM patients with microalbuminuria. Am Soc. of Nephrology, Vol. 8, Sep. 1997; 115A.

    Google Scholar 

  37. Lewis EJ, Hunsicker LG, Bain RP, Rohde RD, for the Collaborative Study Group. The effect of angjotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med 1993; 329: 1456–1462.

    Article  PubMed  CAS  Google Scholar 

  38. Parving H-H, Rossing P. The use of antihypertensive agents in prevention and treatment of diabetic nephropathy. Current Opinion in Nephrology and Hypertension 1994; 3: 292–300.

    Article  PubMed  CAS  Google Scholar 

  39. Mogensen CE, Hansen KW, Nielsen S, Mau Pedersen M, Rehling M, Schmitz A. Monitoring diabetic nephropathy: Glomerular filtration rate and abnormal albuminuria in diabetic renal disease: Reproducibility, progression studies and efficacy of antihypertensive intervention. Am J Kidney Dis 1993; 22: 174–187.

    PubMed  CAS  Google Scholar 

  40. Ravid, M, Savin H, Jutrin I, Bental T, Katz B, Lishner M. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normoten-sivetype II diabetic patients. Ann Intern Med 1993; 118: 577–581.

    Article  PubMed  CAS  Google Scholar 

  41. Weidmann P, Ferrari P. Central role of sodium in hypertension in diabetic subjects. Diabetes Care 1991; 14: 220–232

    Article  PubMed  CAS  Google Scholar 

  42. Østerby R. Microalbuminuria in diabetes mellitus — is there a structural basis? Nephrol Dial Transplant 1995: Editorial Comments: 10:12–14.

    PubMed  Google Scholar 

  43. Krolewski AS, Laffel LMB, Krolewski M, Quinn M, Warram JH. Glycosylated hemoglobin and the risk of microalbuminuria in patients with insulin-dependent diabetes mellitus. N Engl J Med 1995; 332: 1251–1255.

    Article  PubMed  CAS  Google Scholar 

  44. Viberti GC. A glycemic threshold for diabetic complications? N Engl J Med 1995; 332: 1293–1294.

    Article  PubMed  CAS  Google Scholar 

  45. Borch-Johnsen K, Wenzel H, Viberti GC, Mogensen CE. Is screening and intervention for microalbuminuria worthwhile in patients with insulin dependent diabetes? BMJ 1993; 306: 1722–1725.

    Article  PubMed  CAS  Google Scholar 

  46. Mathiesen ER, Borch-Johnsen K, Jensen DV, Deckert T. Improved survival in patients with diabetic nephropathy. Diabetologia 1989; 32: 884–886

    Article  PubMed  CAS  Google Scholar 

  47. Parving H-H, Hommel E. Prognosis in diabetic nephropathy. BMJ 1989; 299: 230–233.

    Article  PubMed  CAS  Google Scholar 

  48. Hasslacher C, Borgholte G, Ritz E, Wahl P. Impact of hypertension on prognosis of IDDM. Diabete Metab (Paris) 1989; 15: 338–342.

    CAS  Google Scholar 

  49. Mogensen CE. Diabetic renal disease: the quest for normotension — and beyond. Diabetic Med 1995; 12: 756–769.

    Article  PubMed  CAS  Google Scholar 

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Mogensen, C.E. et al. (1998). Prevention of Diabetic Renal Disease with Special Reference to Microalbuminuria. In: Mogensen, C.E. (eds) The Kidney and Hypertension in Diabetes Mellitus. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-6752-0_51

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  • DOI: https://doi.org/10.1007/978-1-4757-6752-0_51

  • Publisher Name: Springer, Boston, MA

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