M.V. Hospital for Diabetes & Prof. M. Viswanathan Diabetes Research Centre, WHO Collaborating Centre for Research, Education & Training in Diabetes, Chennai, India.
Indian J Med Res. 2012 Jul;136(1):46-53.
BACKGROUND & OBJECTIVES: Diabetic nephropathy (DN) is the leading cause of chronic kidney disease and end-stage renal disease in developing countries. Early detection and risk reduction measures can prevent DN. The aim of the study was to determine the risk factors for the development of proteinuria over a period of 12 years of follow up in normoalbuminuric type 2 diabetes patients attending a specialized centre.
Of the 2630 type 2 diabetes subjects newly registered in 1996, 152 (M:F;92:60) normoalbuminuric subjects had baseline and subsequent measurements of anthropometric, haemodynamic and biochemical details spanning 12 years. The subjects were divided into 2 groups based on the renal status during follow up visits. Group 1 (non-progressors) had persistent normoalbuminuria and group 2 (progressors) had persistent proteinuria. Presence of other diabetic complications during follow up and details on antidiabetic and antihypertensive agents were noted.
During median follow up of 11 years in subjects with normal renal function at baseline, 44.1 per cent developed proteinuria at follow up. Glucose levels, HbA 1 c, systolic blood pressure (SBP), triglycerides, and urea levels were significantly higher at baseline among progressors than non-progressors. Progressors had a longer duration of diabetes and significant fall in estimated glomerular filtration rate (eGFR) levels at follow up. In Cox's regression analysis, baseline age, duration of diabetes, baseline HbA 1 c and mean values of HbA 1 c, triglycerides, SBP and presence of retinopathy showed significant association with the development of macroalbuminuria.
INTERPRETATION & CONCLUSIONS: Type 2 diabetes patients with uncontrolled diabetes and increase in blood pressure are at high risk of developing nephropathy. Age, long duration of diabetes, elevated BP, poor glycaemic control and presence of retinopathy were significantly associated with the progression of diabetic nephropathy.
糖尿病肾病（DN）是发展中国家慢性肾脏病和终末期肾病的主要病因。早期发现和降低风险措施可以预防 DN。本研究旨在确定在 12 年的随访中，在接受专门中心治疗的 2 型糖尿病患者中，正常白蛋白尿型患者发生蛋白尿的危险因素。
在 1996 年新登记的 2630 例 2 型糖尿病患者中，有 152 例（男：女 92：60）正常白蛋白尿患者具有基线和随后 12 年的人体测量、血液动力学和生化指标的测量值。根据随访期间的肾脏状况，将这些患者分为 2 组。第 1 组（非进展组）持续存在正常白蛋白尿，第 2 组（进展组）持续存在蛋白尿。记录随访期间其他糖尿病并发症的存在情况以及抗糖尿病和抗高血压药物的详细信息。
在基线肾功能正常的患者中，中位随访 11 年后，44.1%的患者在随访期间出现蛋白尿。与非进展组相比，进展组的血糖水平、HbA 1 c、收缩压（SBP）、甘油三酯和尿素水平在基线时明显更高。进展组的糖尿病病程更长，在随访期间肾小球滤过率（eGFR）水平显著下降。在 Cox 回归分析中，基线年龄、糖尿病病程、基线 HbA 1 c 以及 HbA 1 c、甘油三酯、SBP 的平均值和视网膜病变的存在与发生大量白蛋白尿有显著相关性。
血糖控制不佳和血压升高的 2 型糖尿病患者发生肾病的风险较高。年龄、糖尿病病程长、血压升高、血糖控制不佳和视网膜病变与糖尿病肾病的进展显著相关。
