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  • 1
    Electronic Resource
    Electronic Resource
    Association between Mannose-Binding Lectin and Vascular Complications in Type 1 Diabetes (2004)
    Oxford, UK; Malden, USA : Blackwell Science Ltd/Inc.
    Scandinavian journal of immunology 59 (2004), S. 0 
    Details
    ISSN: 1365-3083
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Complement activation and inflammation have been suggested in the pathogenesis of diabetic vascular lesions. We investigated serum mannose-binding lectin (MBL) levels and polymorphisms in the MBL gene in type 1 diabetic (T1DM) patients with and without diabetic nephropathy and associated macrovascular complications. Polymorphisms in the MBL gene and serum MBL levels were determined in 199 T1DM patients with overt nephropathy and 192 T1DM patients with persistent normoalbuminuria matched for age, sex and duration of diabetes as well as in 100 healthy control subjects. The frequencies of high and low expression MBL genotypes were similar in patients with T1DM and healthy controls. High MBL genotypes were significantly more frequent in diabetic patients with nephropathy than in the normoalbuminuric group, and the risk of having nephropathy, given a high MBL genotype, assessed by odds ratio was 1.52 (1.02–2.27), P = 0.04. Median serum MBL concentrations were significantly higher in patients with nephropathy than in patients with normoalbuminuria [2306 µg/l (IQR 753–4867 µg/l) versus 1491 µg/l (IQR 577–2944), P = 0.0003], and even when comparing patients with identical genotypes, serum MBL levels were higher in the nephropathy group than in the normoalbuminuric group. Patients with a history of cardiovascular disease had significantly elevated MBL levels independently of nephropathy status [3178 µg/l (IQR 636–5231 µg/l) versus 1741 µg/l (IQR 656–3149 µg/l), P = 0.02]. The differences in MBL levels between patients with and without vascular complications were driven primarily by pronounced differences among carriers of high MBL genotypes (P 〈 0.0001). Our findings suggest that MBL may be involved in the pathogenesis of microvascular and macrovascular complications in type 1 diabetes and that determination of MBL status might be used to identify patients at increased risk of developing these complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.0300-9475.2004.01423i.x
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  • 2
    Electronic Resource
    Electronic Resource
    Distribution and degradation of albumin in extensive skin disease (1981)
    Oxford, UK : Blackwell Publishing Ltd
    British journal of dermatology 104 (1981), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The distribution and degradation of albumin were determined in twelve patients with extensive skin disease and in ten control subjects by measuring the metabolic turnover and transcapillary escape of 131I-labelled albumin. The ratio of intravascular to total mass of albumin was normal. Thus the observed hypoalbuminaemia and the low intravascular mass reflect a reduced mass of total body albumin. The rate of synthesis was normal, but the transcapillary escape rate reflecting the micro-vascular leakiness to macromolecules, and the fractional disappearance rate were significantly higher n i the patients than in the controls (P〈0·001). It is concluded that the hypoalbuminaemia in these patients is the result of an increased endogenous catabolism of albumin without signiflcant loss via urine, stools or skin. A positive correlation between the transcapillary escape rate and fractional catabolic rate of albumin supports the concept of a causal relationship between these parameters.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2133.1981.tb15308.x
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  • 3
    Electronic Resource
    Electronic Resource
    The effect of glucagon infusion on kidney function in short-term insulin-dependent juvenile diabetics (1980)
    Springer
    Diabetologia 19 (1980), S. 350-354 
    Details
    ISSN: 1432-0428
    Keywords: Albumin ; β 2-microglobulin ; glomerularfiltration rate ; glucagon ; insulin-dependent diabetes kidney function ; renal plasma flow
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Kidney function was studied in nine, metabolically well controlled, short-term insulin-dependent male diabetics before and during glucagon infusion of 4 to 5 and 8 to 10 ng/kg/min. Glomerular filtration rate, effective renal plasma flow (steadystate infusion technique, with urinary collections, using 125I-iothalamate and 131I-iodohippurate), and urinary albumin and β 2-microglobulin excretion rates were measured. The mean plasma glucagon concentration increased during infusion from 254±19 pg/ ml to 440±31 pg/ml (low dose) and 730±52 pg/ml (high dose). Glomerular filtration rate increased in all subjects from 133±5 before the glucagon infusion to 141±4 with the low dose, and 148±7 ml/min/1.73 m2 with the high dose (p〈0.01). The increase in glomerular filtration rate correlated with the rise in plasma glucagon concentration (r=0.67; p〈0.01). Renal plasma flow increased from 530 ±21 before the glucagon infusion to 555±20 with the low dose and 572±29 ml/min/1.73 m2 with the high dose (p〈0.01). Urinary β 2-microglobulin excretion rate rose from 5.8±1.0 before infusion to 8.7±1.7 with the low dose, and 17.9±5.7 μg X 10-2/min with the high dose (p〈0.01). Urinary albumin excretion remained unchanged during the glucagon infusion. These results suggest that glucagon may contribute to the reversible elevation of glomerular filtration rate typically found in poorly regulated insulin-dependent diabetics, but not to the moderate elevation found in well controlled diabetics.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00280519
