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Diabetic kidney disease with and without albuminuria

MacIsaac, Richard J; Jerums, George

Current Opinion in Nephrology and Hypertension: May 2011 - Volume 20 - Issue 3 - p 246–257
doi: 10.1097/MNH.0b013e3283456546
Epidemiology and prevention: Edited by Chi-yuan Hsu

Purpose of review Historically, for people at risk of developing diabetic chronic kidney disease (CKD), an initial increase in albumin excretion rate (AER) has been linked to a subsequent decline in glomerular filtration rate (GFR). We review recent findings that suggest that in some people with diabetic CKD there is an uncoupling of progressive increases in AER and declining GFR.

Recent findings Approximately 20% of people with type 2 diabetes develop at least stage 3 CKD, defined as an estimated GFR (eGFR) less than 60 ml/min/1.73 m2, after accounting for the use of renin–angiotensin system blockers, while remaining normoalbuminuric. A recent analysis from the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications study has shown that 24% of people with type 1 diabetes reached an eGFR threshold of less than 60 ml/min/1.73 m2 that was not associated with a rise in albuminuria to the microalbuminuria or macroalbuminuria range. This discordance between changes in GFR and AER has resulted in a search for new markers that identify people with diabetes who are at risk of declining GFR independent of progressive increases in AER.

Summary The conventional paradigm of kidney disease in people with diabetes has been challenged. Changes in AER and GFR are being increasingly recognized as complementary rather than obligatory manifestations of diabetic CKD.

Endocrine Centre, Austin Health and University of Melbourne, Heidelberg West, Victoria, Australia

Correspondence to Associate Professor Richard J. MacIsaac, Endocrine Centre, Austin Health, Heidelberg Repatriation Hospital, PO Box 5444, Level 2, Centaur Building, 300 Waterdale Rd, Heidelberg West, VIC 3081, Australia Tel: +613 9496 5489; fax: +613 9496 3365; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.