Albuminuria in Non-Insulin-Dependent Diabetes — Renal or Extrarenal Disease?

  • Anita Schmitz

Abstract

Microalbuminuria and overt proteinuria in EDDM have been decisively established as indicators of various stages in diabetic renal disease. Persistent microalbuminuria defines the stage of ‘incipient nephropathy’, that is the stage that heralds progression to overt nephropathy in more than 80 percent of cases within a decade, with proteinuria and relentless decline in kidney function, unless intervention is undertaken. Subsequent research concerning patients with NIDDM has clearly demonstrated, that the course of complications and the implication of albuminuria differ in several respects between the two types of diabetes [1–3].

Keywords

Urinary Albumin Urinary Albumin Excretion NIDDM Patient Glomerular Structure Urinary Albumin Concentration 
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References

  1. 1.
    Mogensen CE, Schmitz O. The diabetic kidney: From hyperfiltration and microalbuminuria to endstage renal failure. Med Clin North Am 1988; 72:1465–1492.PubMedGoogle Scholar
  2. 2.
    Mogensen CE, Damsgaard EM, Frøland A, Nielsen S, de Fine Olivarius N, Schmitz A. Microalbuminuria in non-insulin-dependent diabetes. Clin. Nephrol 1992; 38: s28–s39.Google Scholar
  3. 3.
    Schmitz A. The kidney in non-insulin-dependent diabetes. Studies in glomerular structure and function and the relationship between microalbuminuria and mortality. Acta Diabetol 1992; 29: 47–69.CrossRefGoogle Scholar
  4. 4.
    Fabre J, Baiant LP, Dayer PG, Fox HM, Vernet AT. The kindney in maturity onset diabetes mellitus: A clinical study of 510 patients. Kidney Int. 1982; 21:730–738.PubMedCrossRefGoogle Scholar
  5. 5.
    Schmitz A, Væth M. Microalbuminuria: A major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients. Diabetic Med 1988; 5:126–134.PubMedCrossRefGoogle Scholar
  6. 6.
    Gall M-A, Rossing P, Skøtt P, Damsbo P, Vaag A, Bech K, Dejgaard A, Lauritzen M, Lauritzen E, Hougaard P, Beck-Nielsen H, Parving H-H. Prevalence of micro- and macroalbuminiuria, arterial hypertension, retinopathy and large vessel disease in European Type 2 (non-insulin-dependent) diabetic patients. Diabetologia 1991; 34: 655–661.PubMedCrossRefGoogle Scholar
  7. 7.
    Marshall SM, Alberti KGMM. Comparison of the prevalence and associated features of abnormal albumin excretion in insulin-dependent and non-insulin-dependent diabetes. Q J Med 1989;70:61–71.PubMedGoogle Scholar
  8. 8.
    Damsgaard EM. »Prevalence and incidence of microalbuminuria in non-insulin-dependent diabetes: Relations to other vascular lesions.« In The Kidney and Hypertension in Diabetes Mellitus, 1. ed.. C.E. Mogensen, ed. Boston: Martinus Nijhoff Publishing, 1988; pp 59–63x.Google Scholar
  9. 9.
    Olivarius N de F, Andreasen AH, Keiding N, Mogensen CE. Epidemiology of renal involvement in newly-diagnosed middle-aged and elderly diabetic patients. Cross-sectional data from the population-based study “Diabetes care in Generel Practice”, Denmark. Diabetologia 1993; 36: 1007–1016.CrossRefGoogle Scholar
  10. 10.
    Standi E, Stiegler H. Microalbuminuria in a random cohort of recently diagnosed Type 2 (non-insulin-dependent) diabetic patients living in the Greater Munich area. Diabetologia 1993; 36: 1017–1020.CrossRefGoogle Scholar
  11. 11.
    Ballard DJ, Humphrey LL, Melton LJIII, Frohnert PP, Chu C-P, O’Fallon WM, Palumbo PJ. Epidemiology of persistent proteinuria in type II diabetes mellitus. Population-based study in Rochester, Minnesota. Diabetes 1988; 37:405–412.PubMedCrossRefGoogle Scholar
  12. 12.
