Microalbuminuria Does Not Have
to Lead To Nephropathy
Elevated urinary albumin excretion does
not imply inexorably progressive nephropathy,
say investigators.
Researchers with the Joslin Study of the Natural
History of Microalbuminuria in Boston, Massachusetts,
United States, report that modification of factors
that lead to elevated urinary excretion can reduce
those levels back to normal.
Lead investigator Dr. Bruce A. Perkins of the
Joslin Diabetes Center and colleagues studied
386 patients with type 1 diabetes and persistent
microalbuminuria with urinary albumin excretion
rates ranging from 30 micrograms/min to 299 micrograms/min
over a 6-year period. Excretion rates were grouped
into 2-year intervals during follow-up.
Regression of microalbuminuria occurred frequently
during the study period, with a 6-year cumulative
incidence of 58%. Only 19% went on to develop
overt proteinuria.
Regression of microalbuminuria was associated
with glycosylated haemoglobin levels below 8%,
systolic blood pressure below 115 mmHg, cholesterol
levels below 198 mg/dL and triglyceride levels
below 145 mg/dL.
Dr. Perkins notes that "our study results
indicate that microalbuminuria is more likely
to subside to normal levels than to progress to
overt proteinuria" with modification of risk
factors.
He adds that "although our findings support
a new model of early diabetic nephropathy, the
contributing variables are not known with precision.
Clinical trials that assess the optimal target
level of albumin excretion - in terms of the regression
of microalbuminuria - as well as the optimal levels
of other factors are warranted."
N Engl J Med 2003;348:23:2285-2293.
"Regression of Microalbuminuria in Type 1
Diabetes"
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FACT: A study in the current issue of
The Journal of the American Medical Association
finds that almost six in 10 Americans who suffer
depression seek treatment in a given year. A decade
ago, the figure was one in three. But the researchers
found that only about 40 percent of patients received
what standard guidelines consider "minimally
adequate medical treatment." Those criteria
call for a month of antidepressants monitored
in four office visits or eight half-hour counseling
sessions.
