Diabetic nephropathy: Fault or destiny?

Deckert, T.; Poulsen, Jacob E.

doi:10.1007/bf00252651

Cited by 78 publications

(26 citation statements)

References 13 publications

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“…This is in accordance with the previous findings of Deckert and Poulsen. 17 We also noted a high frequency of significantly elevated blood pressure in persons with juvenile-onset type I diabetes at the time of diagnosis of diabetic nephropathy when the serum creatinine was still normal. This confirms the findings of Parving et al , 10 who found a similar blood pressure of 146/96 mm Hg in type I diabetic patients with persistent proteinuria and normal serum creatinine.…”

Section: Discussionmentioning

confidence: 63%

Hypertension in diabetes as related to nephropathy. Early blood pressure changes.

Feldt‐Rasmussen¹,

Borch‐Johnsen²,

Mathiesen³

1985

Hypertension

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SUMMARY We measured the blood pressure under standardized conditions in three groups of patients with type I (insulin-dependent) diabetes: group 1, patients with Albustix-negative urine and normal urinary albumin excretion rate below 20 /xg/min; group 2, patients with Albustix-negative urine and elevated urinary albumin excretion rate 20 to 200 /xg/min; and group 3, patients with Albustix-positive urine at the time of diagnosis of diabetic nephropathy, that is, proteinuria greater than 0.5 g/24 hr on four consecutive visits with an interval of more than 1 month. We also studied blood pressure data at the time of diagnosis of diabetes in patients with type I diabetes who later died with severe nephropathy (n = 84), and in those who survived their disease for more than 40 years (n = 256). Patients subsequently developing diabetic nephropathy could not be identified on the basis of systolic and/or diastolic blood pressure during the first 2 to 10 years of diabetes. Our study also demonstrated that the blood pressure in group 3 (147/93 mm Hg) was significantly higher than that in group 2 (135/86 mm Hg), which again was higher than that in group 1 (128/79 mm Hg). We concluded that arterial hypertension is an early feature in the developing of diabetic nephropathy, with blood pressure rising before the presence of clinical proteinuria. (Hypertension 7 [Suppl II]: II-18-H-20, 1985) KEY WORDS • type I diabetes * urinary albumin excretion rate * blood pressure D IABETIC nephropathy is the most serious complication of type I (insulin-dependent) diabetes mellitus (IDDM), 1 with a grave prognosis after the onset of proteinuria. "5 It is characterized by glomerular arteriolohyalinosis, glomerulosclerosis, persistent proteinuria, decreasing glomerular filtration rate (GFR), and increasing blood pressure. The etiology of diabetic nephropathy is unknown, and the role of arterial blood pressure in the pathogenesis of clinical nephropathy has been discussed.

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Section: Discussionmentioning

confidence: 63%

Hypertension in diabetes as related to nephropathy. Early blood pressure changes.

Feldt‐Rasmussen¹,

Borch‐Johnsen²,

Mathiesen³

1985

Hypertension

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“…It is noteworthy that these increases are again predominantly in SBP, whereas the change we found was in DBP with an altered population mean. There is conflicting data on whether hypertension itself is a risk factor for the development of nephropathy; the consensus of opinion would seem to be that it is not a primary factor [29] but probably accelerates its development once present [30]. While two groups have suggested that aggressive treatment of hypertension in Type I diabetic patients with nephropathy may reduce the rate of deterioration of renal function [31,32], it is not known whether such treatment at the lower BP of "relative hypertension" will prevent or retard the development of nephropathy, retinopathy or cardiovascular complications.…”

Section: Discussionmentioning

confidence: 99%

Blood pressure in children, adolescents and young adults with Type 1 (insulin-dependent) diabetes

