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Query: UMLS:C0011881 (diabetic nephropathy)
 10,836 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The 24-h urine excretion and renal clearance of albumin, alpha I-acid glycoprotein, transferrin, IgG, IgA and haptoglobin were studied in 30 albustix-negative diabetics with no clinical data for diabetic nephropathy aiming at the precise characterization of proteinuria in patients with diabetes mellitus. The diabetic patients were divided into two groups - 15 patients with newly diagnosed diabetes and 15 - with a longer duration of diabetes. Thirteen healthy subjects, at the same mean age, served as a control group. The results reveal increase of the clearances and 24-h excretion of the proteins studied in the patients with diabetes mellitus, in those with a short duration of the disease including, with authentic difference for albumin, transferrin, IgG and haptoglobin among the patients with a longer duration of the disease and the healthy controls and authentic difference for albumin between those with the newly diagnosed diabetes and the healthy control. The possible prognostic significance of the indices studied is discussed as well as their importance for the early diagnosis of diabetic nephropathy.
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PMID:[Urinary excretion and renal clearance of several specific plasma proteins in diabetics]. 361 8

We prospectively investigated the evolution of proteinuria in 52 type I diabetics over 7.8 +/- 0.3 (mean +/- SE) yr and in 61 type II diabetics over 6.4 +/- 0.3 yr. Measurements of renal protein clearance were performed serially, and the time course of proteinuria was classified in each subject based on a threshold albumin clearance of 11 nl/s, equivalent to a urinary albumin excretion rate of 30 micrograms/min. The classification based on this threshold yielded four distinct patterns of albuminuria: minimal, intermittent, progressing, and established. These patterns occurred in both type I and type II diabetics independently of the duration of follow-up. This study has identified a pattern of intermittent microalbuminuria that is also associated with transient elevations of transferrin and IgG clearances. The relationship of clinical and biochemical parameters to proteinuria patterns was evaluated. No relationship was detected between proteinuria patterns and glycemic control in either type I or type II diabetics. In type I but not type II diabetics, established proteinuria was associated with higher systolic blood pressure and decreased creatinine clearance. The phase of intermittent proteinuria detected in this study may represent a reversible stage in the development of diabetic nephropathy, but the factors that trigger the transition to progressing proteinuria remain obscure.
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PMID:Spectrum of proteinuria in type I and type II diabetes. 362 99

The urinary excretion of beta2-microglobulin, albumin, kappa light chains, transferrin, and IgG as well as their concentration ratios were assessed in 27 nondiabetic patients with proteinuria and in 72 IDDM patients, 41 with proliferative retinopathy (PR) and 31 without retinopathy, matched for age, duration of diabetes, and treatment. The mean excretions of albumin, transferrin, and IgG were similar in patients with nondiabetic proteinuria and in IDDM patients with PR and were significantly higher than in IDDM patients without retinopathy. Despite similar albumin excretion, the amount of excreted kappa light chains was significantly higher in IDDM patients than in patients with nondiabetic proteinuria, resulting in an elevated kappa chain/albumin ratio. Furthermore, diabetic subjects without microalbuminuria showed increased kappa chain/albumin ratio, indicating that increased urinary excretion of kappa chains may be an early sign of diabetic nephropathy. Determination of kappa light chain excretion may have clinical implications in the differentiation between proteinuria of diabetic and nondiabetic origin. The ratio kappa chain/albumin was independent of the excretion of beta2-microglobulin in patients with PR, suggesting that the reduced ability to reabsorb immunoglobulin light chains may occur earlier than that of beta2-microglobulin in the development of tubular dysfunction in insulin-dependent diabetes mellitus.
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PMID:Urinary excretion of plasma proteins in diabetic subjects. Increased excretion of kappa light chains in diabetic patients with and without proliferative retinopathy. 392 92

Nephropathy continues to be the most serious complication in type I-diabetics. When we started chronic hemodialysis in these patients 15 years ago survival figures were poor. Later on the survival rate for diabetics undergoing hemodialysis has improved progressively. The aim of this report was to present our own experience in hemodialysis treatment of insulin-dependent diabetics. The cumulative survival rate of 46 insulin-dependent diabetics undergoing hemodialysis has increased progressively and now amounts to 70% after one year, and 50% after two years of treatment. At the same time we could attain a certain improvement of metabolic control. Nutrition has also been improved, as indicated by increased transferrin (p less than 0.05) and stable serum protein levels. Systolic blood pressure control became better (p less than 0.05) but, a fluid overload was still present. Here, further improvements are necessary to increase the survival rate. Therefore, the survival of diabetic patients with hemodialysis may be approaching that of non-diabetics. In some patients retinopathy was improved after one year of treatment. Despite a better prognosis for survival in diabetics treated by chronic hemodialysis we suggest that the successful renal transplantation should be the treatment of choice in patients suffering from diabetic nephropathy. In general, hemodialysis and renal transplantation should be started earlier than hitherto, i.e. already at creatinine levels of about 600 mumol/l, and at urea levels of 30 mmol/l. Strict metabolic and blood pressure control, as well as early laser coagulation therapy of retinopathy should be instituted for patients with creatine levels above 200 mumol/l, in close cooperation of a diabetologist, nephrologist, and ophthalmologist. This will be our future therapeutic strategy for these patients.
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PMID:Clinical course in insulin-dependent diabetics undergoing hemodialysis. 398 29

