Frequency of proteinuria in type 2 diabetes mellitus seen at a diabetes centre in southern India

The frequency of proteinuria was assessed in a cohort of 1848 diabetic patients attending a diabetes centre in south India. A total of 127 (6.9%) patients had evidence of macroproteinuria and 49 (2.5%) patients had microproteinuria. Thus overall 9.4% of patients had diabetes related proteinuria. In addition, 70 patients (3.8%) had evidence of proteinuria with no evidence of retinopathy. The frequency of both microproteinuria and macroproteinuria increased linearly with duration of diabetes. Multiple logistic regression analysis showed that duration of diabetes, serum creatinine, and glycated haemoglobin were risk factors for macroproteinuria.     

Renal functional reserve in insulin dependent diabetic children

Abstract Background: Microalbuminuria has been shown to be predictive for clinical diabetic nephropathy. Renal functional reserve (RFR), as a response to protein loading in a short period of time, is a parameter to assess the ability of kidneys to increase the glomerular filtration rate (GFR). The aim of this study was to predict the early phase of diabetic nephropathy by measuring urinary albumin level and RFR capacity in patients with insulin-dependent diabetes mellitus (IDDM).
Methods: Twenty-two patients with IDDM were studied: 11 with a disease duration of less than 5 years (group 1) and 11 with a disease duration of more than 5 years (group 2). As the control group, 15 healthy children (group 3) were included in the study. At the beginning of the study, glucose was measured and the urinary albumin/creatinine ratio was calculated. Average glycosylated hemoglobin (HbA₁c) over 1 year was determined. After protein loading (red meat containing 2 g/kg of protein), the creatinine clearance was calculated at each hour for a duration of 4 h. The RFR was accepted as the peak percentage increase in GFR over the baseline value.
Results: Although metabolic control in group 2 was better, the RFR in group 2 was significantly lower than in group 1 (P < 0.05). Urinary microalbumin levels between the groups did not differ (P < 0.05). In two patients in whom microalbuminuria was detected, the RFR was much lower.
Conclusions: Detecting lower RFR levels in patients with normal urinary albumin excretion, as well as in patients with microalbuminuria, may support the idea that the RFR capacity is more sensitive than microalbuminuria in assessing the early phase of diabetic nephropathy.     

Diabetic nephropathy in children and adolescents: a critical review with particular reference to angiotensin-converting enzyme inhibitors

Clinical diabetic nephropathy is a well-recognized cause of increased morbidity and mortality in patients with type 1 diabetes. The finding that microalbuminuria predicts progression to overt nephropathy has allowed early diagnosis and preventive interventions. Several studies have demonstrated that treatment with angiotensin-converting enzyme (ACE) inhibitors slows down the rate of decline of the glomerular filtration rate in type 1 diabetes patients with established proteinuria. The renoprotective properties of the ACE inhibitor captopril extend beyond its antihypertensive effects. ACE inhibitors represent the most appropriate class of antihypertensive drugs for treating type 1 diabetes patients because of their efficacy and safety. When microalbuminuria is detected and confirmed in a diabetic child or adolescent, and if it persists despite 6-12 months of improved metabolic control, treatment with ACE inhibitors should be started, even if the child is normotensive. Careful follow-up of renal function is essential.     

Cardiac tamponade due to systemic lupus erythematosus in a 7-year-old boy with selective IgG subclass deficiency

Systemic lupus erythematosus (SLE) was observed in a 7-year-old boy with IgG₂ and IgG₄ subclass deficiencies who had been treated with immunoglobulin (100–200 mg/kg/4 weeks) since 2 years of age. The mother and the half-brother displayed the same deficiency. Serum IgG mainly consisted of IgG₁ (98.9%) during the acute phase of SLE due to transient IgG₃ deficiency. While he had no common manifestations of SLE such as arthritis or nephropathy, he developed cardiac tamponade due to massive pericardial effusion. Conclusion The clinical features of SLE in the present case such as the development of cardiac tamponade and the absence of renal involvement may result from the markedly imbalanced IgG subclass distribution among auto-antibodies. Received: 20 May 1997 and in revised form: 7 October 1997 / Accepted: 21 October 1997     

Advanced glycosylation end products, protein kinase C and renal alterations in diabetic rats

