Type 2 Diabetes: Absence of Proteinuria Does Not Preclude Loss of Renal Function Nonalbuminuric Renal Insufficiency in Type 2 Diabetes. Diabetes Care 27: 195a€“200, 2004

摘要

Renal failure in type 2 diabetes is truly a medical catastrophe of worldwide dimension (1): In all countries of the western world, diabetes, mostly type 2, has become the most frequent comorbid condition in patients admitted for renal replacement therapy. It had long been recognized that the classical features of diabetic nephropathy, so well documented in type 1 diabetes (2,3), are not present in patients with type 2 diabetes and impaired renal function in an equally uniform fashion. In the third NHANES survey, Kramer et al. (4) noted that retinopathy and albuminuria (spot urine albumin/creatinine ratio) were absent in 30% of elderly type 2 diabetic patients with eGFR 60 ml/min per 1.73 m2 (2) (Modification of Diet in Renal Disease [MDRD] formula). In several independent local surveys we found that 15 to 20% of type 2 diabetic patients reaching end-stage renal failure lacked major proteinuria and had shrunken kidneys, raising the unproven assumption of ischemic nephropathy (5). It is well known that in earlier stages of renal disease the renal histology is much less uniform in type 2 than in type 1 diabetes, with a high frequency of atypical patterns including tubulo-interstitial lesions, advanced glomerular hyalinosis, or global sclerosis (6,7).