Microalbuminuria in non-insulin dependent diabetes mellitus: An Indonesian experience

Abstract

In both IDDM and NIDDM, microalbuminuria predicts diabetic kidney disease and increased mortality. Early detection and treatment of associated factors may reduce albuminuria and retard the progression toward chronic renal failure. With regard to microalbuminuria in NIDDM patients and its associated factors, studies have been done in Indonesia. Microalbuminuria was found in more than one third (39%) of NIDDM patients and in one quarter (24.7%) of IGT patients in the community, and in 26 to 57% of NIDDM patients in the hospital setting. Generally, NIDDM patients with microalbuminuria were non-obese. There was a higher blood pressure and more retinopathy in microalbuminuric NIDDM patients than in normoalbuminuric ones. However, the lipid profile was inconsistently worse in microalbuminuric than normoalbuminuric NIDDM patients. Tubular enzymes namely NAG (N-acetyl-β-glucosaminidase) and IAP (intestinal alkaline phosphatase) were found higher in NIDDM patients with microalbuminuria than those without microalbuminuria. These enzymes were proposed as markers of early tubular changes in NIDDM. In two interventional studies, Captopril was beneficial in reducing albuminuria and increasing HDL-cholesterol in nephropathy patients who mostly were in the incipient (microalbuminuric) stage of diabetic nephropathy.