Microalbuminuria, blood pressure, metabolic control, and renal involvement: longitudinal studies in white non-insulin-dependent diabetic patients.

Abstract

In the present paper, longitudinal studies in non-insulin-dependent diabetes mellitus (NIDDM) dealing with risk factors, especially microalbuminuria, blood pressure, and glycemic control, and the course of the kidney function are addressed. The definition of microalbuminuria, limits for abnormal albuminuria, and possible causes of microalbuminuria in NIDDM are discussed. Microalbuminuria is a major independent risk marker for early mortality, and new studies indicate that even "high normoalbuminuria" carries a risk. Furthermore, risk markers agreed on among various studies include apart from abnormal albuminuria, age and preexisting cardiovascular disease, whereas there is some inconsistency concerning glycemic control, lipoproteins, and even hypertension. People with microalbuminuria, NIDDM patients as well as nondiabetics, share an increased prevalence of atherosclerosis and its risk factors as well as an increased TER(alb). Albuminuria in NIDDM may thus have two different causes: general vascular disease and diabetic glomerulopathy. The clinical course of renal function is with large interindividual variation in both patients with or without overt proteinuria. Systolic blood pressure, glycemic control, and level of albuminuria appear to determine the deterioration in kidney function and progression of albuminuria, and to influence the overall prognosis, thus being obvious items for intervention. Long-term intervention studies demonstrating improved survival are, however, still awaited.