Urinary protein excretion and renal function in young people with diabetes mellitus.

To detect early renal involvement in young diabetic patients (IDDM), urinary protein excretion and renal function were examined in 110 patients aged 5.9-25.0 years. Clearances of inulin and PAH were determined as well as albumin (Alb), IgG, N-acetyl-beta-D-glucosaminidase (NAG) and creatinine (Cr) excretion rates (UV). The patients were grouped according to IDDM duration (2- less than 5, 5-10 and greater than 10 years) and albumin excretion rate (non-albuminuria less than 20, microalbuminuria 20-200, and albuminuria greater than 200 micrograms/min per 1.73 m2). Four patients had overt albuminuria, 17 microalbuminuria (equally distributed among the duration groups). Grouped according to albumin excretion rate, the mean GFR was increased in those without albuminuria but 'normalized' in patients with microalbuminuria/albuminuria. Grouped according to albumin excretion rate and the duration of the disease, the non-albuminuric patients with IDDM for greater than 10 years had a lower GFR than those with a shorter duration of IDDM. The patients with microalbuminuria/albuminuria and IDDM for less than 5 years had a reduced GFR. Patients with increased NAG excretion rate had lower Na excretion rate, lower fractional Na excretion and greater creatinine excretion than those with normal NAG excretion. Albumin excretion correlated with IgG excretion, but also with NAG excretion. Our results suggest that early albuminuria in IDDM is of both glomerular and tubular origin. The hyperfiltration declines with increasing albumin excretion but also with the duration of the disease.     

Dual blockade of the renin-angiotensin system in type 1 patients with diabetic nephropathy.

BACKGROUND: Albuminuria and hypertension are predictors of poor renal and cardiovascular outcome in patients with diabetes. Approximately 30% of type 1 patients with diabetic nephropathy (DN) have albuminuria >1 g/day, and blood pressure >135 and/or >85 mmHg despite antihypertensive therapy with recommended doses of ACE inhibitor (ACEI) and diuretics. We tested the effect of dual blockade of the renin-angiotensin system (RAS) in these patients. METHODS: We performed a randomised double blind crossover trial with 2 months treatment with Irbesartan 300 mg o.d. and placebo added on top of previous antihypertensive treatment. We included 21 type 1 patients with DN responding insufficiently to ACEI and diuretics, as defined above. At the end of each treatment period, albuminuria, 24-h blood pressure and glomerular filtration rate (GFR) were measured. RESULTS: Addition of 300 mg Irbesartan to the patients' usual antihypertensive therapy induced a mean reduction in albuminuria of 37% (95% CI 20-49, P<0.001); from 1574 mg/24 h (95% CI 1162-2132) to 996 mg/24 h (95% CI 699-1419), a reduction in 24-h blood pressure of 8 mmHg systolic (95% CI -2 to 18) and 5 mmHg diastolic (95% CI 1-9) (P=0.11 and 0.01, respectively) (from placebo, mean (SE) 146 (4)/80 (2) mmHg). GFR remained unchanged. Serum potassium increased (mean 4.3 to 4.6 mmol/l, P=0.02). Intervention to reduce serum potassium was needed in two patients with GFR <35 ml/min/1.73 m(2). Otherwise the dual blockade with Irbesartan was safe and well tolerated. CONCLUSIONS: Dual blockade of the RAS may offer additional renal and cardiovascular protection in type 1 patients with DN responding insufficiently to conventional antihypertensive therapy, including recommended doses of ACEI and diuretics.     

