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  • 1
    Electronic Resource
    Electronic Resource
    Improved survival in patients with diabetic nephropathy (1989)
    Springer
    Diabetologia 32 (1989), S. 884-886 
    Details
    ISSN: 1432-0428
    Keywords: Diabetic nephropathy ; Type 1 (insulin-dependent) diabetes mellitus ; blood pressure ; antihypertensive treatment ; survival ; renal failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The effect of early antihypertensive treatment on survival of patients with diabetic nephropathy was evaluated by studying two cohorts of Type 1 (insulin-dependent) diabetic patients developing persistent proteinuria in I: 1957–1973 (late treatment group n=49) and II: 1979–1983 (early treatment groupn=71). At onset of nephropathy, the two cohorts were comparable with regard to age (29(8) vs 30(8) years, mean (SD)), duration of diabetes (16(6) vs 18(7) years), blood pressure (132(16)/85(11) vs 134(16)/86(8) mm Hg), proteinuria (0.8 (0.5–1.2) vs 0.8 (0.6–1.2) g × 24 h−1, median (quartiles)) and serum creatinine (87(14) vs 85(16) μmol×1−1). The patients were followed frequently at the outpatients’ clinic until death or for a median duration of 8 years. In the first cohort antihypertensive treatment was seldom used, whereas, in the second cohort antihypertensive treatment was started when blood pressure reached 144(18)/93(7) mm Hg. The probability of survival with a functioning kidney for more than 8 years was 48% in the first cohort and 87% in the second cohort, p〈0.001. The improvement of survival was due mainly to a decreased mortality from uraemia. Early antihypertensive treatment is the most likely explanation for this improvement.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00297455
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  • 2
    Electronic Resource
    Electronic Resource
    Lack of familial predisposition to cardiovascular disease in Type 1 (insulin-dependent) diabetic patients with nephropathy (1991)
    Springer
    Diabetologia 34 (1991), S. 370-372 
    Details
    ISSN: 1432-0428
    Keywords: Type 1 (insulin-dependent) diabetes mellitus ; diabetic nephropathy ; cardiovascular disease ; familial predisposition
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A familial predisposition has been proposed as a major determinant of the increased morbidity and mortality from cardiovascular disease demonstrated in Type 1 (insulin-dependent) diabetic patients with nephropathy. We assessed this concept by studying 91 parents of Type 1 diabetic patients with nephropathy and 94 parents of aged-matched Type 1 diabetic patients with normoalbuminuria. The two groups of parents were of a similar age (58±8 vs 58±7 years). The prevalence (%) of death and cardiovascular diseases (World Health Organisation questionnaire) was 10 (4–18)% and 12 (6–21)% in parents of nephropathic patients compared to 8 (3–16)% and 13 (6–23)% in parents of normoalbuminuric Type 1 diabetic patients. The frequency of risk factors for cardiovascular disease were about the same in both groups of parents. Microalbuminuria was found in 5% and 11%, hypercholesterolaemia (〉 6.5 mmol/l) in 25% and 26% and smokers constituted 40% and 34% of parents of patients with and without proteinuria, respectively. A familial predisposition to cardiovascular disease cannot explain the increased morbidity and mortality from cardiovascular disease in young patients with diabetic nephropathy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00405012
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  • 3
    Electronic Resource
    Electronic Resource
    Effect of improved metabolic control on loss of kidney function in Type 1 (insulin-dependent) diabetic patients: an update of the Steno studies (1991)
    Springer
    Diabetologia 34 (1991), S. 164-170 
    Details
    ISSN: 1432-0428