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  • 4
    Electronic Resource
    Electronic Resource
    Haemodynamic changes during graded exercise in patients with diabetic autonomic neuropathy (1982)
    Springer
    Diabetologia 22 (1982), S. 318-323 
    Details
    ISSN: 1432-0428
    Keywords: Insulin-dependent diabetes ; autonomic neuropathy ; graded exercise ; heart rate ; blood pressure ; cardiac output ; cardiac stroke volume ; plasma volume ; hepato-splanchnic blood flow ; body temperature ; plasma catecholamines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Haemodynamic variables were measured during supine rest and during ergometer cycle exercise at two work loads (50 W and 100 W) in normal subjects (n = 7), in insulin-dependent diabetic subjects without neuropathy (n = 8), in insulin-dependent diabetic subjects with slight autonomic neuropathy (decreased beat-to-beat variation in heart rate, which is considered due to a cardiac parasympathetic defect; n = 8), and in insulin-dependent diabetic subjects with severe autonomic neuropathy, including orthostatic hypotension (n = 7). Compared with normal subjects, cardiac stroke volume was lower in the diabetic subjects with autonomic neuropathy, both at rest and during exercise (p 〈 0.025), whereas intermediate values were found in the diabetic subjects without neuropathy. The increase in cardiac output in response to exercise was smaller (p 〈 0.05) in both diabetic groups with autonomic neuropathy compared with the normal and diabetic subjects without autonomic neuropathy. The increase in hepato-splanchnic vascular resistance was smaller in the diabetic subjects with severe autonomic neuropathy than in the normal subjects and the diabetic subjects without autonomic neuropathy (p 〈 0.025), whereas intermediate values were found in the diabetic subjects with slight autonomic neuropathy. We conclude that, in diabetic patients with severe autonomic neuropathy, the responses of the heart and the splanchnic resistance vessels to exercise are impaired. While sympathetic neuropathy may be responsible for impaired function of splanchnic resistance vessels, both cardiac sympathetic neuropathy and diabetic cardiomyopathy may be involved in the impaired cardiac response to exercise in diabetic subjects with autonomic neuropathy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00253574
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  • 5
    Electronic Resource
    Electronic Resource
    Diabetic nephropathy and arterial hypertension (1983)
    Springer
    Diabetologia 24 (1983), S. 10-12 
    Details
    ISSN: 1432-0428
    Keywords: Type 1 diabetes ; diabetic nephropathy ; hypertension ; proteinuria ; serum creatinine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The relationship between arterial blood pressure and diabetic nephropathy was examined in 61 Type 1 (insulin-dependent) diabetic patients (22 females and 39 males). All patients fulfilled the following criteria: persistent proteinuria (〉0.5g/day), onset of diabetes before 31 years of age, age 〈42 years, serum creatinine 〈130 μmol/l, and no antihypertensive treatment. Thirty Type 1 diabetic patients without persistent proteinuria but matched for sex, age, ideal body weight and duration of diabetes, and 30 healthy subjects matched for sex, age and ideal body weight were also studied as controls. The diabetic patients with persistent proteinuria had elevated blood pressures (146/96±17/10 mmHg, mean±SD) compared with 123/75±11/8 mmHg in diabetic patients without persistent proteinuria, and normal subjects (120/77±6/6 mmHg; p〈0.001 for each). Diastolic blood pressure ⩾95 mmHg was found in 51% of the group with persistent proteinuria. Elevated arterial blood pressure is frequently present in young Type 1 diabetic patients with diabetic nephropathy and normal serum creatinine.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00275939
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  • 6
    Electronic Resource
    Electronic Resource
    Renal function in streptozotocin-diabetic rats (1981)
    Springer
    Diabetologia 21 (1981), S. 409-414 
    Details
    ISSN: 1432-0428
    Keywords: Streptozotocin ; diabetes ; rat ; micropuncture ; renal plasma flow ; glomerular filtration ; hydraulic pressure ; ultrafiltration coefficient
