The role of ‘‘Borderline Albuminuria`` in the evolution of initial diabetic nephropath

In the last few years, all scientific studies and researchers are focused on detecting the earlier manifestations of chronic diseases` complications. In diabetics with `borderline albuminuria` (BAU), the protein excretion is slightly above the upper limits of normal albuminuria. They are often neglected by general practitioners and specialists, although they represent an important group for studying the initial renal injuries and are potentially suit able for angiotensin-converting enzyme inhibitors` (ACEIs) treatment.Aim of the study: an assessment of the natural evolution of BAU for a 10-years period concerning its role in the initial renal injuries in diabetics. Patients and methods: In a long prospective study, we examined regularly 109 type 1 diabetics with normoalbuminuria at the beginning. The albumin excretion was measured by immuno-turbidometry (Cobas mira plus) with Randox tests in 6-months intervals together with HbA1c, creatinine clearance and blood pressure. Results: In 21,1% of diabetics we found `borderline albuminuria` and 21,74% of them after the 5th year developed microalbuminuria with cumulative index of 0,91% annually. The patients` risk factors with significant importance were: bad metabolic control, `high-normal` hypertension and familiar predisposition to hypertension. Conclusions: We found that the borderline albuminuria plays an important role in the initial diabetic nephropathy, because more than 1/3 of the progressive BAU patients were with DM duration less than 5 years. As the blood pressure was a significant factor for progression of borderline- to micro-AU, the prob lem is not whether to start treatment with ACEIs in such patients and when to start treatment. Our patients with borderline albuminuria were suitable for ACEIs, because they had also some significant risk factors for the progression into early diabetic nephropathy.Scripta Scientifica Medica 2007;39(2):147-15