    Schmitz A, Hvid Hansen H, Christensen T. Kidney function in newly diagnosed Type 2 (non-insulin-dependent) diabetic patients, before and during treatment. Diabetologia 1989; 32: 434–439.PubMedCrossRefGoogle Scholar
  13. 13.
    Uusitupa M, Siitonen O, Penttilä I, Aro A, Pyörälä K. Proteinuria in newly diagnosed type II diabetic patients. Diabetes Care 1987; 10:191–194.PubMedCrossRefGoogle Scholar
  14. 14.
    Martin P, Hampton KK, Walton C, Tindall H, Daview JA. Microproteinuria in Type 2 diabetes mellitus from diagnosis. Diabetic Med 1990; 7:315–318.PubMedCrossRefGoogle Scholar
  15. 15.
    Patrick AW, Leslie PJ, Clarke BF, Frier BM. The natural history and associations of microalbuminuria in type 2 diabetes during the first year after diagnosis. Diabetic Med 1990; 7:902–908.PubMedCrossRefGoogle Scholar
  16. 16.
    Tung P, Levin SR. Nephropathy in non-insulin-dependent diabetes mellitus. Am J Med 1988; 85: Suppl5A: 131–136.PubMedCrossRefGoogle Scholar
  17. 17.
    Mauer SM, Chavers BM. »A Comparison of kidney disease in Type 1 and Type II diabetes.« In Comparison of Type 1 and Type II Diabetes. Similarities and dissimilarities in etiology, pathogenesis, and complications, M. Vranic, C.H. Hollenberg, G. Steiner, eds. New York, London: Plenum Press, 1985; pp 299–303.Google Scholar
  18. 18.
    Rosansky SJ, Eggers PW. Trends in the US end-stage renal disease population: 1973–1983. Am J Kidney Dis. 1987;9:91–97.PubMedGoogle Scholar
  19. 19.
    Brunner FP, Brynger H, Challah S, Fassbinder W, Geerlings W, Selwood NH, Tufveson G, Wing AJ. Renal replacement therapy in patients with diabetic nephropathy, 1980–1985. Report from the European Dialysis and Transplant Association Registry. Nephrol Dial Transplant 1988; 3: 585–595.PubMedGoogle Scholar
  20. 20.
    Mykkänen L, Haffner SM, Kuusisto J, Pyorälä K, Laakso M. Microalbuminuria precedes the development of NIDDM Diabetes 1994;43: 552–557.PubMedCrossRefGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 1984; 310:356–360.PubMedCrossRefGoogle Scholar
  23. 23.
    Mogensen CE, Chachati A, Christensen CK, Close CF, 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 1985–86; 9: 85–95.PubMedGoogle Scholar
  24. 24.
    Mattock MB, Morrish NJ, Viberti GC, Keen H, Fitzgerald AP, Jackson G. Prospective study of microalbuminuria as predictor of mortality in NIDDM. Diabetes 1992; 41:736–741.PubMedCrossRefGoogle Scholar
  25. 25.
    Damsgaard EM, Frøland A, Jørgensen OD, Mogensen CE. Eight to nine year mortality in known non-insulin dependent diabetics and controls. Kidney Int 1992; 41:731–735.PubMedCrossRefGoogle Scholar
  26. 26.
    Dinneen SF, Gerstein HC. The association of microalbuminuria and mortality in Non-insulin-dependent diabetes mellitus. Arch Intern Med; 157:1413–1418.Google Scholar
  27. 27.
    Neil A, Hawkins M, Potok M, Thorogood M, Cohen D, Mann J. A Prospective population-based study of microalbuminuria as a predictor of mortality in NIDDM. Diabetes Care 1993; 16: 996–1004.PubMedCrossRefGoogle Scholar
  28. 28.
    MacLeod JM, Lutale J, Marshall SM Albumin excretion and vascular deaths in NIDDM. Diabetologia 1995; 38: 610–616.PubMedCrossRefGoogle Scholar
  29. 29.
    Gall M-A, Borch-Johnsen K, Hougaard P, Nielsen FS, Parving HH. Albuminuria and poor glycemic control predict mortality in NIDDM Diabetes 1995; 44:1303–1309.PubMedCrossRefGoogle Scholar
  30. 30.
    Jensen JS, Borch-Johnsen K, Jensen G, Feldt-Rasmussen B. Atherosclerotic risk factors are increased in clinically healthy subjects with microalbuminuria. Atherosclerosis 1995; 112: 245–252.PubMedCrossRefGoogle Scholar
  31. 31.
    Yudkin JS, Forrest RD, Jackson CA. Microalbuminuria as predictor of vascular disease in non-diabetic subjects. Islington diabetes survey. Lancet 1988; 2: 530–3.PubMedCrossRefGoogle Scholar