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Renal function was examined with micropuncture methods in the insulin-treated streptozotocin-diabetic rat. Kidney glomerular filtration rate was significantly higher in the diabetic rats (1.21 ml/min) than in the control group (0.84 ml/min) Nephron glomerular filtration rate increased in proportion to the rise in kidney glomerular filtration rate (diabetic rats: 37.0 nl/min; control rats: 27.9 nl/min). Likewise renal plasma flow was significantly higher in the diabetic rats (4.1 ml/min) than in the control group (3.0 ml/min). Glomerular capillary pressure was identical in both groups (56.0 and 56.0 mmHg, respectively). The proximal intratubular pressure was significantly reduced in the diabetic rats (10.4 mmHg; control value: 12.5 mmHg). The effective glomerular ultrafiltration coefficient was slightly but not significantly higher in the diabetic rats (0.027 nl s-1mmHg-1) than in the control group (0.023 nl s-1mmHg-1). Kidney weight was significantly higher in the diabetic rats (1.15 g; control rats: 0.96 g) while body weight was similar in both groups (diabetic rats: 232 g; control rats: 238 g). Calculations indicate that the increases in transglomerular hydraulic pressure, renal plasma flow and ultrafiltration co-efficient of the glomerular membrane contribute about equally to the rise in glomerular filtration rate. The increases in the values of the determinants of glomerular filtration rate may be the result of renal hypertrophy. These studies suggest that this model provides a useful method for investigating kidney function in diabetes, which may have relevance for our understanding of the kidney abnormalities in human diabetes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00252690
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  • 7
    Electronic Resource
    Electronic Resource
    Decreased distensibility of a passive vascular bed in diabetes mellitus: An indicator of microangiopathy? (1982)
    Springer
    Diabetologia 23 (1982), S. 411-414 
    Details
    ISSN: 1432-0428
    Keywords: Type 1 diabetes ; diabetic microangiopathy ; skeletal muscle ; blood flow measurement ; 133Xe washout ; maximal ischaemic exercise ; papaverine ; atherosclerosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This study was undertaken to determine whether the distensibility of a passive vascular bed is reduced in Type 1 (insulin-dependent) diabetic patients with microangiopathy. The change in blood flow induced by 45° head-up tilting was studied in two systems: (a) following maximal ischaemic exercise and (b) in a vascular bed locally paralysed by the injection of papaverine. Five normal subjects, six patients with long-standing Type 1 diabetes and six non-diabetic patients with severe atherosclerosis affecting the legs were studied. Blood flow was measured in the anterior tibial muscle by the isotope washout technique. The median increase in blood flow produced by tilting was greater in normal subjects than in diabetic subjects in both the locally-relaxed bed (58% and 14% respectively) and after maximal ischaemic exercise (45% and 4% respectivley). In the atherosclerotic subjects, the increase in blood flow in the locally relaxed bed was 77%. The results are consistent with the hypothesis that the reduced distensibility seen in the diabetic subjects was related to the presence of microvascular disease and that the behaviour of a vascular bed relaxed by the local injection of papaverine might be an appropriate model to study this condition.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00260953
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  • 8
    Electronic Resource
    Electronic Resource
    Effects of acetazolamide on kidney function in Type 1 (insulin-dependent) diabetic patients with diabetic nephropathy (1988)
    Springer
    Diabetologia 31 (1988), S. 806-810 
    Details
    ISSN: 1432-0428
    Keywords: Acetazolamide ; albuminuria ; diabetic nephropathy ; glomerular filtration rate ; lithium clearance ; normal subjects ; proximal tubules ; sodium excretion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We investigated the effects of 3 days treatment with acetazolamide 250 mg three times daily on kidney function in 8 Type 1 (insulin-dependent) diabetic patients with nephropathy, and in 7 healthy subjects in a double-blind placebo controlled cross-over study. Glomerular filtration rate and extracellular fluid volume were measured with the single injection 51Cr-EDTA technique and fluid flow rate from the proximal tubules was determined by measurement of the renal lithium clearance. A 24% decline in glomerular filtration rate was observed in both groups during acetazolamide treatment (control subjects: 108±11 vs 82±9 ml/min, p〈0.02, diabetic patients: 71±19 vs 54±14 ml/min, p〈0.01). The renal lithium clearance (ml/min) remained about the same (control subjects: 22±6 vs 27±8, NS, diabetic patients: 14±5 vs 15±4, NS). Absolute proximal tubular reabsorption of water (ml/min) was reduced by about one-third (control subjects: 85±11 vs 56±7, p〈0.02, diabetic patients: 55±17 vs 37±6, p〈0.02), and fractional proximal reabsorption of water and sodium (%) declined (control subjects: 79±5 vs 67±8, p〈0.02, diabetic patients: 79±5 vs 72±6, p〈0.02). Renal sodium clearance and distal fractional reabsorption of sodium was unchanged. Extracellular fluid volume declined by 10% in both groups (p〈0.02). Albuminuria and fractional albumin clearance decreased significantly in the nephropathic patients (p〈0.02). Our study suggests that the effects of acetazolamide on kidney function are similar in healthy subjects and patients with diabetic nephropathy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00277481
