1. US Renal Data System: USRDS 2003 Annual Data Report: Atlas
of End-Stage Renal Disease in the United States. Bethesda, MD,
National Institute of Health, National Institute of Diabetes and
Digestive and Kidney Diseases.
2. Thomas S: Diabetic nephropathy. Medicine 2010; 38:639-643
3. McCulloch DK, Bakris GL: Microalbuminuria in type 2 diabetes
mellitus. 2014. http://www.uptodate.com. Accessed 04 Jan 2014
4. Gimeno Orna JA, Boned Juliani B, Lou Arnal LM, Castro Alonso
FJ: Microalbuminuria and clinical proteinuria as the main predictive
factors of cardiovascular morbidity and mortality in patients with
type 2 diabetes. Rev Clin Esp 2003; 203: 526-531
5. Stehouwer CD, Nauta JJ, Zeldenrust GC, Hackeng WH, Donker
AJ, den Ottolander GJ: Urinary albumin excretion, cardiovascular
disease, and endothelial dysfunction in non-insulin-dependent
diabetes mellitus. Lancet 1992; 340: 319-323
6. Stehouwer CD, Fischer HR, van Kuijk AW, Polak BC, Donker AJ:
Endothelial dysfunction precedes development of microalbuminuria
in IDDM. Diabetes 1995; 44: 561-564
7. Robles NR, Joaquin Velasco J, Candido Mena C, Angulo E:
Intensive treatment of persistent microalbuminuria: Determinants
of treatment resistance. Cent Eur J Med 2013; 8: 302-309
8. Dhingra R, Gona P, Wang TJ, Fox CS, D’Agostino RB Sr, Vasan
RS: Serum gamma-glutamyl transferase and risk of heart failure
in the community. Arterioscler Thromb Vasc Biol 2010; 30:
1855-1860
9. Lee DH, Blomhoff R, Jacobs DR Jr: Is serum gamma
glutamyltransferase a marker of oxidative stress? Free Radic Res
2004; 38: 535-539
10. Lee DH, Jacobs DR, Gross M, Kiefe CI, Roseman J, Lewis CE,
Steffes M: γ-Glutamyltransferase is a predictor of incident diabetes
and hypertension: The Coronary Artery Risk Development in Young
Adults (CARDIA) Study. Clin Chem 2003; 49: 1358-1366
11. Wannamethee G, Ebrahim S, Shaper AG: γ-Glutamyltransferase:
Determinants and association with mortality from ischemic heart
disease and all causes. Am J Epidemiol 1995; 142: 699-708
untreated. For reasons that are not understood, the degree of
albuminuria is not necessarily related to disease progression in
patients with diabetic nephropathy (24,25). In the present study,
we found that mean eGFR values were 93 ± 29 ml/min and
73 ± 24 ml/min in patients with normoalbuminuria and those
with microalbuminuria, respectively. In both groups, eGFR
values were lower according to expected values in diabetic
nephropathy stages defined by Mogensen. This likely reflects the
situation mentioned above, in which the degree of albuminuria
is not necessarily related to disease progression in diabetic
nephropathy. On the other hand, eGFR values were significantly
lower in patients with microalbuminuria than in those with
normoalbuminuria. This finding was compatible with natural
history of type 1 diabetic nephropathy defined by Mogensen.
In addition, hypertension was frequent in microalbuminuric
group compared to normoalbuminuric group. This observation
also was compatible with the natural history of type 1 diabetic
nephropathy defined by Mogensen.
The role of renin-angiotensin system (RAS) blockade in
normotensive, normoalbuminuric diabetic patients for the
primary prevention of diabetic nephropathy is controversial.
For diabetic patients with microalbuminuria or overt diabetic
nephropathy, the optimal therapeutic approach to reduce the
rate of progression of nephropathy and to minimize the risk
for cardiovascular events involves aggressive management of
hypertension with a RAS blocker combined with management
of other risk factors including dyslipidemia (26-29). Similarly,
in the present study, RAS blockade (use of ACEI or ARB)
was frequent in microalbuminuric group compared to
normoalbuminuric group.
Table III: The associations between demographic, clinical,
and laboratory parameters and microalbuminuria (by binary
logistic regression analysis).
Parameter β P value
Age 0.007 0.815
Gender (male or female) 0.069 0.899
Duration of diabetes mellitus 0.033 0.343
Presence of hypertension (no or yes) 1.089 0.207
Use of ACEI or ARB (no or yes) 0.666 0.444
GGT status (low or high) 1.155 0.037
Presence of dyslipidemia (no or yes) 0.699 0.203
eGFR -0.053 <0.001
ACE I: Angiotensin converting enzyme inhibitor, ARB: Angiotensin
II receptor blocker, GGT : Gamma glutamyl transferase,
eGFR: Estimated glomerular filtration rate
222
Türk Nefroloji Diyaliz ve Transplantasyon Dergisi
Turkish Nephrology, Dialysis and Transplantation Journal Ünal A et al : GGT is Related to Diabetic Microalbuminuria
Turk Neph Dial Transpl 2014; 23 (3): 217-222
12. Targher G: Elevated serum gamma-glutamyltransferase activity is
associated with increased risk of mortality, incident type 2 diabetes,
cardiovascular events, chronic kidney disease and cancer-a narrative
review. Clin Chem Lab Med 2010; 48: 147-157
13. Yilmaz MI, Turgut F, Kanbay M, Saglam M, Sonmez A, Yaman H,
Demirbas S, Unal HU, Gok M, Karaman M, Ay SA, Demirkaya E,
Covic A, Carrero JJ: Serum gamma-glutamyltransferase levels are
inversely related to endothelial function in chronic kidney disease.