    Keywords: Type 1 (insulin-dependent) diabetes mellitus ; HbA1c ; microalbuminuria ; insulin infusion pumps ; continuous subcutaneous insulin infusion ; blood pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We re-examined 69 of the 70 patients entering the two independent Steno Studies of effects of improved metabolic control on progression of late diabetic complications. They were analysed according to an intent to treat after follow-up for 8 years (Steno Study 1) and 5 years (Steno Study 2). The glycaemic control had improved in the insulin infusion group compared with the conventional treatment group (mean HbA1c) by 2.0±0.6% vs 0.7±1.2 in Steno Study 1 and by 1.8±1.2% vs 0.4±1.3 (p〈0.01) in Steno Study 2. In the insulin infusion groups three patients had died during episodes of ketoacidosis. These were not caused by malfunction of the insulin infusion pumps. In the conventional treatment groups, three patients suffered five cardiovascular events causing two deaths. From the sixth month of Steno Study 1 the annual change of the glomerular filtration rate was −3.7 (−5.4 to −2.0) ml·min−1·1.73 m−2 vs −1.0 (−2.1 to −0.1) (conventional vs insulin infusion group, mean (95% confidence interval, p〈0.01)). The change in urinary albumin excretion was associated with the glycaemic control (n=69, r=0.49, p〈0.0002). No progression was observed among 32 patients with low range microalbuminuria (30 to 99 mg/24 h). Among the 19 patients with an initial albumin excretion between 100 and 300 mg/24 h, progression of complications was more frequent during conventional treatment (n=10) vs insulin infusion (n=9): Clinical nephropathy (10 of 10 vs 2 of 9, p〈0.01) and arterial hypertension (7 of 10 vs 1 of 9, p〈0.01). The glomerular filtration rate declined during conventional treatment by −23 (−42 to −4) ml·mm−1·1.73 m−2 (p〈0.05) but not during insulin infusion (−13 (−31 to 5) NS). These results suggest that patients at risk of nephropathy should be offered near normal glycaemic control in order to preserve their kidney function.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00418270
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  • 4
    Electronic Resource
    Electronic Resource
    Increased blood pressure and erythrocyte sodium/lithium countertransport activity are not inherited in diabetic nephropathy (1990)
    Springer
    Diabetologia 33 (1990), S. 619-624 
    Details
    ISSN: 1432-0428
    Keywords: Type 1 (insulin-dependent) diabetes mellitus ; diabetic nephropathy ; blood pressure ; genetic predisposition ; sodium/lithium countertransport
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Genetic predisposition to essential hypertension, represented by maximal erythrocyte sodium/lithium countertransport activity, has been suggested as a marker for the risk of developing clinical nephropathy in Type 1 (insulin-dependent) diabetes mellitus. To evaluate this hypothesis we measured arterial blood pressure and maximal sodium/lithium countertransport activity of erythrocytes in 80 parents of 49 Type 1 diabetic patients with clinical nephropathy, 78 parents of 49 normoalbuminuric patients and 17 age-matched non-diabetic individuals. The two diabetic groups were carefully matched. In the two groups of parents blood pressure and cell sodium/lithium countertransport activity showed no significant differences (137/83 vs 133/81 mmHg and 0.33 vs 0.32 mmol/(1 cells x h) respectively). The proportion of parents who had died or received anti-hypertensive drugs was similar in the two groups. The patients with Type 1 diabetes had significantly higher sodium/lithium countertransport compared to the 39 non-diabetic control subjects independently of the presence or absence of nephropathy (p〈0.002). However, patients with nephropathy tended to have higher sodium/lithium countertransport activity than normoalbuminuric patients (0.48 vs 0.41 mmol/(1 cells x h), p = 0.06). We conclude that genetic predispositions to essential hypertension and increased maximal erythrocyte sodium/lithium counter-transport activity do not appear to be risk markers for the development of clinical nephropathy in Type 1 diabetic patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400206
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  • 5
    Electronic Resource
    Electronic Resource
    Urinary albumin excretion and 24-hour blood pressure as predictors of pre-eclampsia in Type I diabetes (2000)
    Springer
