Department of Pediatric Endocrinology, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Diabetes Care. 2011 Jul;34(7):1526-8. doi: 10.2337/dc10-2231. Epub 2011 May 11.
We previously found that microalbuminuria (MA) is present in 14% of patients with long-standing cystic fibrosis-related diabetes (CFRD). However, others have reported much higher rates of MA in CF patients with and without diabetes (32-67%), suggesting this test is not sufficiently specific for diabetic nephropathy screening in CF. We investigated transient (TMA) and persistent (PMA) microalbuminuria in CF patients to resolve these contradictory findings.
We reviewed 1,449 outpatient urinary albumin measurements from 467 patients aged ≥10 years, which were collected over a decade. TMA was defined as a single episode of MA that subsequently was resolved. PMA was defined as two consecutive or two out of three consecutive measurements in the MA range.
The prevalence of TMA that subsequently was resolved in CF patients was similar to the general population. It was found in 7.6% of patients, including 5% of youth (aged 10-17 years) and 9% of adults. PMA was found in 6.1% of the overall CF population, including 2% of youth and 8% of adults. The odds of PMA were increased sevenfold in patients with CFRD (95% CI 2.5-20, P=0.0002) and 48-fold in patients with both CFRD and organ transplant (95% CI 13-177, P<0.0001). The five patients with PMA in the absence of CFRD or transplant included two youths with presumed benign orthostatic MA and three adults with hypertension.
The spot urine albumin-to-creatinine ratio is specific enough to be a valid screening test for diabetic kidney disease in CFRD.
我们先前发现，在患有长期囊性纤维化相关糖尿病（CFRD）的患者中，有 14%存在微量白蛋白尿（MA）。然而，其他人报告称，在 CF 患者中，无论是否患有糖尿病，MA 的发生率都高得多（32-67%），这表明该检测对 CF 患者的糖尿病肾病筛查不够特异。我们研究了 CF 患者中短暂性（TMA）和持续性（PMA）微量白蛋白尿，以解决这些相互矛盾的发现。
我们回顾了 467 名年龄≥10 岁的门诊患者的 1449 份尿液白蛋白测量值，这些测量值在十年内收集。TMA 定义为单次 MA 发作，随后得到解决。PMA 定义为 MA 范围内的两次连续或三次中的两次连续测量。
在 CF 患者中，随后得到解决的 TMA 的患病率与普通人群相似。它发生在 7.6%的患者中，包括 5%的年轻人（10-17 岁）和 9%的成年人。PMA 发生在整个 CF 人群的 6.1%中，包括 2%的年轻人和 8%的成年人。患有 CFRD 的患者发生 PMA 的几率增加了七倍（95%CI 2.5-20，P=0.0002），患有 CFRD 和器官移植的患者增加了 48 倍（95%CI 13-177，P<0.0001）。在没有 CFRD 或移植的情况下，有 5 名患者出现 PMA，其中包括两名患有推测为良性直立性 MA 的年轻人和三名患有高血压的成年人。
尿白蛋白/肌酐比值可作为 CFRD 患者糖尿病肾病的有效筛查试验。
