Clinical assessment and prognosis of complications of diabetes

The development of persistent proteinuria (>0.5 g protein/24 h or >300 mg albumin/24 h) in insulin-dependent diabetic patients (IDD) indicates the presence of malignant angiopathy. At the onset of persistent proteinuria, most patients feel absolutely healthy. The glomerular filtration rate (GFR) and blood pressure (BP) are in the normal range although significantly reduced and increased, respectively, compared with IDD patients with normal urinary albumin excretion (UalbV). Therefore it seems that the appearance of persistent proteinuria is an early event in the course of malignant angiopathy. However, attempts to prevent the further decline of GFR and the further increase of BP and UalbV by antihypertensive treatment or strict metabolic control have until now been unsuccessful, although antihypertensive treatment can reduce the decline rate of GFR. Consequently, research has been directed toward possible predictors of persistent proteinuria.