Skip to main content Accessibility help
×
Home
Hostname: page-component-5d6d958fb5-9cwrl Total loading time: 0.377 Render date: 2022-11-28T19:31:35.247Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "displayNetworkTab": true, "displayNetworkMapGraph": false, "useSa": true } hasContentIssue true

4 - Microalbuminuria in diabetes mellitus

Published online by Cambridge University Press:  06 July 2010

Peter H. Winocour
Affiliation:
Queen Elizabeth II Hospital, Welwyn Garden City
Sally M. Marshall
Affiliation:
University of Newcastle upon Tyne
Get access

Summary

Introduction

It has been recognised for many years that IDDM patients with persistent dip-stick positive proteinuria have a very much worse prognosis than patients who remain dip-stick negative. The relative mortality of proteinuric IDDM patients is 75–100 times that of the non-diabetic population, compared with 2–4 times for non-proteinuric patients. Cardiovascular mortality is much more common in those patients with proteinuria than in those without, up to two thirds of proteinuric patients dying of cardiovascular disease and the remainder of renal complications. Conversely, few patients surviving for longer than 40 years with insulin-dependent diabetes have dip-stick positive proteinuria. Thus, the sub-group of proteinuric IDDM patients have an exceptionally poor prognosis. Once proteinuria appears, the renal disease is irreversible, measures such as antihypertensive therapy and low protein diets reducing the rate of decline of the glomerular filtration rate rather than halting or reversing the process. There is thus a need to identify at a much earlier stage those patients who will later develop dip-stick positive proteinuria, in the hope that earlier intervention will completely halt or even reverse the renal and cardiovascular disease processes. The development of a specific and sensitive radioimmunoassay for urine albumin in 1963 opened up this prospect.

The Guy's group quickly followed this initial methodological paper with work showing that in some established IDDM patients without clinical proteinuria the albumin excretion rate was higher than in healthy non-diabetic individuals.

Type
Chapter
Information
Microalbuminuria
Biochemistry, Epidemiology and Clinical Practice
, pp. 53 - 96
Publisher: Cambridge University Press
Print publication year: 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×