http://kidneyfunction.org Renal Information Fri, 03 Sep 2010 23:00:00 +0000 http://wordpress.org/?v=2.9.2 en hourly 1 http://kidneyfunction.org/early-urinary-markers-of-diabetic-kidney-disease-a-nested-case-control-study-from-the-diabetes-control-and-complications-trial-dcct-corrected-proof/ http://kidneyfunction.org/early-urinary-markers-of-diabetic-kidney-disease-a-nested-case-control-study-from-the-diabetes-control-and-complications-trial-dcct-corrected-proof/#comments Mon, 08 Feb 2010 10:00:00 +0000 Elizabeth F.O. Kern, Penny Erhard, Wanjie Sun, Saul Genuth, Miriam F. Weiss 10.1053/j.ajkd.2009.11.009 40 but ≤ 300 mg/d) or macroalbuminuria (AER > 300 mg/d).Measurements: Stored urine samples from DCCT entry and 1-9 years later when macro- or microalbuminuria occurred were measured for the lysosomal enzyme NAG and the AGE pentosidine and AGE fluorescence. AER and adjustor variables were obtained from the DCCT.Results: Submicroalbuminuric AER levels at baseline independently predicted microalbuminuria (adjusted OR, 1.83; P < 0.001) and macroalbuminuria (adjusted OR, 1.82; P < 0.001). Baseline NAG excretion independently predicted macroalbuminuria (adjusted OR, 2.26; P < 0.001) and microalbuminuria (adjusted OR, 1.86; P < 0.001). Baseline pentosidine excretion predicted macroalbuminuria (adjusted OR, 6.89; P = 0.002). Baseline AGE fluorescence predicted microalbuminuria (adjusted OR, 1.68; P = 0.02). However, adjusted for NAG excretion, pentosidine excretion and AGE fluorescence lost the predictive association with macroalbuminuria and microalbuminuria, respectively.Limitations: Use of angiotensin-converting enzyme inhibitors was not directly ascertained, although their use was proscribed during the DCCT.Conclusions: Early in type 1 diabetes, repeated measurements of AER and urinary NAG excretion may identify individuals susceptible to future diabetic nephropathy. Combining the 2 markers may yield a better predictive model than either one alone. Renal tubule stress may be more severe, reflecting abnormal renal tubule processing of AGE-modified proteins, in individuals susceptible to diabetic nephropathy.]]> http://kidneyfunction.org/early-urinary-markers-of-diabetic-kidney-disease-a-nested-case-control-study-from-the-diabetes-control-and-complications-trial-dcct-corrected-proof/feed/ 0