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  • 1
    Electronic Resource
    Electronic Resource
    Kidney function and size in type 1 (insulin-dependent) diabetic patients before and during growth hormone administration for one week (1982)
    Springer
    Diabetologia 22 (1982), S. 333-337 
    Details
    ISSN: 1432-0428
    Keywords: Type 1 diabetes ; glomerular filtration rate ; renal plasma flow ; kidney size ; growth hormone ; albumin ; β-2-microglobulin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Kidney function and size were studied in seven well-controlled male Type 1 (insulin-dependent) diabetic patients before and after administration of highly purified human growth hormone for one week. Glomerular filtration rate, renal plasma flow (steady state infusion technique with urinary collections using 125I-iothalamate and 131I-hippuran), kidney size (ultrasonic scanning) and urinary excretion rates of albumin and β-2-microglobulin were measured. Highly purified growth hormone was injected subcutaneously, 2 IU in the morning and 4 IU in the evening. The growth hormone dosage applied induced an elevation in plasma growth hormone concentration from the normal level seen in these very well controlled diabetics to levels within the range previously demonstrated in normally controlled Type 1 diabetic patients. During the week of growth hormone administration, glycaemic control was maintained unchanged by increasing the insulin dose by 79 ±9% (mean ± SEM). Glomerular filtration rate increased from 122±3 to 131±3 ml/min × 1.73 m2 (p 〈0.05) and renal plasma flow increased from 535±10 to 569±22 ml/min × 1.73 m2 (p〈0.05). Kidney size changed from 128±5 to 133±5 ml/1.73 m2 (NS). Urinary excretion rates of albumin and β-2-microglobulin were unchanged. The present findings suggest that the growth hormone elevation typically found in Type 1 diabetic patients with reasonable clinical control, contributes to the enhanced glomerular filtration rate and renal plasma flow present in that disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00253577
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  • 2
    Electronic Resource
    Electronic Resource
    Effects of indomethacin on kidney function in Type 1 (insulin-dependent) diabetic patients with nephropathy (1987)
    Springer
    Diabetologia 30 (1987), S. 78-81 
    Details
    ISSN: 1432-0428
    Keywords: Albuminuria ; diabetic nephropathy ; glomerular filtration rate ; prostaglandins ; Type 1 diabetes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We investigated whether the glomerular synthesis of prostaglandins modulates the glomerular filtration rate and albumimiria in diabetic nephropathy. The urinary excretion of immunoreactive prostaglandin E2 (253pg/min) was significantly elevated in eight Type 1 (insulin-dependent) diabetic women with nephropathy as compared with nine normoalbuminuric Type 1 diabetic women (95pg/min) and 11 non-diabetic women (132 pg/min), respectively (p〈0.01). Glomerular filtration rate (single bolus 51Cr-EDTA technique) and albuminuria (radioimmunoassay) were measured twice within two weeks in the eight Type 1 diabetic women with nephropathy. All eight patients were on a diabetic diet without sodium restriction. The study was performed as a randomized doubleblind trial, with the patients receiving either indomethacin (150mg/day) or placebo for three days prior to the kidney function studies. Indomethacin treatment induced a significant reduction in urinary prostaglandin E2 excretion (73%, p〈0.01), glomerular filtration rate diminished from 120±18 to 106±17ml/min/1.73m2 (p〈0.05), albuminuria declined from 148 to 69 μg/min (median and range) (p〈0.05) and fractional clearance of albumin diminished 42% (p〈0.05). Blood glucose concentrations were comparable during the placebo and indomethacin treatment, 13.4±4 versus 14.2±3 mmol/l, respectively. Our results suggest that glomerular filtration rate in early diabetic nephropathy is dependent on the enhanced glomerular synthesis of vasodilating prostaglandins.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00274575
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  • 3
    Electronic Resource
    Electronic Resource
    A strong correlation between glomerular filtration rate and filtration surface in diabetic nephropathy (1988)
    Springer
    Diabetologia 31 (1988), S. 265-270 
    Details
    ISSN: 1432-0428
