Original Article

Progression of borderline increases in albuminuria in adolescents with insulin-dependent diabetes mellitus

  1. J.J. Couper1,*,
  2. C.F. Clarke2,
  3. G.C. Byrne3,
  4. T.W. Jones3,
  5. K.C. Donaghue4,
  6. J. Nairn1,
  7. D. Boyce5,
  8. M. Russell3,
  9. M. Stephens4,
  10. J. Raymond6,
  11. D.J. Bates7,
  12. K. McCaul8

Article first published online: 19 JUL 2004

DOI: 10.1002/(SICI)1096-9136(199709)14:9<766::AID-DIA467>3.0.CO;2-X

Issue

Diabetic Medicine

Diabetic Medicine

Volume 14, Issue 9, pages 766–771, September 1997

Additional Information

How to Cite

Couper, J., Clarke, C., Byrne, G., Jones, T., Donaghue, K., Nairn, J., Boyce, D., Russell, M., Stephens, M., Raymond, J., Bates, D. and McCaul, K. (1997), Progression of borderline increases in albuminuria in adolescents with insulin-dependent diabetes mellitus. Diabetic Medicine, 14: 766–771. doi: 10.1002/(SICI)1096-9136(199709)14:9<766::AID-DIA467>3.0.CO;2-X

Author Information

  1. 1

    Department of Endocrinology, Women’s and Children’s Hospital, Adelaide, Australia

  2. 2

    Department of Paediatrics, Monash Medical Centre, Melbourne, Australia

  3. 3

    Department of Endocrinology, Princess Margaret Hospital for Children, Perth, Australia

  4. 4

    Ray Williams Institute of Endocrinology, Royal Alexandra Hospital for Children, Sydney, Australia

  5. 5

    Department of Endocrinology, Royal Children’s Hospital, Melbourne, Australia

  6. 6

    Department of Nutrition and Dietetics, Women’s and Children’s Hospital, Adelaide, Australia

  7. 7

    Department of Paediatrics, University of Adelaide, Australia

  8. 8

    Epidemiology Unit, South Australian Health Commion, Adelaide, Australia

*Department of Endocrinology, Women’s and Children’s Hospital, North Adelaide, 5006, Australia

Publication History

  1. Issue published online: 19 JUL 2004
  2. Article first published online: 19 JUL 2004
  3. Manuscript Accepted: 8 APR 1997
  4. Manuscript Received: 14 JAN 1997

Funded by

  • Juvenile Diabetes Foundation Australia

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Keywords:

  • insulin dependent diabetes mellitus;
  • adolescents;
  • microalbuminura;
  • diabetic nephropathy

Abstract

We aimed to determine the natural history of borderline increases in albuminuria in adolescents with insulin-dependent (Type 1) diabetes mellitus (IDDM) and factors which are associated with progression to persistent microalbuminura. Fifty-five normotensive adolescents with IDDM and intermittent microalbuminura (overnight albumin excretion ratte of 20–200 μg min−1 on one of three consecutive timed collections, n  = 29) or borderline albuminura (mean overnight albumin excretion rate of 7.2–20 μg min−1 on one of three consecutive timed collections, n  = 30) were followed prospectively at 3 monthly intervals. The endpoint was persistent microalbuminuria defined as a minimum of three of four consecutive overnight albumin excretion rates of greater than 20 μg min−1 . One hundred and forty-two adolescents with IDDM and normoalbuminura were also followed prospectively. Fifteen of the 59 patients (25.4 %) with intermittent (9/29) or borderline (6/30) albuminura progressed to persistent microalbuminura (progressors) over 28 (15–50) months [median (range)] in comparison with two of the 142 patients with normoalbuminuria at entry (relative risk =12.6; p  =0.001). Progressors to persistent microalbuminura were pubertal and had higher systolic (p  = 0.02) and diastolic (p  = 0.02) blood pressure, and HbAlc (p  = 0.004) than non-progressors. All patients remained normotensive. Glomerular filtration rate, apolipoproteins, dietary phosphorus, protein and sodium intakes, and prevalence of smoking did not differ between progressors and non-progressors. Total renin was higher in the diabetic patients without a difference between progressors and non-progressors. In conclusion there is a relatively high rate of progression to persistent microalbuminuria in pubertal adolescents with borderline increases in albuminura and duration greater than 3 years. These patients require attention to minimize associated factors of poor metabolic control and higher blood pressure in the development of incipient nephropathy. © 1997 John Wiley & Sons, Ltd.

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