  32. 32.
    Damsgaard EM, Mogensen CE, Microalbuminuria in elderly hyperglycaemic patients and controls. Diabetic Med 1986; 3:430–435.PubMedCrossRefGoogle Scholar
  33. 33.
    Hostetter TH, Rennke HG, Brenner BM The case for intrarenal hypertension in the initiation and progression of diabetic and other glomerulopathies. Am J Med 1982; 72:375–380.PubMedCrossRefGoogle Scholar
  34. 34.
    Schmitz A Increased urinary haemoglobin in diabetics with microalbuminuria — measured by an ELISA. Scand J Clin Lab Invest 1990; 50: 303–308.CrossRefGoogle Scholar
  35. 35.
    Deckcert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A. Albuminuria reflects widespread vascular damage. The Steno hypothesis. Diabetologia 1989; 32: 219–226.CrossRefGoogle Scholar
  36. 36.
    Mattock MB, Keen H, Viberti GC, El-Gohari MR, Murrells TJ, Scott GS, Wing JR, Jackson PG. Coronary heart disease and urinary albumin excretion rate in type 2 (non-insulin-dependent) diabetic patients. Diabetologia 1988; 31: 82–87.PubMedCrossRefGoogle Scholar
  37. 37.
    Eiskjær H, Bagger JP, Mogensen CE, Schmitz A, Pedersen EB. Enhanced urinary excretion of albumin in congestive heart failure: effect of ACE-inhibition. Scand J Clin Lab Invest 1992; 52: 193–199.PubMedCrossRefGoogle Scholar
  38. 38.
    Kelbæk H, Jensen T, Feldt-Rasmussen B, Christensen NJ, Richter EA, Deckert T, Nielsen SL. Impaired left-ventricular function in insulin-dependent diabetic patients with increased urinary albumin excretion. Scand J Clin Lab Invest 1991; 51:467–473.PubMedCrossRefGoogle Scholar
  39. 39.
    Keen H. »Macrovascular disease in diabetes mellitus.« In Diabetic Complications: Early Diagnosis and Treatment, D. Andreani, G. Crepaldi, U. Di Mario, G. Pozza, eds. John Wiley & Sons Ltd., 1987; pp 3–12.Google Scholar
  40. 40.
    Jensen T Albuminuria — a marker of renal and generalized vascular disease in insulin-dependent diabetes mellitus (thesis). Copenhagen: København: Lægeforeningens Forlag, 1991.Google Scholar
  41. 41.
    Winocour PH, Durringjton PN, Ishola M, Anderson DC, Cohen H. Influence of proteinuria on vascular disease, blood pressure, and lipoproteins in insulin dependent diabetes mellitus. BMJ 1987;294:1648–1651.PubMedCrossRefGoogle Scholar
  42. 42.
    Niskanen L, Uusitupa M, Sarlund H, Siitonen O, Voutilainen E, Penttilä I, Pyörälä K. Microalbuminuria predicts the development of serum lipoprotein abnormalities favouring atherogenesis in newly diagnosed Type 2 (non-insulin-dependent) diabetic patients. Diabetologia 1990; 33: 237–243.PubMedCrossRefGoogle Scholar
  43. 43.
    Strandl F., Stiegler H, Janka HU, Mehnert H. Risk profile of macrovascular disease in diabetes mellitus. Diabete Metab (Paris) 1988; 14: 505–511.Google Scholar
  44. 44.
    Schmitz A, Ingerslev J. Haemostatic measures in Type 2 diabetic patients with microalbuminuria. Diabetic Med 1990; 7: 521–525.PubMedCrossRefGoogle Scholar
  45. 45.
    Stehouwer CD A, Nauta JJP, Zeldenrust GC, Hackeng WHL, Donker AJM, den Ottolander GJH. Urinary albumin excretion, cardiovascular disease and endothelial dysfunction in non-insulin-dependent diabetes mellitus. Lancet 1992; 340: 319–323.PubMedCrossRefGoogle Scholar
  46. 46.
    Jensen T, Bjerre-Knudsen J, Feldt-Rasmussen B, Deckert T. Features of endothelial dysfunction in early diabetic nephropathy. Lancet 1989; i: 461–463.CrossRefGoogle Scholar
  47. 47.
    Yudkin JS. Coronary heart disease in diabetes mellitus: three new risk factors and a unifying hypothesis. J Intern Med 1995; 238:21–30.PubMedCrossRefGoogle Scholar
  48. 48.
    Gellman DD, Pirani CL, Soothill JP, Muehrcke RC, Kark RM. Diabetic nephropathy, a clinical and pathologic study based on renal biopsies. Medicine 1959; 38:321–367.PubMedGoogle Scholar