    Keywords: Diabetic glomerulopathy ; diabetic nephropathy ; glomerular ultrastructure ; glomerular filtration rate ; stereology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Quantitative structural studies were performed in kidney biopsy specimens from 24 long-term Type 1 (insulin-dependent) diabetic patients with persistent albuminuria due to diabetic glomerulopathy. Ten patients were receiving antihypertensive treatment, and among the remaining patients the mean blood pressure was 142/91 mmHg (SD = 11/9). The urinary albumin excretion rate showed a range from 100 to 5494 μg/min (geometric mean 688 μg/min.) Glomerular filtration rate also showed a wide range, from supranormal to markedly decreased values (128 to 28 ml·min−1· (1.73 m2)−1, mean 75). The filtration surface (interface between capillary and urinary space) per total number of nephrons (open+occluded) was estimated by combined light- and electron microscopy. The percentage occluded glomeruli as well as structural quantities in the open glomeruli were taken into account in this estimate. A highly significant correlation was seen between glomerular filtration rate and filtration surface per nephron (r=0.77, p〈10−4). The percentage occluded glomeruli contributed significantly to the variation in glomerular filtration rate (for this relationship tested separately r=-0.78, p〈10−5). The volume of open glomeruli was even larger than that seen in early diabetic glomerular hypertrophy and tended to increase with the percentage of glomerular closure, indicating that a compensatory hypertrophy might have taken place. In the open glomeruli the filtration surface constituted a smaller percent of total capillary surface (the remaining part facing the mesangial regions) than in early diabetic patients and control subjects. Our study has demonstrated that reduced glomerular filtration surface is closely associated with reduced glomerular filtration rate in Type 1 diabetic patients with diabetic nephropathy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00277406
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  • 4
    Electronic Resource
    Electronic Resource
    Monitoring kidney function in diabetic nephropathy (1994)
    Springer
    Diabetologia 37 (1994), S. 708-712 
    Details
    ISSN: 1432-0428
    Keywords: Insulin-dependent diabetes mellitus ; diabetic nephropathy ; glomerular filtration rate ; creatinine clearance ; progression of renal disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Progression in diabetic nephropathy is usually determined by repeated measurements of glomerular filtration rate and expressed as rate of decline in glomerular filtration rate. Our aim was to evaluate the agreement between rate of decline in glomerular filtration rate estimated from the Cockroft-Gault formula: (140-age)*K*body weight* (1/S-creatinine) and measured by the plasma clearance of 51CrEDTA. All insulin-dependent diabetic patients with diabetic nephropathy followed-up for at least 5 years with at least 5 simultaneous measurements of glomerular filtration rate, s-creatinine, and weight were included in the study. Forty-three patients (32 male/11 female), age 31 (18–61) years were enrolled. Observation period: 6.6 (5.1–9.9) years and number of investigations per patient 6 (5–16) (median(range)). Baseline glomerular filtration rate (ml/min) was 97 (30) measured and 107 (37) estimated (mean(SD))(p〈0.001) and the 95% limits of agreement were −42.0 to 20.8 ml/min. Measured and estimated glomerular filtration rate correlated significantly (r = 0.91, p〈0.00001). Rate of decline in kidney function ml · min−1 · year−1 was 4.7 (3.3) measured and 4.8 (3.5) estimated (mean(SD)) (NS), but the 95% limits of agreement showed a wide range −3.9 to 3.5 ml · min−1 · year−1. A significant correlation between rate of decline in measured and estimated glomerular filtration rate was present (r = 0.84, p〈0.00001). In conclusion, glomerular filtration rate is overestimated by the Cockroft-Gault formula. The mean rates of decline in glomerular filtration rate are comparable, but the limits of agreement are wide, which make the Cockroft-Gault method unacceptable for clinical purposes, i.e. monitoring progression in kidney function in the individual patient. However, the estimated glomerular filtration rate may be used for comparison of groups in observational studies and in clinical trials with a long observation period.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00417696
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  • 5
    Electronic Resource
    Electronic Resource
    Effect of metabolic regulation on renal leakiness to Dextran molecules in short-term insulin-dependent diabetics (1979)
    Springer
    Diabetologia 17 (1979), S. 157-160 
    Details
    ISSN: 1432-0428
