Robbins D C, Knowler W C, Lee E T, Yeh J, Go O T, Welty T, Fabsitz R, Howard B V
Medlantic Research Institute, Washington, D.C., USA.
Kidney Int. 1996 Feb;49(2):557-63. doi: 10.1038/ki.1996.79.
Albuminuria is a risk factor for renal and cardiovascular disease. We conducted a cross sectional survey of 4549 older American Indians in Arizona, Oklahoma and North and South Dakota of (micro)albuminuria. A range of 20.1 to 48.3% of all participants had either micro- (> or = 30 to < 300 mg albumin/g creatinine) or macroalbuminuria (> or = 300 mg albumin/g creatinine). A total of 53% of the participants were diabetic, and the prevalence in Arizona (65 to 70%) was significantly greater than the other two sites. Prevalence of micro- and macroalbuminuria were significantly higher among those who were older, diabetic or hypertensive, and participants from Arizona. Even normotensive, nondiabetic Arizona Indians had higher prevalence rates than similar participants elsewhere. Higher prevalence rates of micro- and macroalbuminuria were also found among Arizona participants than participants with similar degrees of glucose intolerance from the other two sites. Indians reporting the greatest degree of Indian blood were more likely to have abnormal albuminuria (P < 0.0001). The duration of diabetes, fasting plasma glucose, systolic blood pressure, fibrinogen and Indian heritage were independently associated with micro- or macroalbuminuria. The association of albuminuria with subsequent ESRD, cardiovascular morbidity and overall mortality suggests that these American Indians will face a large disease burden. The correlation with reported Indian blood implies a strong component of genetic susceptibility, possibly independent of diabetes.
蛋白尿是肾脏疾病和心血管疾病的一个危险因素。我们对亚利桑那州、俄克拉何马州以及北达科他州和南达科他州的4549名美国印第安老年人进行了一项关于（微量）蛋白尿的横断面调查。所有参与者中，20.1%至48.3%的人患有微量蛋白尿（≥30至<300毫克白蛋白/克肌酐）或大量蛋白尿（≥300毫克白蛋白/克肌酐）。共有53%的参与者患有糖尿病，亚利桑那州的患病率（65%至70%）显著高于其他两个地区。在年龄较大、患有糖尿病或高血压的人群以及来自亚利桑那州的参与者中，微量和大量蛋白尿的患病率显著更高。即使是血压正常、无糖尿病的亚利桑那州印第安人，其患病率也高于其他地区的类似参与者。与其他两个地区葡萄糖不耐受程度相似的参与者相比，亚利桑那州参与者的微量和大量蛋白尿患病率也更高。报告印第安血统比例最高的印第安人更有可能出现异常蛋白尿（P<0.0001）。糖尿病病程、空腹血糖、收缩压、纤维蛋白原和印第安血统与微量或大量蛋白尿独立相关。蛋白尿与随后的终末期肾病、心血管疾病发病率和总体死亡率之间的关联表明，这些美国印第安人将面临巨大的疾病负担。与报告的印第安血统的相关性意味着遗传易感性的一个重要组成部分，可能独立于糖尿病。
