ALBUMIN EXCRETION RATE AND ITS RELATION TO KIDNEY-DISEASE IN NON-INSULIN-DEPENDENT DIABETES-MELLITUS

Objective. To estimate the occurrence of increased albumin excretion r ate (AER) and its significance as a marker of diabetic kidney disease in non-insulin-dependent diabetic subjects. Design. Population-based, controlled cross-sectional study. Setting. A primary health care centr e in the city of Tampere, south-west Finland. Subjects. Consecutive, r ecently diagnosed (n = 150) and long-term (n = 146) middle-aged non-in sulin-dependent diabetic subjects, Matched non-diabetic control subjec ts (n = 150). Main outcome measures. Albumin excretion rate, fractiona l AER, microalbuminuria (AER 30-300 mg 24 h(-1)), clinical nephropathy (AER exceeding 300 mg 24 h(-1)) and kidney biopsy in diabetic subject s with an AER exceeding 100 mg 24 h(-1). Results. Mean (+/-standard de viation [SD]) 24-h AER was increased in recently diagnosed diabetic su bjects, 54 (111) mg, and long-term diabetic subjects, 134 (479) mg, co mpared to non-diabetic control subjects, 16 (19) mg, The fractional AE R was 7.5 (183) x 10(-6) in recent diabetic subjects, 53.1 (306.9) x 1 0(-6) in long-term diabetic subjects and 2.8 (3.7) x 10(-6) in non-dia betic control subjects. Microalbuminuria was found in 8% of non-diabet ic subjects, in 29% of recent and in 27% of long-term diabetic subject s. The prevalence of clinical nephropathy was 7% in long-term and 4% i n recent diabetic subjects, whilst no non-diabetic subject had nephrop athy. In 12 of 16 eligible kidney biopsies, diabetic glomerulosclerosi s was found, in four subjects the finding was normal. Conclusions. The AER is clearly increased in recent non-insulin-dependent diabetic sub jects and further increased in diabetic subjects with a mean disease d uration of 10 years. An increased AER in noninsulin-dependent diabetic subjects suggests diabetic kidney disease.