ISSN:
1432-0428
Keywords:
Key words Diabetic glomerulopathy, microalbuminuria, basement membrane thickness, mesangial expansion, mesangial matrix, stereology, hyperglycaemia.
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Summary We investigated in a randomized, prospective study the influence of improved blood glucose control during 2–3 years in young insulin-dependent diabetic (IDDM) patients with microalbuminuria, which is indicative of early nephropathy. Patients were randomized either to intensive treatment by continuous subcutaneous insulin infusion (CSII) (n =9) or CT (n =9). Kidney biopsies were taken at baseline and after 26–34 months. End points were structural changes in the glomeruli. Sensitive, quantitative, morphometric methods were used. The blood glucose control improved significantly (p =0.01) during the study in the CSII-group as glycated haemoglobin (HbA1 c) fell from 10.1 % ([95 % CI] 8.9–11.3) to 8.6 % (7.9–9.2), but not in the CT-group, 10.1 % (8.3–11.9) vs 9.7 % (8.7–10.8). Mean HbA1 c during the study period was significantly lower in the CSII-group than in the CT-group, 8.7 % (8.1–9.3) vs 9.9 % (8.5–11.3), p =0.04. Basement membrane thickness (BMT) increased in both groups, most (CT vs CSII, p =0.03) in the CT-group: 140 nm (50–230) vs CSII: 56 nm (27–86). In the CT-group only an increase was seen in matrix/mesangial volume fraction (p =0.006) and matrix star volume (p =0.04). Furthermore, a positive correlation between mean HbA1 c during the study and change from baseline in BMT (r =0.70, p =0.001) and matrix/glomerular volume fraction (r =0.33, p =0.09, NS) was demonstrated. Albumin excretion rate correlated significantly to BMT and most of the matrix parameters. The present study shows that during a period of only 2.5 years, a close relationship between the level of mean blood glucose and progression of glomerular morphological changes in early diabetic nephropathy can be demonstrated. [Diabetologia (1994) 37: 483–490]
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/s001250050136
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