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Query: UMLS:C0730345 (microalbuminuria)
 4,018 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Increased urinary albumin excretion rate (AER) in the microalbuminuric phase of diabetic nephropathy has been attributed to intraglomerular hypertension. This could be caused by constriction of efferent glomerular arterioles, which carry alpha-adrenoceptors. We tested the hypothesis that insulin-dependent diabetes mellitus (IDDM) patients with microalbuminuria are hypersensitive to vasoconstriction induced by norepinephrine (NE). We studied 15 IDDM patients with microalbuminuria (AER 32-295 mg/24 h), 13 IDDM patients with normal AER (5-24 mg/24 h), and 9 nondiabetic subjects (AER 8-22 mg/24 h). All were normotensive. NE-induced vasoconstriction was measured in dorsal hand veins, which carry alpha-receptors similar to those of glomerular efferent arterioles. Vein diameter was measured with a linear displacement probe during a stepped NE infusion (1-32 ng/min) into the vein, and venoconstriction was expressed as a percentage of the maximum passively distended venous diameter. Microalbuminuric IDDM patients exhibited significantly greater vasoconstriction (P less than 0.005) at all NE infusion rates than both other groups. The NE infusion rate producing 50% of maximal venoconstriction (ED50) in the microalbuminuric IDDM group (median 1.1 ng/min, range 0.2-25.2 ng/min) was significantly less than in both the normoalbuminuric IDDM group (median 12.5 ng/min, range 4.9-40.5 ng/min, P = 0.00007) and the nondiabetic group (median 17.7 ng/min, range 5.9-42.2 ng/min, P = 0.0003). Dose-response curves and ED50 did not differ significantly between normalbuminuric IDDM and nondiabetic groups. IDDM patients with microalbuminuria are hypersensitive to NE-induced vasoconstriction.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Exaggerated sensitivity to NE-induced vasoconstriction in IDDM patients with microalbuminuria. Possible etiology and diagnostic implications. 173 11

Kidney biopsies from 10 patients with diagnosed insulin-dependent diabetes mellitus of various duration with clinical manifestations of hyperglycemia, increased rate of glomerular filtration, presence or absence of microalbuminuria, were studied morphologically. Gradual increase of kidney alterations was observed: changes of thickness and loosening of basal membrane of glomerular capillaries, its focal homogenization, partial mesangium increase due to the increase of membranous substance and decrease of cellular component. These alterations positively correlate with immunohistochemistry of renal glomeruli. Dynamics of morphological changes does not show a direct connection with the patient age and the duration of diagnosed disease but is stipulated by the presence of one or another antigen of the class II major histocompatibility complex.
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PMID:[Morphologic manifestations of the preclinical stage of diabetic nephropathy]. 174 69

In this article, we analyze the blood pressure (BP) threshold for the start of antihypertensive treatment in insulin-dependent diabetes mellitus (IDDM) patients, with particular emphasis on those with persistent microalbuminuria or proteinuria (incipient and overt nephropathy, respectively). In such individuals, there is a clear increase in the prevalence of hypertension and in actual measured BP values that is not observed in normoalbuminuric patients. In 94 young healthy adults (less than 45 yr of age), average mean +/- SD arterial pressure (MAP; diastolic + 1/3 pulse pressure) was approximately 90.0 +/- 8.1 mmHg, closely corresponding to large population studies. In microalbuminuric IDDM patients, MAP values between approximately 105 and approximately 95 mmHg have been found in different studies, and the level has progressively decreased in various studies between 1984 and 1990 with similar BP-measuring techniques. Somewhat higher values are seen in patients with proteinuria, who are also consistently characterized by reduced glomerular filtration rate (GFR). A clear correlation is found between MAP plotted against the increased rate of microalbuminuria (%/yr) in incipient nephropathy and against fall rate of GFR (ml.min-1.mo-1) in proteinuric patients. In the natural history of renal disease, different cutoff points in MAP for start of progression are observed: greater than 95 mmHg for the start of progression of microalbuminuria and greater than 105 mmHg for the decrease in GFR. During antihypertensive treatment, there is reduction or no progression in microalbuminuria with MAP of approximately 90-95 mmHg and only a limited fall in GFR with MAP of approximately 100 mmHg. However, certain antihypertensive drugs (angiotensin-converting enzyme inhibitors) may have specific renoprotective actions, reducing microalbuminuria at rather low BP levels or even independent of BP reduction. The optimal way of monitoring BP may be by 24-h ambulatory recording.
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PMID:Renal factors influencing blood pressure threshold and choice of treatment for hypertension in IDDM. 174 53

In order to obtain more information on the quality of metabolic control and presence of secondary complications in type 2 diabetic patients treated in a hospital outpatient-clinic, we studied 124 of our diabetic patients (56 males, 68 females, age 65 (SD 11) years, duration of diabetes 9, range 1-32 years). HbA1c levels were 7.9% in patients on oral hypoglycaemic agents (n = 56), and 8.2% in insulin-treated patients (n = 59). Cholesterol and triglyceride levels tended to be lower in the insulin-treated patients. The prevalence of vascular abnormalities was high: in comparison with a population of general practice patients more patients had hypertension (56% vs 38%), coronary artery disease (48% vs 40%), and cerebrovascular disease (15% vs 6%). In addition, 35% of our diabetics had signs of peripheral artery disease. Retinopathy was present in 35 patients, microalbuminuria was found in 31 patients, proteinuria in 18 patients. The presence of microalbuminuria and proteinuria was a strong indicator for cardiovascular disease, polyneuropathy and retinopathy. The use of cardiovascular medication was high: 57 patients used antihypertensive therapy, 37 used diuretics, and 26 long-acting nitrates. Only 25 patients took no medication apart from to their diabetes therapy.
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PMID:[Regulation of diabetes and late complications in the ambulatory treatment of patients with Type II diabetes mellitus]. 174 45