    Keywords: Dextran ; early diabetes ; glomerular filtration rate ; influence of metabolic regulation ; kidney function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Renal clearance of dextran of two ranges of molecular size and glomerular filtration rate (GFR,51Cr-EDTA) were measured in seven short-term insulin-dependent diabetics (mean age 25 years). Measurements were carried out in the same patient during good and poor metabolic regulation (plasma glucose, mean±SEM, 6.5±0.9 and 14.8±1.5 ] mmol/l, respectively). GFR was elevated in all patients during poor metabolic regulation (119±6 ml/min/1.73 m2, versus 99±2 ml/min/1.73 m2 during good control, p〈0.01). The average renal clearance of dextran with molecular weights ranging from 25,000 to 35,000 and 35,000 to 45,000 increased during poor metabolic regulation from 14.8±0.8 to 19.8±1.8 ml/min/1.73 m2, and 5.2±0.3 to 6.8±0.6 ml/min/1.73 m2, respectively (p〈 0.05). The elevated GFR and renal dextran clearance found during poor metabolic regulation were normalized within one to three weeks of effective insulin treatment. This rapid reversibility can hardly be explained by the previously demonstrated enlargement in glomerular size and filtration surface area, since these alterations remain unchanged after more than one month of insulin treatment. The metabolic regulation did not influence the size-selective properties of the glomerular wall. Therefore, we suggest that the dominating mechanism involved in the GFR and renal dextran clearance alterations is functional, viz. increased filtration pressure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01219742
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  • 6
    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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  • 7
    Electronic Resource
    Electronic Resource
    Prevalence of micro- and macroalbuminuria, arterial hypertension, retinopathy and large vessel disease in European Type 2 (non-insulin-dependent) diabetic patients (1991)
    Springer
    Diabetologia 34 (1991), S. 655-661 
    Details
    ISSN: 1432-0428
    Keywords: Type 2 (non-insulin-dependent) diabetes mellitus ; microalbuminuria ; macroalbuminuria ; arterial hypertension ; retinopathy ; macroangiopathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The prevalence of micro- and macroalbuminuria was determined in Type 2 (non-insulin-dependent) diabetic patients, less than 76 years of age, attending a diabetic clinic during 1987. All eligible patients (n=557) were asked to collect a 24-h urine sample for quantitative albumin analysis. Urine collections were obtained in 296 males and 253 females (96%). Normoalbuminuria were defined as urinary albumin excretion≤30 mg/24 h (n=323), microalbuminuria as 31–299 mg/24 h (n=151), and macroalbuminuria as ≥300 mg/ 24 h (n=75). The prevalence of macroalbuminuria was significantly higher in males (20%) than in females (6%), while the prevalence of microalbuminuria was almost identical in males (26%) and females (29%). The prevalence of arterial hypertension increased with increased albuminuria, being 48%, 68%, and 85% in patients with normoalbuminuria, microalbuminuria, and macroalbuminuria respectively. Prevalence of proliferative retinopathy rose with increasing albuminuria, being 2%, 5% and 12% in patients with normoalbuminuria, microalbuminuria, and macroalbuminuria respectively. Prevalence of coronary heart disease, based on Minnesota coded electrocardiograms, was more frequent in patients with macroalbuminuria (46%) compared to patients with microalbuminuria (26%) and patients with normoalbuminuria (22%). Foot ulcers were more frequent in micro- and macroalbuminuric patients, being 13% and 25%, respectively, compared to 5% in patients with normoalbuminuria. This cross-sectional study has revealed a high prevalence of microalbuminuria (27%) and macroalbuminuria (14%) in Type 2 diabetic patients. Patients with raised urinary albumin excretion are characterized by obesity, elevated haemoglobin Alc, increased frequency of arterial hypertension, proliferative retinopathy, coronary heart disease and foot ulcers. Thus, these findings suggest that urinary excretion of albumin should be monitored routinely in patients with Type 2 diabetes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400995
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  • 8
    Electronic Resource
    Electronic Resource
    Plasma lipoproteins and renal function during simvastatin treatment in diabetic nephropathy (1992)
    Springer
    Diabetologia 35 (1992), S. 447-451 
    Details
    ISSN: 1432-0428
