The Early Natural History of Nephropathy in Type 1 Diabetes
Open accessAbstract
Predictors of albumin excretion rate (AER) abnormalities could provide earlier indicators of diabetic nephropathy risk. Data from the Natural History Study, a prospective 5-year observation of renal structure and function in young type 1 diabetic patients, were examined for predictors of AER patterns in normoalbuminuric type 1 diabetic patients. Included were 170 patients (96 females) (aged 16.7 ± 5.9 years, duration of diabetes 8.0 ± 4.3 years) with normal blood pressure, normoalbuminuria (AER <20 μg/min), and eight or more follow-up visits over 5 years. AER, blood pressure, and HbA1c (A1C) were determined quarterly and glomerular filtration rate (GFR) annually. Persistent microalbuminuria (PMA) was defined as 20–200 μg/min in two of three consecutive values within 6–12 months. Four different AER patterns were identified. Group 1 (n = 99): all values <20 μg/min. Group 2 (n = 49): intermittent levels >20 μg/min but not meeting microalbuminuria criteria. Group 3 (n = 14): PMA during follow-up but normoalbuminuria at study exit. Group 4 (n = 8): microalbuminuria at study exit. Group 4 (497 ± 95 nm, P < 0.01) and group 3 (464 ± 113 nm, P = 0.03) patients had greater baseline glomerular basement membrane (GBM) width versus group 1 (418 ± 67 nm). Baseline GFR in group 4 (163 ± 37 ml · min−1 · 1.73 m−2) was higher than group 1 (143 ± 28 ml · min−1 · 1.73 m−2, P = 0.04). A1C was higher in group 2 (9.0 ± 1.2%) than group 1 (8.4 ± 1.1%, P = 0.008). Thus, greater increases in GBM width and GFR were predictors of PMA. Since 64% of the patients that developed microalbuminuria reverted to normoalbuminuria, the risk of diabetic nephropathy as defined by current microalbuminuria criteria is unclear.
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Approximately 20% of people with diabetes progress to end-stage kidney disease without an increase in moderately increased albuminuria.
“Moreover, approximately 20% of people with diabetes progress to end-stage kidney disease without an increase in moderately increased albuminuria (488).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [488]
The introduction discusses ESRD risk and persistent microalbuminuria, while the Discussion describes kidney injury that can precede albuminuria. Neither section reports that approximately 20% of people with diabetes reach ESRD without an increase in albuminuria. Searches for that percentage and for progression to ESRD without microalbuminuria found no supporting passage. (LLM, conf=0.75)
Experimental — accuracy not yet measuredAbout 20% of people progress to end-stage kidney disease without an increase in low levels of albuminuria.
“Moreover, about 20% of people progress to end-stage kidney disease without an increase in low levels of albuminuria (341).”
From Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (2011) · cites this paper as [341]
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- Authors
- Steinke, J. M., Sinaiko, A. R., Kramer, M. S., Suissa, S., Chavers, B. M., Mauer, M., & for the International Diabetic Nephropathy Study Group
- Affiliations
- University of Minnesota (US)
- McGill University (CA)
- ORCID
- Venue
- Diabetes
- Publisher
- American Diabetes Association
- Published
- 2005-07-01
- Volume
- 54
- Issue
- 7
- Pages
- 2164-2171
- ISSN
- 0012-1797 (ISSN-L)
- 1939-327X
- OpenAlex
- W2112256909
- Semantic Scholar
- 7a78e8481111649045e56ab130bb8182b6d769ac
- Cited by
- 190
- References
- 56
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2023: 5 · 2022: 4 · 2021: 6 · 2020: 4 · 2019: 4 · 2018: 9 · 2017: 7 · 2016: 13 · 2015: 7 · 2014: 15 · 2013: 13 · 2012: 9
- FWCI
- 9.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (RR00400)
- Canadian Institutes of Health Research
- National Center for Research Resources (M01RR000400, M01-RR00400)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Nephrology › Renal Diseases and Glomerulopathies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 1 diabetes, diabetic nephropathy, urinary albumin excretion rate, microalbuminuria, normoalbuminuria, glomerular filtration rate, HbA1c, glycemic control, youth with diabetes, natural history research, albuminuria regression, blood pressure, renal function, renal structure
- MeSH terms
- Adolescent, Albuminuria, Blood Pressure, Diabetes Mellitus, Type 1, Diabetic Nephropathies, Female, Follow-Up Studies, Glomerular Filtration Rate, Humans, Kidney, Male, Reference Values, Time Factors, Cohort Studies, Age of Onset, Disease Progression
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