Endocrine Abstracts

The aim was to analyze the efficiency of various methods of examination to update the degree of diabetic nephropathy and to determine the optimal to predict the decline in renal function in patients with diabetes mellitus type 1 (T1DM).

We examined 50 patients (17 m; 33 f; age 40.1±11.7 years; BMI 25.9±5.0 kg/m²; duration of T1DM 22.3±8.1 years; and age at T1DM onset 21.6±13.2 years) at chronic kidney disease (CKD) stages 1, 2, 3 (n=22; 18; and 10 respectively). GFR was estimated using Cockcroft–Gault (CG) and MDRD formulas. Urinary protein excretion in the morning and daily samples, urine albumin:creatinine ratio (ACR), endogenous creatinine clearance (CrCl), serum creatinine levels (sCr) were measured.

Comparative analysis of patients in the subgroups according to CKD stages revealed reliable differences in protein excretion in the morning urine sample (0.160 g/l, 95% CI 0.081–0.240, P=0.047). Assessing the level of urinary albumin excretion, ACR, the urinary protein excretion in the daily sample no differences have been received. eGFR using CG and MDRD formulas strongly correlates with endogenous CrCl based GFR (r=0.717; 0.614 respectively).

Urinary protein excretion in the morning sample correlates with GFR (r=0.393), urinary daily protein excretion (r=0.916), sCr (r=0.470), eGFR CG (r=−0.398), and CKD stage (r=0.417). At the same time the urinary daily protein excretion correlates only with sCr (r=0.527). ACR correlates with the age at T1DM onset (r=−0.334).

We can assume that urinary protein excretion in the morning sample which is rather cheap, simple and convenient for patients in compare with such reliable and accurate methods as the evaluation of daily urinary protein excretion and ACR can be an efficient method of predicting the decline in renal function in patients with T1DM at CKD stages 1–3. The obtained data confirm that the use of CG formula to estimate GFR is preferable in patients with earlier stages of CKD.