    Keywords: Plasma lipoproteins ; albuminuria ; diabetic nephropathy ; glomerular filtration rate ; Type 1 (insulin-dependent) diabetes mellitus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The aim of this study was to assess the effect of simvastatin on plasma lipoproteins and renal function in hypercholesterolaemic Type 1 (insulin-dependent) diabetic patients with diabetic nephropathy. Twenty-six hypercholesterolaemic (total cholesterol ≽ 5.5 mmol/l) Type 1 diabetic patients with nephropathy were enrolled in a double-blind randomized placebo-controlled study for 12 weeks. The active treatment group (n -14) received simvastatin (10–20 mg/day) for 12 weeks while the remaining 12 patients received treatment with placebo. The results during simvastatin treatment (baseline vs 12 weeks): total cholesterol 6.6 vs 4.8 mmol/1 (p 〈 0.01), LDL-cholesterol 4.25 vs 2.57 mmol/l (p 〈 0.01) and apolipoprotein B 1.37 vs 1.06 mmol/l (p 〈 0.01). HDL-cholesterol, and apolipoprotein A-I remained unchanged. Total cholesterol, LDL-cholesterol, HDL-cholesterol, apolipoprotein A–I, apolipoprotein B remained unchanged during placebo treatment. Albuminuria measured during the simvastatin and the placebo treatment (baseline vs 12 weeks) (the data are logarithmically transformed before analysis because of their positively skewed transformation; geometric mean (×/÷ antilog SE) is indicated) was 458 (×/÷ 1.58) vs 393 (×/÷ 1.61) and 481 (×/÷ 1.62) vs 368 (×/÷ 1.78 μg/min (NS). Glomerular filtration rate during simvastatin and placebo treatment (baseline vs 12 weeks) was 64 vs 63 and 72 vs 74 ml·min−1·1.73 m−2, respectively. Two patients receiving simvastatin treatment were withdrawn, one due to gastrointestinal side effects and one due to myalgia. In conclusion, our short-term study in Type 1 diabetic patients with diabetic nephropathy did not reveal any beneficial effect on albuminuria despite a striking lipid-lowering effect of simvastatin in diabetic nephropathy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02342442
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  • 9
    Electronic Resource
    Electronic Resource
    Renoprotection in diabetes: genetic and non-genetic risk factors and treatment (1998)
    Springer
    Diabetologia 41 (1998), S. 745-759 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Type I and Type II diabetes ; microalbuminuria ; diabetic nephropathy ; antihypertensive treatment ; angiotensin converting inhibition ; renal progression promoters ; insertion/deletion polymorphism of angiotensin converting enzyme gene ; end stage renal failure ; glycaemic control.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050983
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  • 10
    Electronic Resource
    Electronic Resource
    The effect of intravenous insulin infusion on kidney function in insulin-dependent diabetes mellitus (1981)
    Springer
    Diabetologia 20 (1981), S. 199-204 
    Details
    ISSN: 1432-0428
    Keywords: Insulin-dependent diabetes ; glomerular filtration rate ; renal plasma flow ; insulin infusion ; hyperglycaemia ; β-2-microglobulin ; albumin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Glomerular filtration rate, renal plasma flow, urinary excretion of β-2-microglobulin and albumin, heart rate and blood pressure were studied in eight young male insulin-dependent diabetics. Measurements were performed before and during insulin infusion at 2 mU/kg/min. No patient had discernible insulin antibodies. Two studies were performed at random in each patient. In series A blood glucose concentration was allowed to decline, while in series B it was maintained at a constant level. Ten 20 min clearance periods were performed, four before and six during insulin infusion. Results are given as mean±SEM of values from the first four (control) and last four (test) clearance periods. Blood glucose declined in series A experiments from 10.8±0.8 mmol/l in the control period to 5.8±0.5 mmol/l during the test period, but remained constant during experiment B (9.8±1.1 and 9.5±1.1 mmol/l). Plasma insulin levels were comparable in the two series. Glomerular filtration rate fell from 141±7 ml/ min X 1.73m2 to 132±7ml/min X 1.73m2 (p〈 0.01) in series A but did not change significantly during series B. Similarily renal plasma flow declined with declining glucose but remained constant when glucose was maintained at a constant level. In series A the magnitude of decrease in renal plasma flow was correlated with the magnitude of decrease in glomerular filtration rate (r=0.95, p〈 0.001). β-2-microglobulin excretion decreased significantly (p 〈 0.05) in both series (A: 89±17 to 60±13 ng/min, B: 117±46 to 62±17ng/min). Albumin excretion increased in five out of six patients with normal control values (not significant) in series A and in four out of six in series B. No significant changes in heart rate or blood pressure were observed. Thus insulin infusion reduced renal plasma flow and glomerular filtration rate, but this effect could be completely abolished by keeping blood glucose constant. This suggests that it is not the lack of insulin but the associated hyperglycaemia which contributes to the elevated renal plasma flow and glomerular filtration rate in insulin-dependent diabetics.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00252628
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