Improved metabolic control does not alter the charge-dependent glomerular filtration of albumin in uncomplicated Type 1 (insulin-dependent) diabetes

Kverneland, A.; Welinder, Benny S.; Feldt‐Rasmussen, Bo; Deckert, T.

doi:10.1007/bf00278756

Cited by 8 publications

(3 citation statements)

References 9 publications

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“…In contrast, diabetic patients showed a 30 % higher clearance of nonglycated albumin combined with a slightly higher clearance of glycated albumin, resulting in a mean selectivity index significantly higher than in normal subjects. This finding indicates that in normoalbuminuric diabetic patients the renal excretion of glycated albumin is relatively lower than that of non-glycated albumin, as previously documented by Kverneland et al [7,8] on 24-h urine collection during normal physical activity. On the other hand, our results and those of Kverneland et al disagree with the preferential urinary excretion of glycated proteins reported by others [5,6] using a method considered as poorly specific for glycated albumin [17].…”

Section: Discussionsupporting

confidence: 78%

The increase in albuminuria induced by exercise is not associated with preferential excretion of glycated albumin in Type 1 (insulin-dependent) diabetic patients

et al. 1991

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The increase in urinary albumin excretion induced by acute exercise in Type 1 (insulin-dependent) diabetic patients is associated with the urinary excretion of cationic proteins. To test whether the renal excretion of glycated albumin (more anionic than non-glycated albumin) is affected by exercise, we submitted seven normoalbuminuric (albumin excretion rate less than 30 mg/24 h) Type 1 diabetic patients and six well-matched healthy subjects to an exercise test (600 kpm/min for 20 min) on a bicycle ergometer, preceded and followed by a 1-h resting period. The selectivity index (renal clearance of non-glycated/glycated albumin) was not significantly different among the pre-exercise, exercise and post-exercise periods, either in the normal subjects (1.01 +/- 0.03 vs 1.08 +/- 0.06 vs 1.08 +/- 0.05) or in the diabetic patients (1.25 +/- 0.09 vs 1.20 +/- 0.07 vs 1.20 +/- 0.06), whereas it was significantly higher (p less than 0.05) in diabetic patients compared to healthy subjects during pre-exercise. These results are not consistent with the hypothesis that acute exercise may induce a preferential excretion of glycated albumin.

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Section: Discussionsupporting

confidence: 78%

The increase in albuminuria induced by exercise is not associated with preferential excretion of glycated albumin in Type 1 (insulin-dependent) diabetic patients

et al. 1991

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“…The increment was most pronounced after 6 and 12 months. One previous study investigated prospectively the influence of strict metabolic control during 12 weeks using non-glycated/glycated albumin as a selectivity index [17]. Their subjects were normoalbuminuric and no effect of strict metabolic control was observed.…”

Section: Discussionmentioning

confidence: 99%

Glomerular charge selectivity and the influence of improved blood glucose control in Type 1 (insulin-dependent) diabetic patients with microalbuminuria

Bangstad¹,

Kofoed‐Enevoldsen²,

Dahl‐Jørgensen³

et al. 1992

Diabetologia

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We first compared glomerular charge selectivity index in two matched groups of Type 1 (insulin-dependent) diabetic patients with micro- and normoalbuminuria respectively, and secondly, investigated prospectively in a randomized clinical trial, the influence of improved metabolic control on selectivity index in diabetic patients with microalbuminuria. In Study 1, 27 patients with microalbuminuria (albumin excretion > or = 15 micrograms/min in at least two out of three overnight urine samples) were matched (age, diabetes duration, mean 1-year HbA1c, gender) with normoalbuminuria patients (n = 24), and in Study 2, 23 microalbuminuric patients were randomly allocated to either intensive (continuous subcutaneous insulin infusion) or conventional treatment. Glomerular charge selectivity index was measured as IgG/IgG4 selectivity index, i.e. total IgG/IgG4 clearance ratio in timed overnight urine samples. The microalbuminuric patients had a significantly reduced selectivity index compared to the normoalbuminuric patients: 1.20 (0.92-1.40) vs 1.68 (1.22-2.21), median and 95% confidence interval (p < 0.01). In Study 2, the HbA1c improved in the intensive-treatment group compared to the conventional-treatment group: at 2, 6 and 12 months the difference in mean percentage HbA1c between the groups was 1.1, 1.2 and 1.4, respectively (p < 0.01). A sharp 50% increment in IgG/IgG4 selectivity index was seen in the intensive-treatment group during the first 6 months (p < 0.05 compared to the conventional group). We conclude that adolescents and young adults in an early stage of diabetic nephropathy have reduced glomerular charge selectivity, which may be improved by reducing the mean blood glucose level.

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“…By measuring the renal clearance of pairs of plasma proteins which differ in charge but not in molecular size, alterations of the charge selectivity of the GBM can be identified. We have used nonglycated and glycated albumin [61,621, glycated albumin being more negatively charged in comparison to nonglycated [62]. We have also used neutral IgG and the anionic charged IgG4 fraction [64, 651. The ratio between the clearance of the less anionic and the more anionic plasma proteins is the selectivity index (SI).…”

Section: Alteration Of the Composition Of The Extracellular Matrixmentioning

confidence: 99%

Albuminuria reflects widespread vascular damage

Deckert¹,

et al. 1989

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Albuminuria in Type 1 (insulin-dependent) diabetes is not only an indication of renal disease, but a new, independent risk-marker of proliferative retinopathy and macroangiopathy. The coincidence of generalised vascular dysfunction and albuminuria, advanced mesangial expansion, proliferative retinopathy, and severe macroangiopathy suggests a common cause of albuminuria and the severe renal and extrarenal complications associated with it. Enzymes involved in the metabolism of anionic components of the extracellular matrix (e.g. heparan sulphate proteoglycan) vulnerable to hyperglycaemia, seem to constitute the primary cause of albuminuria and the associated complications. Genetic polymorphism of such enzymes is possibly the main reason for variation in susceptibility.

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Improved metabolic control does not alter the charge-dependent glomerular filtration of albumin in uncomplicated Type 1 (insulin-dependent) diabetes

Cited by 8 publications

References 9 publications

The increase in albuminuria induced by exercise is not associated with preferential excretion of glycated albumin in Type 1 (insulin-dependent) diabetic patients

The increase in albuminuria induced by exercise is not associated with preferential excretion of glycated albumin in Type 1 (insulin-dependent) diabetic patients

Glomerular charge selectivity and the influence of improved blood glucose control in Type 1 (insulin-dependent) diabetic patients with microalbuminuria

Albuminuria reflects widespread vascular damage

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