Albuminuria is a good predictive marker for the progression of CKD and cardio-vascular events in diabetic patients. However, mild reduction of eGFR does not predict the progression of CKD and cardio-vascular events in diabetic patients. Although albuminuria is a clinically good predictive marker for the prognosis of CKD or CVD, pathological changes of typical
diabetic nephropathy are occasionally detected in patients with find more normoalbuminuria. Although 30 mg/gCr is now the upper limit of normoalbuminuria, this level should be re-estimated with new evidence in future. Furthermore, albuminuria is not specific for diabetic nephropathy. More sensitive and specific markers are necessary to detect early diabetic nephropathy. Bibliography 1. Katayama S, et al. Diabetologia. 2011;54:1025–31. (Level 4) 2. Adler AI, et al. Kidney Int. 2003;63:225–32. (Level 4) 3. Agardh CD, et al. Diabetes Res click here Clin Pract. 1997;35:113–21. (Level 4) 4. Mogensen CE, et al. N Engl J Med. 1984;311:89–93. (Level 4) 5. Bruno G, et al.Diabetologia. 2007;50:941–8.
(Level 4) 6. Ninomiya T, et al. J Am Soc Nephrol. 2009;20:1813–21. (Level 4) 7. Bouchi R, et al. Hypertens Res. 2009;32:381–6. (Level 4) 8. MacIsaac RJ, et al. Diabetes Care. 2004;27:195–200. (Level 4) 9. Middleton RJ, et al. Nephrol Dial Transplant. 2006;21:88–92. (Level 4) 10. Hanai K, et al. Nephrol Dial Transplant. 2009;24:1884–8. (Level 4) 11. Caramori ML, et al. Diabetes. O-methylated flavonoid 2003;52:1036–40. (Level 4) Is tight glycemic control recommended for preventing the onset and progression of diabetic nephropathy? Chronic hyperglycemia is the main causal factor of diabetic vascular complications, including nephropathy. Previous landmark clinical studies (the DCCT and EDIC studies for type 1 diabetes, UKPDS, Kumamoto, ADVANCE,
ACCORD and the VADT study for type 2 diabetes) showed that tight glycemic control prevents the onset and progression of early nephropathy, and the target for HbA1c is <7.0 %. There are no reports of prospective studies that examined the effect of blood glucose control at the advanced stage with overt nephropathy; therefore, the effect of tight glycemic control on the suppression of diabetic nephropathy is not clear. Bibliography 1. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329:977–86. (Level 2) 2. Ohkubo Y, et al. Diabetes Res Clin Pract. 1995;28:103–17. (Level 2) 3. UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:837–53. (Level 2) 4. Ismail-Beigi F, et al. Lancet. 2010;376:419–30. (Level 2) 5. Patel A, et al. N Engl J Med. 2008;358:2560–72. (Level 2) 6. Duckworth W, et al. N Engl J Med. 2009;360:129–39. (Level 2) 7. Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (EDIC) study. JAMA. 2003;290:2159–67. (Level 4) 8. Holman RR, et al. N Engl J Med.