Objective To study the relationship between advanced glycosylation end products (AGE) an d protein kinase C (PKC), and their effects on renal alteration in diabetic rats .
Methods Insulin or aminoguanidine was administered to diabetic rats. Blood glucose, hem oglobin A_1C (HbA_1C), glomerular tissue extracts AGE (GTE-AGE), PKC, glomerular basement membrane thickness (GBMT) and urine protein/creatinine ( Pr/Cr) ratio in diabetic rats were measured and analysed.
Results Levels of blood glucose, HbA_1C and AGE, PKC activity, the Pr/Cr ratio an d GBMT were all significantly increased (P values all less than 0.01) in di abetic rats. Insulin could decrease the formation of HbA_1C and AGE, and improve PKC activity. Aminoguanidine had no influence on PKC activity (P >0.05) although it decreased the formation of AGE. Both drugs could delay t he increase of urine Pr/Cr ratio and GBMT (P<0.05 or P<0.01).
Conclusions Chronic hyperglycemia may lead to an increase of PKC activity. HbA_1Cand AGE may not directly contribute to alterations of PKC activity, but the increa se of PKC activity could promote the action of AGE on GBM thickening. It is imp ortant t o inhibit the formation of AGE and reduce the PKC activity so as to prevent or d elay the development of diabetic nephropathy.     

SLE患者PBMCs雌激素受体mRNA水平与IL-10 mRNA水平的研究

目的：探讨未经刺激外周血单个核细胞（PBMCs）雌激素受体（ER）mRNA水平和白细胞介素10（IL-10）mRNA水平在系统性红斑狼疮发病中的作用。方法：分离25例系统性红斑狼疮（SEE）患者（患者组）和15例正常人（对照组）新鲜外周血单个核细胞，提取总RNA，利用半定量RT-PCR方法逆转录并扩增雌激素受体和IL-10．通过凝胶图像扫描系统对PCR产物的电泳条带进行密度扫描。结果：患者组PBMCsERmRNA水平和IL-10mRNA水平均高于正常对照组（P〈0．01）。患者组和对照组PBMCsERmRNA水平与IL-10mRNA水平均呈正相关（r分别为0．442和0．557，P〈0．05）。结论：SLE患者外周血单个核细胞存在雌激素受体mRNA和IL-10mRNA表达异常．IL-10表达的上调可能与雌激素受体有关．过量的IL-10可能导致了SLE患者B细胞产生大量自身抗体。     

毒乃清颗粒对糖尿病肾病肾功能不全大鼠的影响

目的研究毒乃清对糖尿病肾病模型大鼠的作用.方法采用改良法对大鼠进行5/6肾切除以及腹腔注射链脲佐菌素制作糖尿病肾病肾功能不全模型,设立健康组、假手术组、病理组、尿毒清组、毒乃清治疗组进行对照,观察各组一般状况、尿素氮、血肌酐、血糖、总胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白、24 h尿蛋白定量、肾脏病理学变化.结果毒乃清颗粒能改善大鼠的一般状况、降低血糖、降低BUN及SCr、降低血脂(TG、TCHOL)、减少24 h尿蛋白排泄量(与各对照组比较,P<0.01或P<0.05),病理组织学方面能延缓肾小球硬化的发生发展.结论初步证实毒乃清颗粒对糖尿病肾病模型大鼠具有较好的治疗作用,其机理有待进一步研究.     

中药防治糖尿病肾病的分子生物学研究进展

糖尿病肾病已成为糖尿病严重的并发症之一,其发病率及死亡率呈上升趋势.本文介绍了中药通过影响糖基化终产物、葡萄糖转运蛋白1、血小板衍化生长因子-β、血管内皮素-l、一氧化氮合酶、转化生长因子-β1、金属蛋白酶、血管紧张素转化酶、凋亡细胞和相关组织的基因表达,预防和治疗糖尿病肾病.     

系统性红斑狼疮肺部病变高分辨率CT分析

为评价高分辨率 CT( HRCT)对系统性红斑狼疮 ( SLE)患者肺、胸膜病变诊断的价值 ,对 62例 SL E患者的胸部进行HRCT扫描 ,并与普通 X线平片进行了对比。结果发现 ,HRCT对 SLE患者肺、胸膜病变较普通 X线具有更高的灵敏性 ,能早期发现肺、胸膜的细微病变