Magri C J, Fava S
Department of Internal Medicine, Mater Dei Hospital, Tal-Qroqq, Msida, Malta.
Minerva Urol Nefrol. 2011 Dec;63(4):273-80.
The aim of this paper was to analyze the relation between glomerular filtration rate (GFR) and albumin excretion rate (AER) in subjects with type 2 diabetes.
Three hundred thirteen type 2 diabetic patients attending Diabetes Centre, Malta, were studied between 2008 and 2009. GFR was estimated using the Modified Diet Renal Disease (MDRD) formula while two spot measurements of urinary AER were used to determine albuminuria.
Forty-nine patients were hyperfiltrating, of whom 69% were normoalbuminuric, 24% microalbuminuric, and 6% macroalbuminuric; 229 subjects had normal eGFR; of these 67% were normoalbuminuric, 27% microalbuminuric and 6% macroalbuminuric; 35 subjects had eGFR<60mL/min/1.73 m2, of whom 43% were normoalbuminuric, 37% microalbuminuric and 20% macroalbuminuric. No association was found between eGFR and AER in subjects with hyperfiltration (P=0.39); however eGFR was strongly correlated with AER in subjects with eGFR <60ml/min/1.73 m2 (r= -0.376; P=0.026). In multinomial logistic regression analysis, eGFR was significantly associated with albuminuria in non-hyperfiltrating, but not in hyperfiltrating, subjects.
Our data suggests that hyperfiltration and albuminuria occur independently of each other in the early stages of DN, but the decline in eGFR and albuminuria follow a parallel course in later stages of DN suggesting that they may share common pathophysiological mechanisms or they may be causally linked.
本文旨在分析2型糖尿病患者肾小球滤过率（GFR）与白蛋白排泄率（AER）之间的关系。
2008年至2009年期间，对就诊于马耳他糖尿病中心的313例2型糖尿病患者进行了研究。采用改良饮食肾脏病（MDRD）公式估算GFR，同时通过两次随机尿AER测量来确定蛋白尿情况。
49例患者存在高滤过，其中69%为正常白蛋白尿，24%为微量白蛋白尿，6%为大量白蛋白尿；229例患者的估算肾小球滤过率（eGFR）正常，其中67%为正常白蛋白尿，27%为微量白蛋白尿，6%为大量白蛋白尿；35例患者的eGFR<60mL/（min·1.73 m²），其中43%为正常白蛋白尿，37%为微量白蛋白尿，20%为大量白蛋白尿。高滤过患者的eGFR与AER之间未发现相关性（P=0.39）；然而，eGFR<60ml/（min·1.73 m²）的患者中，eGFR与AER密切相关（r=-0.376；P=0.026）。在多项逻辑回归分析中，eGFR在非高滤过患者中与蛋白尿显著相关，但在高滤过患者中并非如此。
我们的数据表明，在糖尿病肾病早期，高滤过和蛋白尿相互独立发生，但在糖尿病肾病后期，eGFR下降和蛋白尿呈平行变化，这表明它们可能具有共同的病理生理机制，或者可能存在因果联系。
