Short-Term Administration of Captopril and Nifedipine and Exercise-Induced Albuminuria in Normotensive Diabetic Patients With Early-Stage Nephropathy

Romanelli, Giuseppe; Giustina, Andrea; Bossoni, Simonetta; Caldonazzo, A; Cimino, Antonino; Cravarezza, P; Giustina, G

doi:10.2337/diab.39.11.1333

Cited by 23 publications

(19 citation statements)

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“…Arterial grafts, which in our study showed preserved functional and structural integrity, appeared, therefore, to be more suitable for CABG procedure, particularly in the presence of poorly compensated diabetes or when signs of peripheral diabetes-related complications have already occurred. More aggressive or patient-tailored pharmacological therapy could be also advisable in diabetic subjects (32)(33)(34)(35)(36), especially those with poorly controlled disease, in an attempt to reduce the impact of other risk factors on the fate of venous conduits, although this approach has given conflicting results.…”

Section: Discussionmentioning

confidence: 99%

Influence of Type 2 Diabetes on Functional and Structural Properties of Coronary Artery Bypass Conduits

et al. 2003

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Recent studies have reported a high incidence of postoperative unfavorable cardiac-related events in patients with diabetes who underwent coronary artery bypass grafting (CABG). Structural and functional characteristics of CABG conduits, which have been shown to play an important role in patient outcome after myocardial revascularization, have not been fully investigated in diabetic subjects. Therefore, we sought to determine the influence of adult-onset diabetes on vasoreactivity and morphological profile of venous and arterial grafts. Of the 160 consecutive patients enrolled in the study, 90 were diagnosed with type 2 diabetes and 70 did not have diabetes (control group). All patients underwent evaluation of glucose control before surgery. Tissue specimens were collected from left internal thoracic artery (LITA) and saphenous vein (SV) grafts harvested during elective CABG. Functional tests were performed to assess contractile and vasodilative responses of bypass conduits. Histological evaluation was carried out to examine vessel wall structure. Univariate and multivariate analyses were performed to correlate the preoperative factors related to the control of the endocrine disorder with histological findings. Patient medical history and demographics did not differ between the groups. Diabetic patients showed significant microalbuminuria and higher plasma levels of C-peptide and GHb as compared with nondiabetic subjects. Functional tests of the LITA segments revealed no difference between groups with regard to contractile and vasodilative responses. In contrast, significant impairment in the endothelium-related vasodilation of the SV grafts was observed in diabetic subjects. Histological studies showed structural preservation of the arterial conduits in both groups. However, marked intimal abnormalities (also atherosclerotic calcified plaques) were detected in SV grafts harvested from diabetic patients. Logistic regression analysis showed that high levels of proteinuria and GHb were independent predictors of advanced structural degeneration of SV conduits. Treatment modality, duration of diabetes, and other demographic or metabolic factors were found to have no influence on the morphological characteristics of SV conduits. In conclusion, biological properties of LITA conduits for CABG were preserved in diabetic patients. However, these patients frequently showed impairment of the endothelium-dependent vasorelaxation and intimal degeneration of SV grafts. The extent of structural abnormalities of SV grafts was inversely correlated with the efficacy of the metabolic control of the endocrine disorder. Further studies are required to conclusively correlate preoperative SV graft abnormalities with postoperative conduit patency rate and the occurrence of adverse cardiac-related events in diabetic subjects.

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Section: Discussionmentioning

confidence: 99%

Influence of Type 2 Diabetes on Functional and Structural Properties of Coronary Artery Bypass Conduits

et al. 2003

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“…In particular, physical exercise can be used as a provocative test to detect the silent stage of the kidney disorder in both types of diabetes (7). The renin-angiotensin system was the focus of most in the studies performed to explain the severe proteinuria occurring after exercise in diabetic patients (12,32). The results of our study may indicate that one of the reasons for exerciseinduced proteinuria in diabetic and hypertensive patients could be decreased NO production, because decreased NO production due to endothelial damage was reported in diabetes and hypertension (20).…”