Int Urol Nephrol 2013; 45:1071-1078
14. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D: A
more accurate method to estimate glomerular filtration rate from
serum creatinine: A new prediction equation. Modification of Diet
in Renal Disease Study Group. Ann Intern Med 1999; 130:461-470
15. National Cholesterol Program: The Third Report of The National
Cholesterol Education Program (NCEP). Expert Panel on Detection,
Evaluation, and Treatment of High Blood Cholesterol In Adults
(Adult Treatment Panel III). JAMA 2001; 285:2486-2497
16. Scandling JD, Myers BD: Glomerular size-selectivity and
microalbuminuria in early diabetic glomerular disease. Kidney Int
1992; 41:840-846
17. Nakamura Y, Myers BD: Charge selectivity of proteinuria in
diabetic glomerulopathy. Diabetes 1988; 37:1202-1211
18. Tamsma JT, van den Born J, Bruijn JA, Assmann KJ, Weening
JJ, Berden JH, Wieslander J, Schrama E, Hermans J, Veerkamp
JH: Expression of glomerular extracellular matrix components in
human diabetic nephropathy: Decrease of heparan sulphate in the
glomerular basement membrane. Diabetologia 1994; 37:313-320
19. David K McCulloch DK, Bakris GL: Microalbuminuria in type 1
diabetes mellitus. 2014. http://www.uptodate.com. Accessed 04 Jan
2014.
20. Evans JL, Goldfine ID, Maddux BA, Grodsky GM: Oxidative stress
and stress-activated signaling pathways: A unifying hypothesis of
type 2 diabetes. Endocr Rev 2002; 23:599-622
21. Acikgoz N, Ermiş N, Yağmur J, Cansel M, Karincaoğlu Y, Ataş H,
Cuglan B, Barutcu I, Pekdemir H, Özdemir R: Elevated oxidative
stress markers and its relationship with endothelial dysfunction in
Behçet disease. Angiology 2011; 62:296-300
22. Daeppen JB, Smith TL, Schuckit MA: Influence of age and body
mass index on gamma-glutamyltransferase activity: A 15-year
follow-up evaluation in a community sample. Alcohol Clin Exp Res
1998; 22:941-944
23. Mogensen CE: How to protect the kidney in diabetic patients: With
special reference to IDDM. Diabetes 1997; 46 (Suppl 2):S104-S111
24. Perkins BA, Ficociello LH, Roshan B, Warram JH, Krolewski AS:
In patients with type 1 diabetes and new-onset microalbuminuria
the development of advanced chronic kidney disease may not
require progression to proteinuria. Kidney Int 2010; 77:57-64
25. MacIsaac RJ, Tsalamandris C, Panagiotopoulos S, Smith TJ,
McNeil KJ, Jerums G: Nonalbuminuric renal insufficiency in type 2
diabetes. Diabetes Care 2004; 27:195-200
26. Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB,
Ritz E, Atkins RC, Rohde R, Raz I; Collaborative Study Group:
Renoprotective effect of the angiotensin-receptor antagonist
irbesartan in patients with nephropathy due to type 2 diabetes. N
Engl J Med 2001; 345:851-860
27. Tong LL, Adler S: Prevention and treatment of diabetic nephropathy.
In: Floege J, Johnson RJ, Feehally J, eds. Comprehensive Clinical
Nephrology. Missouri: Elsevier Saunders, 2010; 377-384
28. Barylski M, Nikfar S, Mikhailidis DP, Toth PP, Salari P, Ray KK,
Pencina MJ, Rizzo M, Rysz J, Abdollahi M, Nicholls SJ, Banach
M; Lipid and Blood Pressure Meta-Analysis Collaboration
Group: Statins decrease all-cause mortality only in CKD patients
not requiring dialysis therapy-a meta-analysis of 11 randomized
controlled trials involving 21.295 participants. Pharmacol Res
2013; 72:35-44
29. Nikolic D, Nikfar S, Salari P, Rizzo M, Ray KK, Pencina MJ,
Mikhailidis DP, Toth PP, Nicholls SJ, Rysz J, Abdollahi M, Banach
M; Lipid and Blood Pressure Meta-Analysis Collaboration Group:
Effects of statins on lipid profile in chronic kidney disease patients:
A meta-analysis of randomized controlled trials. Curr Med Res
Opin 2013; 29:435-451
Thank you for copying data from http://www.arastirmax.com