皮肤电导率在早期糖尿病肾病筛查中的应用价值

目的 探讨皮肤电导率（ESC）在早期糖尿病肾病筛查中的应用价值。方法 选取2022年10月至2023年2月于安徽医科大学第二附属医院分泌科住院的176例2型糖尿病患者,根据尿白蛋白/肌酐比值（UACR）和肾小球滤过率（eGFR）将其分为两组,糖尿病肾病组（DKD组,n=68）和糖尿病非肾病组（non-DKD组,n=108）,所有患者均完善SUDOSCAN仪检测,获得双手、双足ESC(HESC、FESC),肾病风险分数（SUDOSCAN-DN）,采用Spearman相关性分析UACR与SUDOSCAN各指标的关系。采用受试者工作特征（ROC）曲线判断SUDOSCAN各指标对糖尿病肾病的诊断效能。结果 与non-DKD组相比,DKD组年龄较大,病程较长,收缩压较高,三酰甘油（TG）、血尿酸及肌酐、促甲状腺激素（TSH）水平较高,HbA1c水平偏低,HESC、FESC、SUDOSCAN-DN值均较低,差异有统计学意义（P<0.05）;Spearman相关分析显示,UACR与TC、LDL-C、血肌酐、TSH呈正相关（r值分别为0.202、0.207、0.378、0.174,P<0....     

肾舒胶囊配合激素治疗重度肾性蛋白尿疗效观察

目的:观察肾舒胶囊配合激素等西药治疗重度肾性蛋白尿的效果。方法:32例重度肾性蛋白尿患者在常规激素治疗基础上加服肾舒胶囊,同期与单用常规激素治疗的30例进行对比观察3个月。结果:肾舒组总有效率90.6％,1年复发率9.1％,不良反应发生率26.6％;对照组总有效率73.3％,1年复发率40.0％,不良反应发生率56.7％。两组比较,差异有显著性(P<0.05)。结论:肾舒胶囊与激素等配合治疗重度肾性蛋白尿具有增强疗效、减少复发及减轻激素不良反应的作用。     

Transcapillary escape rate and albuminuria in Type II diabetes. Effects of short-term treatment with low-molecular weight heparin (Short Communication)

Summary The relation between urinary albumin excretion rate (UAE), transcapillary escape rate of albumin (TER_alb), haemostatic factors, ambulatory blood pressure, and metabolic variables was investigated in 45 Type II (non-insulin-dependent) diabetic patients without overt nephropathy or uncontrolled blood pressure. We enrolled 44 patients in a placebo controlled study to test the effects of 3 week long treatment with low-molecular weight heparin (tinzaparin) on the same variables. BMI, 24 h systolic and diastolic blood pressure, plasma concentrations of triglycerides, fasting glucose, factor VIII, von Willebrand factor (vWf), fibrinogen, α-2 macroglobulin, and fibronectin were notably higher in patients with increased albuminuria compared with normoalbuminuric patients, whereas the TER_alb was similar in the two groups. TER_alb correlated with fasting plasma glucose. UAE correlated more closely than TER_alb with 24 h ambulatory blood pressure, vWf, and factor VIII. Urinary albumin excretion rate was unchanged during tinzaparin [28.9 ± 5.6 vs 28.1 ± 6.0 μg/min (geometric mean (antilog SD)] vs placebo (18.0 ± 5.4 vs 17.6 ± 5.3 μg/min), and no change was found in TER_alb [6.3 ± 1.6 vs 6.0 ± 1.5 %/h (means ± SD), and 6.3 ± 1.5 vs 5.6 ± 1.8 %/h; tinzaparin versus placebo, respectively]. Only minor changes were observed in blood pressure, lipids, glycaemic control and haemostatic factors. This study shows no correlation between albuminuria and transcapillary escape rate in Type II diabetic patients without overt nephropathy or uncontrolled blood pressure. UAE is related to markers of atherosclerosis, endothelial injury and dysfunction, and haemostatic factors. Moreover, UAE correlates much more than TER_alb with 24 h ambulatory blood pressure, von Willebrand factor, and factor VIII. Finally, short-term treatment with tinzaparin does not change the transvascular or glomerular leakage of albumin. These results indicate that TER_alb is not a sensitive marker of microvascular dysfunction in such patients and that factors other than abnormal glycosaminoglycan metabolism may contribute to the vascular damage of these patients. [Diabetalogia (1999) 42: 60–67] Received: 2 February 1998 and in final revised form: 1 September 1998