To investigate the clinical significance of the urinary glycosaminoglycans excretion rate (GER) in patients with incipient diabetic nephropathy. GER was measured by the dye-binding method (Whiteman, 1972) in nocturnal urines of 30 normoalbuminuric (urinary albumin albumin excretion rate (AER) < 10 micrograms/min) and 10 microalbuminuric (10 < or = AER < 200 micrograms/min) diabetics without hypertension and 24 healthy control subjects. The mean GER in microalbuminuric diabetics was 56.5 +/- 15.0 micrograms/min and was significantly higher than that in the healthy controls (41.1 +/- 12.9 micrograms/min, p < 0.01). There was no significant difference in GER between normoalbuminuric diabetics and the healthy controls (50.2 +/- 36.3 micrograms/min, p < 0.1). GER correlated positively with HbA1c levels in the diabetics (r = 0.451, p < 0.01). In diabetics with good glycemic control (HbA1c, < 8.0%), GER positively correlated with urinary transferrin and albumin excretion rates (r = 0.593, 0.584, both p < 0.01), whereas it did not correlate significantly with N-acetyl-beta-D-glucosaminidase excretion rate (NAGER). In diabetics with poor glycemic control (HbA1c > or = 8.0%), GER correlated positively with NAGER (r = 0.626, p < 0.01), whereas it did not correlate significantly with urinary transferrin and AER. These results indicate that GER may be affected by glycemic control and is associated with the severity of the glomerular basement membrane lesion in well-controlled diabetics and with the severity of the tubulointerstitial lesion in poorly controlled diabetics. The measurement of GER is useful for determining the pathophysiological state in incipient diabetic nephropathy.
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PMID:[Urinary glycosaminoglycans in patients with incipient diabetic nephropathy]. 769 49

Microalbuminuria, transferrin and IgG were determined in the urine of diabetic patients with normal renal function. Microalbuminuria was assayed by the immunoturbidity method, transferrin by the latex agglutination method and IgG by the ELISA method using biotin labelled IgG.HRP labelled protein G. The correlation between microalbuminuria and urinary transferrin concentrations was high (r = 0.902). However, a low titer of transferrinuria was observed, (25.5%) among the patients with microalbuminuria; a wider distribution of transferrinuria was noted than microalbuminuria. Determination of transferrinuria did not appear to be superior to the determination of microalbuminuria in early diabetic nephropathy. The urinary IgG levels assayed by ELISA using biotin labelled IgG.HRP labelled protein G method were distributed from zero to 5 mg/g Cr in the patients with normoalbuminuria. The reference intervals of the urinary IgG concentration should be settled below 5 mg/g Cr. In the patients with microalbuminuria, the concentration of urinary IgG showed a wide variation and no correlation between concentrations of microalbuminuria and urinary IgG was noted (r = 0.02). Determination of urinary IgG is not useful as an early diagnostic procedure for diabetic nephropathy.
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PMID:[Determinations of microproteinuria in early diabetic nephropathy]. 778 62

The clinical diagnosis of diabetes is often prompted by symptoms such as increased thirst and urine volume, and weight loss. High levels of glucosuria are usually present. A single blood glucose estimation of diagnostic value indicated > or = 200 mg/dl at random, or > or = 140 mg/dl at fasting in specimens of venous plasma. Only if blood glucose values lie in the uncertain range (i.e., between the level that establish or exclude diabetes) need an oral glucose tolerance test (OGTT) be considered in order to establish the diagnosis status. Diagnostic interpretation of the 75 g OGTT responses is performed by the criteria of the expert committee of the Japan Diabetic Society. Glycated hemoglobin (HbA1c, HbA1) is widely used as a cumulative estimate of the mean blood glucose concentration over the preceding one approximately two months. Reference ranges of HbA1c are 4 approximately 6%. Labile glycohemoglobin often influences the estimate. Fructosamine and glycated albumin are also used as means of evaluating the degree of control. These data reveal the mean blood glucose concentration over the preceding 2 weeks. 1.5-Anhydroglucitol in blood is measured as a means of diagnosis and control evaluation of diabetes. Microalbuminuria is widely measured for early detection of diabetic nephropathy. Recently other microproteinuria such as urinary transferrin and IgG are assayed for the same purpose. There are highly significant correlations between microalbuminuria and urinary transferrin or IgG.
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PMID:[Clinical laboratory tests in diabetes mellitus]. 793 14