  49. 49.
    Thomsen AC. The Kidney in Diabetes Mellitus (thesis). Copenhagen: Munksgaard, 1965.Google Scholar
  50. 50.
    Schmitz A, Gundersen HJG, Osterby R. Glomerular morpology by light microscopy in non-insulin-dependent mellitus. Lack of glomerular hypertrophy. Diabetes 1988; 37:38–43.PubMedCrossRefGoogle Scholar
  51. 51.
    Østerby R, Gall M-A, Schmitz A, Nielsen FS, Nyberg G, Parving H-H. Glomerular structure and function in proteinuric Type 2 (non-insulin-dependent) diabetic patients. Diabetologia 1993; 36: 1064–1070.PubMedCrossRefGoogle Scholar
  52. 52.
    Parving H-H, Gall M-A, Skøtt P, Jørgensen HE, Løkkegaard H, Jørgensen F, Nielsen B, Larsen S. Prevalence and causes of albuminuria in non-insulin-dependent diabetic patients. Kidney Int 1992;41:758–762.PubMedCrossRefGoogle Scholar
  53. 53.
    Taft JL, Billson VR, Nankervis A, Kincaid-Smith P, Martin FIR. A clinical-histological study of individuals with diabetes mellitus and proteinuria. Diabetic Med 1990; 7: 215–221.PubMedCrossRefGoogle Scholar
  54. 54.
    Olsen S, Mogensen CE. Non-diabetic renal disease in NIDDM proteinuric patients may be rare in biopsies from clinical practice (Abstract). JASN 1995; 6: 454.Google Scholar
  55. 55.
    Waldherr R, Ilkenhans C, Ritz E. How frequent is glomerulonephritis in diabetes mellitus type II ? Clin Nephrol 1992; 37: 271–273.PubMedGoogle Scholar
  56. 56.
    Keen H, Chlouverakis C, Fuller J, Jarrett RJ. The concomitants of raised blood sugar: studies in newly-detected hyperglycaemics II: Urinary albumin excretion, blood pressure and their relation to blood sugar levels. Guys Hosp Rep 1969; 118: 247–254.PubMedGoogle Scholar
  57. 57.
    Ibsen H, Hilden T. New views on the relationship between coronary heart disease and hypertension. J Intern Med 1990; 227: 77–79.PubMedCrossRefGoogle Scholar
  58. 58.
    Jensen JS, Borch-Johnsen K, Jensen G, Feldt-Rasmussen B. Microalbuminuria reflects a generalized transvascular albumin leakiness in clinically healthy subjects. Clinical Science 1995; 88:629–633.PubMedGoogle Scholar
  59. 59.
    Nannipieri M, Rizzo L, Rapuano A, Pilo A, Pernio G, Navalesi R. Increased transcapillary escape rate of albumin in microalbuminuric Type II diabetic patients. Diabetes Care 1995; 18: 1–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Nielsen S, Schmitz A, Rehling M, Ingerslev J, Mogensen CE. Dissociation of urinary albumin excretion and transcapillary escape rate as markers of microvascular and/or endothelial function in NIDDM patients. Diabetes 1997; 46 (suppl. 1): 309AGoogle Scholar
  61. 61.
    Mogensen CE. Microalbuminuria as a predictor of clinical diabetic nephropathy. Kidney Int 1987;31:673–689.PubMedCrossRefGoogle Scholar
  62. 62.
    Humphrey LL, Ballard DJ, Frohnert PP, Chu C-P, O’Fallon WM, Palumbo PJ. Chronic renal failure in non-insulin-dependent diabetes mellitus. A population based study in Rochester, Minnesota. Ann Intern Med 1989; 111: 788–796.PubMedCrossRefGoogle Scholar
  63. 63.
    Schmitz A. Renal function changes in middle-aged and elderly Caucasian Type 1 (non-insulin-dependent) diabetic patients — a review. Diabetologia 1993; 36: 985–992.PubMedCrossRefGoogle Scholar
  64. 64.
    Schmitz A, Væth M, Mogensen CE. Systolic blood pressure relates to the rate of progression of albuminuria in NIDDM. Diabetologia 1994; 37: 1251–1258.PubMedCrossRefGoogle Scholar
  65. 65.
    Gall MA, Hougaard P, Borch-Johnsen K, Parving HH. Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: prospective,observational study. BMJ 1997; 314:783–788.PubMedCrossRefGoogle Scholar
  66. 66.