Pulse wave velocity (PWV) of the aorta was measured in 40 patients with diabetes mellitus, in order to study the relation between PWV and diabetic angiopathy. The PWV was significantly faster in diabetic patients on oral hypoglycemic agents than in those on diet alone or on insulin. The PWV correlated significantly and positively with age, systolic blood pressure and urinary albumin index. The PWV significantly faster in diabetics with microalbuminuria than in those without this findings. It was concluded that PWV in addition to known risk factors such as elevated blood pressure, atherogenic abnormalities of plasma lipids and lipoproteins, and elevated blood glucose, may be a reliable index of diabetic micro- and macroangiopathy.
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PMID:[The correlation between pulse wave velocity and diabetic angiopathy]. 175 29

Glomerular or tubular contribution for microalbuminuria was estimated by assessing albumin excretion rate (AER) in glomerular urine obtained by L-arginine infusion (AI) and glomerular filtration rate (GFR) in 20 non-insulin-dependent diabetes mellitus (NIDDM) patients before and after glycemic control, and in 19 age-matched controls. Glycemic control normalized AER during AI, while it decreased AER before AI, though it was still above normal. Glycemic control increased tubular reabsorption rate of albumin, but it was still less than normal. Tubular reabsorption rate of albumin declined in close relation with duration of diabetes mellitus, while AER in glomerular urine had no correlation with the duration. GFR had no correlation with AER before or during AI. In conclusion, impaired tubular reabsorption of albumin plays a key role for microalbuminuria in NIDDM.
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PMID:The etiology of microalbuminuria in early non-insulin-dependent diabetes mellitus. 177 12

Morphometric analysis of 80 renal biopsy specimens from patients with non-insulin-dependent diabetes mellitus, who had been classified into four groups by grade of proteinuria and renal function, revealed mitochondrial enlargement in the proximal tubules, with cellular hypertrophy as an initial morphologic change in the microalbuminuria. This was followed by a thickening of the proximal tubular basement membrane and an increased interstitial volume, causing persistent overt proteinuria. Glomerular nodular and sclerotic lesions and severe tubulointerstitial damage became evident in the advanced stages. As an initial cause of microalbuminuria, the mitochondrial abnormality disturbed adenosine triphosphate (ATP) metabolism in proximal tubules, reducing active transport and causing urinary excretion of low-molecular-weight protein.
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PMID:Mitochondrial derangement: possible initiator of microalbuminuria in NIDDM. 177 11

This study was undertaken to examine whether patients with non-insulin-dependent diabetes (NIDDM) are hypercalciuric and whether there is a pathophysiologic relationship between urinary calcium excretion (UCE) and the degree of diabetic nephropathy. Although UCE did not parallel the increase of urinary albumin excretion rate (AER) and the presence of hematuria was not corrected with the degree of UCE, we confirmed that 36% of diabetic patients have hypercalciuria and that the prevalence of hypercalciuria is more frequent in diabetic patients with normo- or microalbuminuria than in the controls. In 6 months, the AER of two hypercalciuric patients increased. However, the blood pressure and HbA1c of these two patients increased during the same 6 months. Therefore, it remains unclear whether hypercalciuria induced an increase in the AER of these patients.
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PMID:Hypercalciuria and hematuria in non-insulin-dependent diabetes mellitus. 177 27

Serum levels of type IV collagen (7S-IV) and laminin P1 in 185 non-insulin-dependent diabetes mellitus patients were significantly higher than those in normal subjects. Furthermore, they were significantly elevated in relation to the excretion of urinary albumin, showing their increases even at the stage of microalbuminuria, although they were not correlated with HbA1c or age in diabetic patients. Thus, the determination of serum levels of basement membrane components, 7S-IV and laminin, could be beneficial as the early indices of diabetic microangiopathy, including diabetic nephropathy.
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PMID:Clinical implications of serum levels of basement membrane components in diabetic patients with and without albuminuria. 177 44

In order to elucidate the clinical significance of microalbuminuria in non-insulin-dependent diabetes mellitus (NIDDM), 62 Japanese subjects with NIDDM and without proteinuria were followed for three years. After the three-year follow up, four (19%) of 21 microalbuminuric patients--albumin excretion rates (AER) greater than 15 micrograms/min--developed overt proteinuria, while none of the 42 normoalbuminuric patients did. Among these normoalbuminuric patients, eight patients (19.5%) developed microalbuminuria. The microalbuminuric patients who developed overt proteinuria had higher AER at the beginning of the study than the patients who stayed microalbuminuric. The patients who developed microalbuminuria showed a significantly higher systolic blood pressure in the final year than the patients who stayed normoalbuminuric. These results indicate that microalbuminuria precedes overt proteinuria in Japanese NIDDM, and progression of diabetic nephropathy is rapid and associated with a rise in blood pressure.
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PMID:Clinical significance of microalbuminuria in Japanese subjects with non-insulin-dependent diabetes. 177 61


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