Section: Discussionmentioning

confidence: 99%

Effect of nitric oxide on exercise-induced proteinuria in rats

Gündüz

Kuru

Şentürk

2003

Journal of Applied Physiology

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Gü ndü z, Filiz, Oktay Kuru, and Ü mit Kemal S entü rk. Effect of nitric oxide on exercise-induced proteinuria in rats. J Appl Physiol 95: 1867-1872, 2003. First published July 18, 2003 10.1152/japplphysiol.00599.2003.-Temporary proteinuria occurring after exercise is a common finding, and it is explained predominantly by alterations in renal hemodynamics. In this study, we investigated whether nitric oxide (NO), which is known to have an effect on renal hemodynamics and to increase during exercise, has a role in postexercise proteinuria. In the first step of this study, the effect of acute NO synthase blockage on exercise proteinuria was evaluated. The urinary protein levels in animals that performed acute exhaustive treadmill running exercise were considerably elevated compared with the control animals. Significantly elevated urinary protein levels were also detected in animals that received N -nitro-L-arginine methyl ester before exhaustion, compared with both control and exhausted groups, and mixed-type proteinuria was detected in electrophoresis, as in all exhausted animals. In the second step of the study, a NO donor (isosorbide mononitrate) was given to rats 1 h before exhaustive exercise. Mixed-type proteinuria and the elevation in urinary protein levels that occur as a consequence of exhaustive exercise were prevented by NO donor treatment. Finally, in the third step of our study, a calcium channel blocker (diltiazem), another vasodilator, was applied to the rats 1 h before exhaustive exercise. Urinary protein levels were not different in exhausted rats with or without calcium channel blocker treatment. On the other hand, in both groups, urinary protein levels were higher than in the control group. The tail-cuff blood pressure alterations caused by vasodilator drug applications before exercise were not different for NO donor and calcium channel blocker groups. These results suggest that endogenous NO might prevent the postexercise proteinuria from becoming more severe by affecting hemodynamic changes that occur during exercise. nitric oxide synthase; nitric oxide synthase blockage; isosorbide mononitrate; diltiazem NITRIC OXIDE (NO) has an important role in regulation of kidney functions, as well as in the regulation of many other tissues and organs. NO is effective in regulation of glomerular and medullary hemodynamics through vascular resistance, tubuloglomerular feedback response, renin release, and regulation of extracellular fluid volume (16,17). It was demonstrated that acute systemic NO synthase (NOS) blockage causes a prominent increase in resistance of efferent and afferent arterioles and decreases renal blood flow besides increasing the systemic blood pressure (BP) (1). However, glomerular filtration rate either is not affected or is decreased less compared with the renal blood flow, because of the increased filtration fraction after NOS blockade (15,16). In addition, it was shown that NOS blockage affects proximal tubular functions, and decreases total (absolute) and fractional tubular reabs...

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“…Indeed, short term angiotensin converting enzyme inhibition with captopril reduces exercise induced albuminuria in diabetics to a greater extent than nifedipine. 19 Our study has limitations. We chose to study normal volunteers who were capable of vigorous exercise, not the group generally tested for microalbuminuria; those with hypertension and diabetes or renal disease.…”

Section: Discussionmentioning

confidence: 89%

Prevalence and duration of exercise induced albuminuria in healthy people

Heathcote¹,

Wilson²,

Quest³

et al. 2009

CIM

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Clin Invest Med 2009; 32 (4): E261-E265. AbstractPurpose: Vigorous exercise increases urine protein excretion. However, whether exercise increases urine albumin enough to reach the threshold for microalbuminuria (2.8 and 2.0 mg/mmol creatinine in women and men respectively) is uncertain. Furthermore, the duration of such albuminuria is unknown. We aimed to estimate the prevalence and duration of exercise induced microalbuminuria in normal healthy volunteers. Methods: Thirty normal subjects provided a urine sample, then exercised to maximal heart rate, or exhaustion, using the standard Bruce Treadmill protocol. Further urine samples were collected within 15 min of completing exercise, and 24 and 48 hr later. Urine creatinine was measured by the Jaffé method and albumin via immunoturbidometry. Results: Baseline urine albumin: creatinine ratio (A/C) was 0.5 ± 0.3 (SD) in women (n=14) and 0.4 ± 0.1 mg/ mmol in men (n=16). Immediately after exercise A/C increased to 5.6 ± 9.7 (in women) and 7.6 ± 17.6 (in men). Twelve of 30 subjects reached the threshold for microalbuminuria and 2 that for macroalbuminuria. By 24 hr all had returned to baseline and there was no further change at 48 hours. Conclusions: A short period, 15-20 min, of maximal exercise leads to A/C ratios above the microalbuminuria threshold in a substantial proportion of normal subjects. Physicians should not measure urine albumin in patients who give a history of such activity in the past 24 hr.

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Short-Term Administration of Captopril and Nifedipine and Exercise-Induced Albuminuria in Normotensive Diabetic Patients With Early-Stage Nephropathy

Cited by 23 publications

References 0 publications

Influence of Type 2 Diabetes on Functional and Structural Properties of Coronary Artery Bypass Conduits

Influence of Type 2 Diabetes on Functional and Structural Properties of Coronary Artery Bypass Conduits

Effect of nitric oxide on exercise-induced proteinuria in rats

Prevalence and duration of exercise induced albuminuria in healthy people

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