Tubular dysfunction and non-albuminuric renal disease in subjects with type 2 diabetes mellitus

Introduction. Micro-albuminuria is considered an early marker of glomerular injury in patients with diabetes but it has yet to be determined whether testing for markers of tubular injury can also identify people who are at risk of progressive renal disease. Objective. To evaluate markers of tubular injury and renal characteristics in a sample of community treated type 2 diabetic subjects. Material and methods. We carry-out an assessment of a group of community diabetic patients, anthropometric measures, creatinine clearance, HbA1c, lipid profile, the mean fast serum glucose levels, albuminuria and alpha 1-microglobulin (alpha 1M) urine excretion were evaluated. Results. From 95 included patients, 45.2% had alpha 1M urinary excretion >= 10 mu g/gCr, 23.1% micro-albuminuria, 9.6% macro-albuminuria and 27.2% had a GFR < 60 mL/min. The most important risk factor associated with a1M excretion was fasting glucose level (OR 4.3, 95IC 1.7-11.1 p = 0.001); HbA1c >= 8% and age were the most important risk factors associated with GFR <= 60 mL/min. Most of patients had uncontrolled glucose levels and 45.1% patients with albuminuria were not receiving any drug with anti-proteinuric effects. Conclusions. Fasting glucose levels was the most important risk factor associated with tubular dysfunction; non-albuminuric presentation of CKD defined as GFR < 60 mL/min was frequent in our population, so is necessary to implement different strategies for surveillance in patients with type 2 diabetes aiming to delay progression to CKD.