RESUMEN
Micro-albuminuria is an indicator of early diabetic nephropathy [DN]. The trends towards increased end stage renal disease [ESRD] secondary to DN are expected to contiue in developing countries. An understanding of the risk factors, which lead to the development of micro-albuminuria in non-insulin dependent diabetes mellitus [NIDDM], is required to develop strategies for primary prevention of DN. A case-control design was used to determine the risk factors of early DN in 184 patients with NLDDM [48 with micro-albuminuria and 136 with normo-albuminuria]. We defined micro-albuminuria where the ratio of urine albumin in micrograms [mcg] urine creatinine in milligrams [mg] was in the range of 17-299 for males and 25-299 for females. The glycosylated hemoglobin [HbAlc] of >/= 8.1%. was used to define the poor glycemic control. Patients were examined for retinopathy, peripheral neuropathy, coronary artery disease [CAD] and peripheral vascular disease [PVD]. We measured fasting serum triglyceride, cholesterol, low-density lipoprotein [LDL], high-density lipoprotein [HDL], lipoprotein [a] [Lp[a]], C-peptide of insulin, transforming growth factor beta [TGF beta] and e-selectin. HbAlc, duration of diabetes mellitus, systolic blood pressure [SBP], diastolic blood pressure [DBP] and serum C-peptide of insulin, triglyceride, LDL and Lp[a] were positively correlated with micro-albuminuria, while HDL was inversely correlated with it. The TGF beta and e-selectin did not significantly correlated with micro-albuminuria [P>0,05]. After adjustments for the effects of covariates with logistic regression [LR] analysis, the odds ratio [OR] and 95% confidence interval [CI] of micro-albuminuria for the potential risk factors were estimated, LR revealed a significant association between micro-albuminuria and male gender [OR = 5.1], poor glycemic control [OR = 4.7], young age at onset of diabetes [OR = 4.1], dyslipidemia [OR = 3.8], hypertension [OR = 3.1], and the longer duration of diabetes mellitus [OR=2.6]. Male gender, poor glycemic control, young age at onset of diabetes, long duration of diabetes, hypertension and disturbed lipid profile especially triglyceride, LDL and Lp[a] are significant risk factors for development of DN. The possible mediators of progression of nephropathy [serum TGF beta, e-selectin and insulin] are not found to be significant markers of micro-albuminuria stage of DN