Iron accumulates within proximal tubular lysosomes in several models of renal disease and may play a role in the progression of proteinuric chronic renal disease by the generation of reactive oxygen species. In this study, tubular iron was examined at an ultrastructural level by energy dispersive x-ray spectrometry in streptozotocin (STZ) and BB diabetic rats, and in humans with diabetic nephropathy, and compared to their respective nondiabetic controls. Substantial amounts of iron accumulated in the secondary lysosomes of proximal tubules in STZ diabetic rats (4.16 +/- 0.47 iron-containing lysosomes/microns 2 x 10(-3) tubular area vs. 0.90 +/- 0.29 in controls, p < 0.001). Proximal tubular iron was related independently with urinary protein and transferrin excretion, suggesting increased cellular uptake of iron from the tubular fluid. Lysosomal iron accumulation was also associated with tubular damage (r = 0.55, p < 0.001). Minimal amounts of tubular iron were observed in BB diabetic and nondiabetic littermates. In humans with diabetic nephropathy, increased proximal tubular lysosomal iron concentration (35.6 +/- 13.0 mg% Fe vs. 9.5 +/- 2.7, p < 0.05) and numbers of iron-containing lysosomes were observed compared to nondiabetic controls, and the latter correlated with elevation of serum creatinine (r = 0.94, p = 0.016). These results suggest that filtered iron enters proximal tubular lysosomes across the brush-border membrane and are consistent with a role for iron in causing the tubular damage of diabetic nephropathy.
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PMID:Lysosomal iron accumulation in diabetic nephropathy. 805 20

We evaluated the diagnostic utility of urinary transferrin (Tf) in patients with diabetic nephropathy by comparing the diagnostic findings with those of clinical stage and renal biopsy specimens. According to the rate of urinary albumin excretion, a total of 60 patients with non-insulin-dependent diabetes mellitus were separated into normoalbuminuria (< 28.8 mg/day), microalbuminuria (28.8 approximately 288 mg/day), and overt proteinuria (> 288 mg/day). They were also divided into 5 groups, D0, DI, DII, DIII and DIV according to the severity of glomerular diffuse lesions using Gellman's criteria. Thirty-eight non-diabetic volunteers were used as controls. Using 24-hour urine specimens, Tf was measured by latex-immuno-turbidimetry. Urinary concentrations of albumin, alpha 1-microglobulin, beta 2-microglobulin and N-acetyl-beta-D-glucosaminidase (NAG) were also evaluated. Urinary Tf was significantly increased in the diabetic patients relative to the non-diabetic controls. The incidence of microtransferrinuria (440 approximately 4,400 micrograms/day) was 33.3% in normoalbuminuria, 63.2% in microalbuminuria, and 18.2% in overt proteinuria. The incidence of overt transferrinuria (> 4,400 micrograms/day) was 0%, 36.8% and 81.8%, respectively. Among the diabetic patients, urinary Tf showed a significant increase with respect to the progress of glomerular diffuse lesions. The glomerular diffuse lesions of 10 normoalbuminuric cases with microtransferrinuria were graded as DI in 8 cases, DII in 1 case, and DIII in 1 case. There was a significant correlation between the urinary excretion of Tf and that of albumin, alpha 1-microglobulin or NAG. The findings indicate that urinary Tf may be useful in detecting diabetic nephropathy at an early stage.
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PMID:Diagnostic significance of urinary transferrin in diabetic nephropathy. 858 2

It is well established that the detection of microalbuminuria in a patient with diabetes mellitus indicates the presence of glomerular involvement in early renal damage. Recent studies have demonstrated that there is also a tubular component to renal complications of diabetes, as shown by the detection of renal tubular proteins and enzymes in the urine. In fact, tubular involvement may precede glomerular involvement, as several of these tubular proteins and enzymes are detectable even before the appearance of microalbuminuria. This review looks at the studies reported so far on serum and urinary markers of diabetic nephropathy, both glomerular and tubular, and their roles in the early detection of renal damage. The advantages and disadvantages of some of these markers are also discussed. The markers reviewed include (1) glomerular--transferrin, fibronectin, and other components of glomerular extracellular matrix, and (2) tubular--low molecular weight proteins (beta 2 microglobulin, retinol binding protein, alpha 1 microglobulin, urine protein 1), other proteins such as Tamm-Horsfall protein, beta 2 glycoprotein-1, urinary enzymes (N-acetyl-beta-D-glucosaminidase, cholinesterase, gamma glutamyltranspeptidase, alanine aminopeptidase), and tubular brush-border antigen.
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PMID:Markers of diabetic nephropathy. 944 15


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