Tarn

Drury

1986

Diabetologia

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Summary, Blood pressure has been measured by a single observer using a standardised technique in 163 Type I (insulindependent) diabetic patients aged 4 to 32 years, 232 of their non-diabetic siblings in the same age range and in 292 of their natural parents. Results for each sex were examined separately by analysis of variance. Systolic pressures were not significantly different overall nor in any single 4-year age band. In contrast, phase IV diastolic pressure was slightly but significantly higher in the diabetic males than in their sibling group overall (increment = + 2.8 mmHg; p < 0.03), a difference also shown individually within the 16-20 year age band (81.3 versus 76.5 mmHg, p < 0.025). There were no significant differences in diastolic pressure between the female groups, and no effect of duration of diabetes on blood pressure was shown in either sex. Eighteen of 97 male diabetic patients (19%) had mean blood pressures above the 90th centile for age, derived from the sibling data, compared with 12 of 137 siblings (9%, p =0.05). The higher blood pressures among the diabetic males could not be explained solely by early nephropathy; familial factors appeared to be important in the determination of elevated blood pressure in this group as well as in the siblings. Alone, these small differences in blood pressure are unlikely to make a major contribution to the incidence of diabetic vascular disease, but the isolated increase in diastolic pressure may indicate altered vascular regulation in Type 1 diabetes.

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“…It is well known that hyperglycaemia is a major risk factor for diabetic nephropathy but hyperglycaemia does not account for all changes observed [2]. Extracellular matrix (ECM) accumulation is central to the glomerular and interstitial lesions that ultimately culminate in diabetic nephropathy [3,4] and studies have suggested that the renin-angiotensin-system (RAS) has an important influence on renal ECM dynamics [4].…”

Section: :82-88]mentioning

confidence: 99%

Juxtaglomerular apparatus T-cell infiltration affects glomerular structure in Type 1 diabetic patients

2004

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Aims/hypothesis. Type 1 diabetes is an autoimmune disorder associated with T-cell mediated injury to multiple endocrine tissues. T-cell infiltration of the juxtaglomerular apparatus could be associated with changes in local renin angiotensin system activity and, thus, with changes in the renal microenvironment. We examined the frequency of juxtaglomerular apparatus T-cell infiltration early in Type 1 diabetes and tested whether this is associated with renal structure and function. Methods. We classified 89 Type 1 diabetic patients by immunohistochemical analysis as either juxtaglomerular apparatus T-cell positive (n=37) or T-cell negative (n=38). Borderline cases (n=14) were not considered further.Results. T-cell positive patients had a shorter duration of diabetes (6.7±2.5 years) than T-cell negative patients (9.2±5.0 years, p=0.011) and lower albumin excretion rate, but they had a similar glomerular filtration rate and blood pressure. Renal biopsy morphometric analysis showed similar glomerular basement membrane width and mesangial fractional volume in these two groups. However, glomerular capillary surface density (p=0.0012) and filtration surface per glomerulus (p=0.0155) were greater in the T-cell positive patients. Conclusion/Interpretation. Increased filtration surface per glomerulus could be associated with glomerular filtration rate preservation in diabetes. Thus, juxtaglomerular apparatus immunologic injury in Type 1 diabetes patients could delay the clinical consequences of diabetic nephropathy. [Diabetologia (2004) Minneapolis, MN 55455, USA E-mail: mauer002@umn.edu Abbreviations: ECM, Extracellular matrix; RAS, renin-angiotensin-system; JGA, juxtaglomerular apparatus; NHDN, natural history of diabetic nephropathy; IP, immunoperoxidase; GV, mean glomerular volume; TGF-B, transforming growth factor-B; Vv(Mes/glom), mesangial fractional volume per glomerulus; GBM, glomerular basement membrane; Sv(PGBM/glom), surface density of the peripheral glomerular capillary perglomerulus ; TFS, total filtration surface per glomerulus; Vv(Int/cortex), fractional volume of renal cortical interstitium.

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Diabetic nephropathy: Fault or destiny?

Cited by 78 publications

References 13 publications

Hypertension in diabetes as related to nephropathy. Early blood pressure changes.

Hypertension in diabetes as related to nephropathy. Early blood pressure changes.

Blood pressure in children, adolescents and young adults with Type 1 (insulin-dependent) diabetes

Juxtaglomerular apparatus T-cell infiltration affects glomerular structure in Type 1 diabetic patients

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