High risk factors for elevated excretion of albumin in diabetic subjects.

ABSTRACT

Background: Microalbuminuria refers to the excretion of albumin in the urine at a rate that exceeds normal limits but is less than the detection level for traditional dipstick methods and is considered as a marker of diabetic nephropathy. Aims: To establish the prevalence of elevated urinary albumin levels (microalbuminuria) in a sequential sample of diabetic patients and to determine its relationship with known and putative risk factors, to ascertain relationship of serum angiotensin converting enzyme (ACE) activity with diabetic incipient nephropathy. Study design: This cross-sectional analytical study included 100 control and 325 diabetic patients (180 type 2 and 145 type 1 diabetic patients) subjects attending outpatient department of the hospital. Patients having clinical albuminuria and with other causes of proteinuria were excluded. Result: Microalbuminuria was observed in 34.48% in patients with type 1 and 28.33% in patients with type 2 diabetes mellitus respectively. Having the condition was significantly associated with advanced age, poor glycaemic control, dyslipidemia (with respect to total cholesterol, triglycerides and LDL-C), smoking, body mass index and coexisting hypertension. The duration of diabetes was a significant correlate in type 1 DM subjects only. No significant association with gender, HDL-C levels, age at onset of DM, mode of treatment, socio-economic status and other lifestyle variations was found. All clinical and biochemical parameters in patient with microalbuminuria was more adversely affected than patients with normoalbuminuria. Serum angiotensin converting enzyme (ACE) levels were significantly elevated (P<0.001) in both of the diabetic groups, moreover, its levels were higher in subjects with microalbuminuria than in those without this complication (P<0.05). Conclusions: Microalbuminuria in diabetes, which represents an earlier phase in the development of clinical nephropathy, is associated with many potentially modifiable risk factors. In estimating diabetic nephropathy risk, AER is most important and should be done frequently but there are gains to be made in predictive precision by considering family history, smoking habits, glycemia, B.P.,BMI lipid levels and ACE activity. Early screening for incipient diabetic nephropathy and aggressive management of these risk factors is important in optimising the renal outcome of patients with diabetes mellitus.