Renal Insufficiency Without Albuminuria,
Retinopathy Common in Type 2 Diabetics
A substantial number of adults with type
2 diabetes have chronic renal insufficiency without
albuminuria or retinopathy, researchers report.
This finding has important implications for screening
for renal disease in type 2 diabetics said, Dr.
Holly J. Kramer of Loyola University Medical Center
in Maywood, Illinois.
In a cross-sectional analysis of adults aged 40
or older with type 2 diabetes in the Third National
Health and Nutrition Examination Survey, 13% had
chronic renal insufficiency, defined as a GFR
< 60 mL/min per 1.73 m of body surface area.
That translates to a population estimate of 1.1
million Americans.
Among this group of type 2 diabetics with chronic
renal insufficiency, 28% had diabetic retinopathy,
while the frequencies of microalbuminuria and
macroalbuminuria were 45% and 19%, respectively.
Dr. Kramer stated that, they noted the absence
of increased urine albumin and diabetic retinopathy
in 30% of adults with type 2 diabetes and chronic
kidney disease." The population estimate
of this group is approximately 0.3 million.
In the June 25th issue of The Journal of the American
Medical Association, Dr. Kramer's team says kidney
disease in the absence of albuminuria and retinopathy
is "likely due to renal parenchymal disease
other than classic diabetic glomerulosclerosis."
"If physicians do not estimate the individual's
glomerular filtration rate in addition to examining
urine albumin and diabetic retinopathy, approximately
one-third of type 2 diabetics with chronic kidney
disease will be missed," Dr. Kramer said.
"Unfortunately," she added, "many
physicians" are not measuring serum creatinine
levels or estimating glomerular filtration rate
in addition to monitoring albumin excretion and
funduscopic changes to screen for kidney disease
in type 2 diabetics, despite recent National Kidney
Foundation guidelines supporting this approach.
JAMA 2003;289:3273-3277
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