Higa Mariko, Ichijo Takamasa, Hirose Takahisa
Division of Diabetes and Endocrinology, Department of Medicine, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan.
Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan.
Med Sci Monit. 2022 Mar 20;28:e935615. doi: 10.12659/MSM.935615.
BACKGROUND It is well established that primary aldosteronism (PA) and aldosterone-to-renin ratio (ARR) are associated with kidney disease. The aim of this study was to retrospectively investigate the relationship between ARR, urinary albumin excretion (UAE), and estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes from a single center. MATERIAL AND METHODS We included 70 patients with type 2 diabetes, UAE ≤100 mg/day, not taking renin-aldosterone system inhibitors, did not meet the diagnostic criteria for PA, and had an ARR <20. The patients were divided into 3 groups: the normal low (NL) group (33 patients) with a UAE <10 mg/day, the normal (N) group (22 patients) with a UAE of 10-29 mg/day, and the microalbuminuria (M) group (15 patients) with a UAE of 30-100 mg/day. The ARR, plasma renin activity (PRA), and plasma aldosterone (PAC) were compared among groups. RESULTS The ARR was highest in group M (10.1±4.6), 6.5±0.3 in group NL, and 7.0±2.7 in group N. The PRA and PAC were significantly lower in group M (P<0.001). The ARR showed a significant positive correlation with log UAE (r=0.37, P<0.001) and a significant negative correlation with eGFR (r=-0.33, P<0.01). CONCLUSIONS High levels of aldosterone relative to renin, which did not fulfill confirmatory criteria for PA, may be one of the risk factors for the development of diabetic nephropathy in patients with diabetes. The present results are supported by previous research showing that an increased ARR without PA was a risk factor for kidney disease.
背景 原发性醛固酮增多症（PA）和醛固酮与肾素比值（ARR）与肾脏疾病的关联已得到充分证实。本研究的目的是回顾性调查来自单一中心的2型糖尿病患者中ARR、尿白蛋白排泄率（UAE）和估计肾小球滤过率（eGFR）之间的关系。材料与方法 我们纳入了70例2型糖尿病患者，UAE≤100mg/天，未服用肾素-醛固酮系统抑制剂，不符合PA的诊断标准，且ARR<20。患者被分为3组：正常低（NL）组（33例），UAE<10mg/天；正常（N）组（22例），UAE为10 - 29mg/天；微量白蛋白尿（M）组（15例），UAE为30 - 100mg/天。比较各组的ARR、血浆肾素活性（PRA）和血浆醛固酮（PAC）。结果 M组的ARR最高（10.1±4.6），NL组为6.5±0.3，N组为7.0±2.7。M组的PRA和PAC显著更低（P<0.001）。ARR与log UAE呈显著正相关（r = 0.37，P<0.001），与eGFR呈显著负相关（r = -0.33，P<0.01）。结论 相对于肾素而言醛固酮水平较高（未达到PA的确证标准）可能是糖尿病患者发生糖尿病肾病的危险因素之一。先前的研究表明无PA的情况下ARR升高是肾脏疾病的危险因素，本研究结果支持了这一点。