    Kikkawa R, Haneda M. »Risk factor for progression of microalbumiuria in relatively young NIDDM-patients.« In Kidney and Hypertension in Diabetes Mellitus, 2. ed., C.E. Mogensen, ed. Boston, Dordrecht, London: Kluwer Academic Publishers, 1994; pp 103–109.CrossRefGoogle Scholar
  67. 67.
    Melbourne Diabetic Nephropathy Study Group: Comparison between peridopril and nifedipine in hypertensive and normotensive diabetic patients with microalbuminuria. BMJ 1991; 302: 210–216.CrossRefGoogle Scholar
  68. 68.
    Lacourcière Y, Nadeau A, Poirier L, Tancrède G. Captopril or conventional therapy in hypertensive type-II diabetics — 3-year analysis. Hypertension 1993; 21:786–794.PubMedCrossRefGoogle Scholar
  69. 69.
    Ravid M, Lang R, Rachmani R, Lishner M Long-term renoprotective effect of angiotensin-converting enzyme inhibition in Non-insulin-dependent diabetes mellitus. Arch Intern Med. 1996;156:286–289.PubMedCrossRefGoogle Scholar
  70. 70.
    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.CrossRefGoogle Scholar
  71. 71.
    Hellman R, Regan J, Rosen H. Effect of intensive treatment of diabetes on the risk of death or renal failure in NIDDM and IDDM Diabetes Care 1997; 20: 258–264.PubMedCrossRefGoogle Scholar
  72. 72.
    Uusitupa MU, Niskanen LK, Siitonen O, Voutilainen E, Pydrälä K. Ten-year cardiovascular mortality in relation to risk factors and abnormalkies in lipoprotein composition in Type 2 (non-insulin-dependent) diabetic and non-diabetic subjects. Diabetologia 1993; 36:1175–1184.PubMedCrossRefGoogle Scholar
  73. 73.
    Kuusisto J, Mykkänen L, Pyörälä K, Laakso M. NIDDM and its metabolic control predict coronary heart disease in elderly subjects. Diabetes 1994; 43:960–967.PubMedCrossRefGoogle Scholar
  74. 74.
    Genuth S. Exogenous insulin administration and cardiovascular risk in non-insulin-dependent and insulin-dependent diabetes mellitus. Ann Intern Med 1996; 124 (1 pt 2): 104–109.PubMedCrossRefGoogle Scholar
  75. 75.
    U.K. Prospective Study Group. U.K. Prospective Diabetes Study 16. Overview of 6 years’ therapy of type II Diabetes: A progressive disease. Diabetes 1995; 44:1249–1258;.CrossRefGoogle Scholar
  76. 76.
    Wolffenbuttel BHR, van Haeften TW. Prevention of complications in non-insulin-dependent diabetes mellitus (NIDDM). Drugs 1995;50 (2): 263–288.PubMedCrossRefGoogle Scholar
  77. 77.
    Foote EF. Prevention and treatment of diabetic nephropathy. Am J Heakh-Syst Pharm 1995; 52: 1781–1792.Google Scholar
  78. 78.
    Antiplatelet Trialists’ Collaboration. Collaborative overview of randomized trials of antiplatelet therapy: I. Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994; 308:81–106CrossRefGoogle Scholar
  79. 79.
    Haffher SM. Editorial. The Scandinavian Simvastatin Survival Study (4S) Subgroup analyses of diabetic subjects: Implications for the prevention of coronary heart disease. Diabetes Care 1997;20: 469–471.Google Scholar
  80. 80.
    The PPP Project Investigators. Design, rationale, and baseline characteristics of the prospective Pravastatin pooling (PPP) project- A combined analyses of three large-scale randomized trials: long-term intervention with Pravastatin on ischaemic disease (LIPID), Cholesterol and recurrent events (CARE), and West of Scotland coronary prevention study (WOSCOPS). Am J Cardiol 1995; 76: 899–905.CrossRefGoogle Scholar
  81. 81.
    Vedel P, Gæde P, Obel J, Parving H-H, Pedersen O. Intensive multifactorial intervention in NIDDM patients with persistent microalbuminuria (Abstract). Diabetologia 1996; 39: Suppl. 1: A308.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1998

Authors and Affiliations

  • Anita Schmitz
    • 1
  1. 1.Medical Department Horsens SygehusHorsensDenmark

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