    Diabetologia 43 (2000), S. 927-931 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Urinary albumin excretion, ambulatory blood pressure monitoring, blood pressure, pregnancy, pre-eclampsia, pregnancy-induced hypertension, haemoglobin A1C, Type I diabetes.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Aims/hypothesis. To evaluate the value of 24-h blood pressure monitoring compared to office blood pressure and urinary albumin excretion in predicting pre-eclampsia in Type I (insulin-dependent) diabetes mellitus.¶Methods. The study included 136 consecutive pregnancies in Caucasian women with Type I diabetes before gestation without diabetic nephropathy, anamnestic hypertension or early abortion. Values of urinary albumin excretion and office blood pressure before pregnancy and the HbA1C value at the time of conception were obtained. Microalbuminuria was defined as urinary albumin excretion of 30–300 mg/24 h in two out of three consecutive urine samples. Single measurements of 24-h urinary albumin excretion, office blood pressure and HbA1C were done five 5 times during pregnancy. In a subgroup of 74 women 24-h blood pressure measurements were done at 10 and 28 weeks of gestation. Pre-eclampsia was defined as office blood pressure higher than 140/90 mm Hg accompanied by proteinuria above 0.3 g/24 h later than 20 weeks of gestation.¶Results. Urinary albumin excretion and systolic blood pressure were higher before and throughout pregnancy in 14 women developing pre-eclampsia compared with women remaining normotensive (p 〈 0.001; p 〈 0.05, respectively). By logistic regression analysis the best predictor for pre-eclampsia was microalbuminuria before pregnancy (p 〈 0.05) with no additive predictive effect of 24-h blood pressure or office blood pressure measurement. The night:day ratio of blood pressure was similar in the two groups.¶Conclusion/interpretation. Microalbuminuria before pregnancy is the strongest predictor of pre-eclampsia in Type I diabetes. Measuring 24-h blood pressure early in pregnancy did not improve the ability to identify women at risk. [Diabetologia (2000) 43: 927–931]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051471
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  • 6
    Electronic Resource
    Electronic Resource
    Prevalence of microalbuminuria in children with Type 1 (insulin-dependent) diabetes mellitus (1986)
    Springer
    Diabetologia 29 (1986), S. 640-643 
    Details
    ISSN: 1432-0428
    Keywords: Arterial blood pressure ; children ; glycosylated haemoglobin ; retinopathy ; Type 1 diabetes ; urinary albumin excretion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The prevalence of microalbuminuria was determined in children aged 7 to 18 years with Type 1 (insulin-dependent) diabetes of more than 2 years' duration. All patients (n =102) attending 2 diabetes clinics were asked to collect 2 overnight timed urine samples for albumin analysis by radioimmunoassay. Complete urine collection was obtained in 97 patients (95%). Overnight urinary albumin excretion rates were also measured in 36 healthy children matched for age and sex. Nineteen of the 97 patients (20%) had microalbuminuria, i. e. overnight urinary albumin excretion rates above the upper normal level (14 μg/min) in both urine collections. Microalbuminuria was only demonstrated in patients aged ≥ 15 years, prevalence 37% (19/52 patients). Arterial blood pressure was elevated, mean 122/84±11/9mmHg, in the microalbuminuric group (19 patients) compared to the age-matched normoalbuminuric diabetic group (33 patients), mean 117/74±10/10 mm Hg,p 〈 0.001. The prevalence of simplex retinopathy was identical in these two groups, i. e. 25%. Glycosylated haemoglobin was slightly higher in the microalbuminuric patients,p 〈 0.10. Our cross-sectional study reveals a high prevalence (37%) of persistent microalbuminuria, a stage highly predictive of later development of diabetic nephropathy, in Type 1 diabetic children aged ≥ 15 years.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00869263
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  • 7
    Electronic Resource
    Electronic Resource
    Central role for sodium in the pathogenesis of blood pressure changes independent of angiotensin, aldosterone and catecholamines in Type 1 (insulin-dependent) diabetes mellitus (1987)
