Department of Nephrology, Zonguldak Atatürk State Hospital, Zonguldak, Turkey.
J Diabetes Complications. 2012 Nov-Dec;26(6):531-5. doi: 10.1016/j.jdiacomp.2012.05.016. Epub 2012 Jul 12.
Increased evidence suggests that apart from patients with increased albumin excretion and decreased glomerular filtration rate (GFR); there are also patients with type 2 diabetes with decreased GFR but without albuminuria. The exact pathophysiologic mechanisms regarding these clinical conditions are not known. We suggest that different blood pressure (BP) levels may be one the factors for these different clinical conditions. However, before labeling BP as a causative factor; one must show whether BP levels are different in these patients. Thus the current study was performed to analyze the relationship between creatinine clearance, microalbuminuria and circadian blood pressure levels in newly diagnosed essential hypertensive and type 2 diabetic patients.
Medical history, physical examination, laboratory analysis and ambulatory blood pressure measurements (ABPMs) were analyzed. 24-h urine specimens were collected to measure creatinine clearance and albumin excretion
In total 216 patients were included which were divided into 4 groups: group 1 composed of 90 patients with normal GFR and without microalbuminuria (MA), group 2 composed of 50 patients with normal GFR and with MA, group 3 composed of 36 patients with decreased GFR and without MA and group 4 composed of 40 patients with both decreased GFR and MA. The ratio of dippers vs. non dippers was not different between group 1, group 2 and group 3 patients. However ratio of dippers was higher in group 1 when compared to group 4 (P: 0.003) and group 4 patients have an odds of 7.678 (CI: 1.657-35.576, P: 0.009) for non-dapping status when compared to patients in group 1.
In conclusion, ABPM measurements were highest in patients with both decreased GFR and MA, whereas they are lowest in patients with normal GFR and normal UAE.
越来越多的证据表明，除了白蛋白排泄增加和肾小球滤过率（GFR）降低的患者外；还有一些 2 型糖尿病患者 GFR 降低但没有蛋白尿。关于这些临床情况的确切病理生理机制尚不清楚。我们认为，不同的血压（BP）水平可能是这些不同临床情况的一个因素。然而，在将 BP 标记为致病因素之前；必须证明这些患者的 BP 水平是否不同。因此，目前的研究旨在分析新诊断的原发性高血压和 2 型糖尿病患者的肌酐清除率、微量白蛋白尿和昼夜血压水平之间的关系。
分析了病史、体格检查、实验室分析和动态血压测量（ABPM）。收集 24 小时尿标本以测量肌酐清除率和白蛋白排泄量。
共纳入 216 例患者，分为 4 组：第 1 组由 90 例 GFR 正常且无微白蛋白尿（MA）的患者组成，第 2 组由 50 例 GFR 正常且有 MA 的患者组成，第 3 组由 36 例 GFR 降低且无微白蛋白尿的患者组成，第 4 组由 40 例 GFR 降低且有 MA 的患者组成。第 1 组、第 2 组和第 3 组患者的夜间血压下降与非夜间血压下降的比例无差异。然而，与第 1 组相比，第 4 组的夜间血压下降比例更高（P：0.003），与第 1 组相比，第 4 组的非夜间血压下降状态的优势比为 7.678（CI：1.657-35.576，P：0.009）。
总之，在同时存在 GFR 降低和 MA 的患者中，ABPM 测量值最高，而在 GFR 正常且 UAE 正常的患者中最低。