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  • 9
    Electronic Resource
    Electronic Resource
    Effect of antihypertensive treatment on blood-retinal barrier permeability to fluorescein in hypertensive Type 1 (insulin-dependent) diabetic patients with background retinopathy (1989)
    Springer
    Diabetologia 32 (1989), S. 440-444 
    Details
    ISSN: 1432-0428
    Keywords: Arterial blood pressure ; antihypertensive treatment ; diabetic retinopathy ; diabetic nephropathy ; Type 1 (insulin-dependent) diabetes ; vitreous fluorometry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The effect of antihypertensive treatment on blood-retinal barrier leakage of fluorescein in background retinopathy was studied in nine hypertensive Type 1 (insulin-dependent) diabetic patients suffering from nephropathy. The patients were investigated before and after 7 (3 to 13) months of treatment with captopril (n=8; 25 to 100 mg daily) and a diuretic, either frusemide (n=4; 80 to 200 mg daily) or bendrofluazide (n=2; 2.5 mg daily). Retinal function was assessed by fundus photography, fluorescein angiography, vitreous fluorometry, and renal function by glomerular filtration rate, and albuminuria. The antihypertensive treatment induced a significant reduction (p〈0.05) in: blood pressure from 152/97±14/8 mmHg to 134/82±11/6 mmHg; blood-retinal barrier leakage of fluorescein from 2.4 ±1.1 to 1.4±0.5·10−7 cm/second; albuminuria from 1391 (range: 168–4852) μg/min to 793 (range: 35–2081) ug/min. Glomerular filtration rate declined from 88±15 to 78±23 ml·min−1·1.73 m2 (0.05〈p〈0.10). The metabolic control of the patients as reflected by their blood glucose and HbA1c levels remained stable during the study. Our study suggests that systemic blood pressure elevation contributes to the abnormal blood-retinal barrier permeability to fluorescein characteristically found in diabetic background retinopathy and that this abnormality can be reversed during antihypertensive treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00271264
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  • 10
    Electronic Resource
    Electronic Resource
    The course of kidney function in Type 2 (non-insulin-dependent) diabetic patients with diabetic nephropathy (1993)
    Springer
    Diabetologia 36 (1993), S. 1071-1078 
    Details
    ISSN: 1432-0428
    Keywords: Type 2 (non-insulin-dependent) diabetes mellitus ; diabetic nephropathy ; kidney function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We evaluated the impact of some putative progression promoters on kidney function in albuminuric Type 2 (non-insulin-dependent) diabetic patients with biopsyproven diabetic glomerulosclerosis. Twenty-six patients (1 female) with a mean age of 52 (standard error 2) years and a known mean duration of diabetes of 9 (1) years were followed-up prospectively for a mean of 5.2 (range 1.0–7.0) years. Twenty-one patients received antihypertensive treatment. During the observation period the glomerular filtration rate decreased from 83 (24–146) to 58 (2–145) ml·min−1·1.73 m−2 (mean (range)) (p〈0.001). The mean rate of decline in glomerular filtration rate was 5.7 (−3.5 to 22.0) ml/min per year. Albuminuria increased from 1.2 (0.3–7.2) to 2.3 (0.4–8.0) g/24 h (geometric mean (range)) (p〈0.001). Arterial blood pressure remained unchanged: 162/93 (SE 4/3) and 161/89 (4/2) mm Hg. Univariate analysis showed the rate of decline in glomerular filtration rate to correlate with systolic blood pressure (r=0.71,p〈0.001), mean blood pressure (r=0.56,p〈0.005), albuminuria (r=0.58,p〈0.005) and the initial glomerular filtration rate (r=−0.49,p〈0.02). The rate of decline in glomerular filtration rate did not correlate significantly with dietary protein intake, total cholesterol, high-density lipoprotein cholesterol or HbA1c. Three patients died from uraemia and four patients died from cardiovascular disease. Two patients required renal replacement therapy at the end of the observation period. Our prospective observational study revealed that one-fifth of the patients developed end-stage renal failure during the 5-year observation period. The decline in glomerular filtration rate varied considerably between patients. Increase in arterial blood pressure to a hypertensive level is an early feature of diabetic nephropathy. Elevated systolic blood pressure accelerates the progression of diabetic nephropathy in Type 2 diabetic patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02374501
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