    Springer
    Diabetologia 30 (1987), S. 610-617 
    Details
    ISSN: 1432-0428
    Keywords: Type 1 (insulin-dependent) diabetes ; urinary albumin excretion ; exchangeable sodium ; blood pressure ; extracellular volume ; plasma volume ; catecholamines ; renin ; converting enzyme ; angiotensin II
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We studied 73 Type 1 (insulin-dependent) diabetic patients, 18 to 50 years of age, with a diabetes duration of more than five years. Group 1: normal urinary albumin excretion below 30 mg per 24 h (n=19); group 2: microalbuminuria, 30–300 mg per 24 h (n=36); and group 3: diabetic nephropathy, above 300 mg per 24 h (n=18). Fifteen non-diabetic persons matched for sex and age served as control subjects. The sodium intake evaluated on the basis of 24-h urine sodium excretion was similar in patients and control subjects. Blood pressure in groups 1 and 2 and control subjects was below 160/95 mmHg. The blood pressure was increased in group 3 as compared with the other groups (systolic/diastolic 161±22/101±9 mmHg vs 131±13/84±10, mean±SD, p〈0.0001). Exchangeable sodium was increased in patients (p〈0.01) and correlated to the mean blood pressure (n=70, r=0.41, p〈0.01). Extracellular volume was increased in patients (p〈0.05), whereas plasma volume was normal. Supine serum angiotensin II was suppressed in the patients (p〈0.001). A negative correlation was found between mean blood pressure and supine serum aldosterone (n=68, r=-0.24, p〈0.05), and exchangeable sodium and aldosterone (n=66, r=-0.36, p〈0.002) in all patients. The catecholamine levels were also suppressed or normal in the patients. These data suggest that sodium retention plays a major role and that the aldosterone, angiotensin II and catecholamine levels are suppressed during the blood pressure rise observed in the very early stages of diabetic renal disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00277316
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  • 8
    Electronic Resource
    Electronic Resource
    Incipient nephropathy in Type 1 (insulin-dependent) diabetes (1984)
    Springer
    Diabetologia 26 (1984), S. 406-410 
    Details
    ISSN: 1432-0428
    Keywords: Diabetic nephropathy ; incipient nephropathy ; proteinuria ; urinary albumin excretion rate ; glomerular filtration rate ; blood pressure ; Type 1 diabetes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Patients with Type 1 (insulin-dependent) diabetes without proteinuria were studied to define those patients who will later develop persistent proteinuria (more than 0.5 g protein/24 h). Two investigations were performed; 71 patients were studied longitudinally for 6 years and another 227 patients were studied cross-sectionally. All were less than 50 years of age and had developed diabetes before the age of 40 years. At entry into the study they had no proteinuria (Albustix method), had normal blood pressure and urinary albumin excretion rates 〈 200 μg/min (normal ⩽ 20 μg/min). The best predictor of persistent proteinuria or an albumin excretion rate 〉 200 μg/min was the initial urinary albumin excretion rate. During the longitudinal study, seven patients with an urinary albumin excretion rate of more than 70 μg/min at the start of the study developed persistent proteinuria or an albumin excretion rate 〉 200 μg/min. In contrast, only three out of the remaining 64 patients with urinary albumin excretion rate ⩽ 70 μg/min developed urinary albumin excretion rate 〉 200 μg/min. Patients with an urinary albumin excretion rate 〉 70 μg/min are thus at risk of developing diabetic nephropathy. We designate this stage of renal involvement incipient nephropathy. Patients with incipient nephropathy were further characterized in the cross-sectional study. Compared with normoalbuminuric patients, patients with incipient nephropathy had increased systolic and diastolic blood pressure, but normal serum creatinine. The glomerular filtration rate was higher than normal in patients with incipient nephropathy though not different from that of normoalbuminuric patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00262210
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