Abstract
In patients with diabetes, the presence of persistent microalbuminuria is an established predictor of development of overt diabetic nephropathy, progressive renal insufficiency and increased risk of cardiovascular disease, in both type 1 and 2 diabetes [1‐4]. Approximately 30% of type 1 diabetic patients may develop diabetic nephropathy within 25 years of diabetes, although recent data suggest a declining incidence [5, 6]. In the original studies demonstrating the predictive value of microalbuminuria, up to 80% of patients with microalbuminuria progressed to overt diabetic nephropathy. Recently, it has been suggested that microalbuminuria may not be as sensitive and specific as predictor of diabetic nephropathy as originally suggested [7]. Observational studies have found regression from microalbuminuria to normoalbuminuria in a substantial fraction of patients with type 1 diabetes and microalbuminuria [8]. Furthermore, it has been suggested from uncontrolled studies of patients with long duration of diabetes that microalbuminuria is not a good predictor of progression to overt nephropathy in longstanding type 1 diabetic patients [9]. We conducted a 10-year observational follow-up study of a large cohort of type 1 diabetic patients to elucidate putative risk markers for the progression from microalbuminuria to overt diabetic nephropathy. We have previously demonstrated the presence of poor glycemic control, retinopathy, smoking, and elevated urinary albumin excretion within normal range to be predictors of development of microalbuminuria [10]. In the present study, the factors involved in progression from microalbuminuria to overt nephropathy are evaluated, as well as the predictive value of microalbuminuria in longstanding type 1 diabetes for the development of overt diabetic nephropathy. In addition, we wanted to determine the annual rate of progression in urinary albumin excretion rate in microalbuminuric patients.
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