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  • 1
    Electronic Resource
    Electronic Resource
    Acute renal effects of angiotensin converting enzyme inhibition in microalbuminuric type 1 diabetic patients (1993)
    Springer
    Acta diabetologica 30 (1993), S. 149-153 
    Details
    ISSN: 1432-5233
    Keywords: Angiotensin converting enzyme inhibition ; Microalbuminuria ; Renal haemodynamics ; Type 1 diabetes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The renal effects of intravenous injection of 40 mg enalapril were investigated in 16 normotensive microalbuminuric type 1 (insulin-dependent) diabetic patients. After enalapril the following changes were observed: fractional albumin clearance (Θ Alb) decreased from 9.9 (3.0–23.8) to 8.2 (2.0–18.3)×10−6 (2P〈0.01); filtration fraction (FF) decreased from 0.260 (0.225–0.312) to 0.253 (0.190–0.297) (2P〈0.01); renal plasma flow (RPF) increased from 565 (411–690) to 623 (449–785) (2P〈0.01); and glomerular filtration rate (GFR) remained stable at 149 (128–181) versus 150 (124–185) ml · min−1 (NS). These values were unchanged after placebo (n=8), except for RFP which decreased from 606 (401–701) to 559 (381–677) ml · min−1 (2P〈0.05) and GFR which was reduced from 148 (111–173) to 138 (111–167) (2P〈0.05). A reduction in mean blood pressure from 94 (87–103) to 89 (79–101) mmHg (2P〈0.05) was found in the enalapril group and a minor reduction in the placebo group from 97 (83–106) to 96 (81–104) mmHg (2P〈0.05) was also noted. The relative changes in systolic blood pressure in the enalapril group correlated with changes in Θ Alb (Spearman'sr=0.66, 2P〈0.02) and FF (r=0.53, 2P〈0.05). Acute inhibition of angiotensin converting enzyme does not reduce the pathological hyperfiltration in these patients and a reduction in Θ Alb and FF can not be dissociated from the reduction in blood pressure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00572859
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  • 2
    Electronic Resource
    Electronic Resource
    Reduced glomerular filtration rate and cardiovascular damage in diabetes: a key role for abnormal albuminuria (1992)
    Springer
    Acta diabetologica 29 (1992), S. 201-213 
    Details
    ISSN: 1432-5233
    Keywords: Abnormal albuminuria ; ACE-inhibition ; Hypertension ; Microalbuminuria ; Diabetic nephropathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract There is general agreement that a fall rate in glomerular filtration rate (GFR) is the principal endpoint in diabetics with renal disease, and that abnormal albuminuria (including microalbuminuria) is an important intermediate end-point. The relative roles of blood pressure (BP) elevation and abnormal albuminuria in the prediction and genesis of renal disease are a matter of debate, and are further analysed in this paper. New studies show that neither genetic predisposition to hypertension (parental BP) nor parental abnormal albuminuria can be used to predict renal disease in patients with type 1 (insulin-dependent) diabetes. However, parental predisposition to proteinuria seems to be important to certain types of patients with type 2 (non-insulin-dependent) diabetes. Cross-sectional as well as follow-up studies document that GFR is generally well preserved in microalbuminuria (in both type 1 and type 2 patients), while the transition to clinical proteinuria is associated with a decline in GFR. Thus, prevention of overt proteinuria is important in clinical trials in microalbuminuric patients. In type 1 diabetes clear ultrastructural changes have been documented with microalbuminuria and a good correlation between abnormal albuminuria and structural damage is seen. Structural damage in normo- and microalbuminuric patients correlates poorly with BP. New studies in type 1 diabetes document that microalbuminuria (but not elevated BP) predicts not only clinical diabetic nephropathy but also end-stage renal failure and mortality. In type 2 diabetes microalbuminuria is the strongest predictor of mortality, whereas BP elevation is not a predictor. Several studies now document that antihypertensive treatment, especially with inhibitors of angiotensin converting enzyme, is able to reverse or reduce abnormal albuminuria, even in non-hypertensive type 1 patients, and possibly preserve GFR. Therefore, microalbuminuria may be the main indicator for starting antihypertensive treatment in these patients. With respect to organ damage in the retina, abnormal albuminuria is an important indicator of the risk of severe diabetic retinopathy. BP elevation seems not to be an initiating factor, but rather aggravates established retinopathy. Left ventricular hypertrophy has a stronger correlation with BP elevation than normoalbuminuria, suggesting that left ventricular hypertrophy is at least partially a phenomenon secondary to elevated BP in diabetic patients with abnormal albuminuria. Generally, abnormal albuminuria is a strong indicator of cardiovascular renal damage in diabetic patients and in most organs is a stronger factor than elevated BP.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00573489
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  • 3
    Electronic Resource
    Electronic Resource
    Intravenous insulin decreases urinary albumin excretion in long-term diabetics with nephropathy (1980)
    Springer
    Diabetologia 18 (1980), S. 285-288 
    Details
    ISSN: 1432-0428
    Keywords: Arterial blood pressure ; blood glucose ; cardiovascular ; heart rate ; insulin ; long-term diabetes ; nephropathy ; neuropathy ; noradrenaline ; proteinuria ; urinary albumin excretion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The effect of intravenous injection of insulin on heart rate, plasma noradrenaline and urinary excretion rates of albumin and beta-2-microglobulin was examined in 10 long-term diabetics, 5 of whom had albuminuria. — In patients without albuminuria intravenous injection of insulin resulted in changes similar to but less pronounced than those previously observed in short-term diabetics: albumin excretion, plasma noradrenaline and heart rate increased, creatinine excretion decreased significantly. —Intravenous injection of insulin increased heart rate but not plasma noradrenaline in long-term diabetics with albuminuria. Arterial blood pressure did not change after insulin. Contrary to expectation insulin decreased urinary albumin excretion (from 418 to 312 μg/min, 27 per cent) in these patients. There was a marked decrease in urinary excretion rates of beta-2-microglobulin and creatinine (55 and 17 per cent, respectively) after insulin. — The decrease in albumin excretion after insulin in diabetics with albuminuria is most likely due to renal vasoconstriction. The absence of a rise in albumin excretion after insulin may be due to severe morphological changes in glomeruli in these patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00251006
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  • 4
    Electronic Resource
    Electronic Resource
    Early recognition of autonomic dysfunction in microalbuminuria: significance for cardiovascular mortality in diabetes mellitus? (1994)
    Springer
    Diabetologia 37 (1994), S. 788-796 
    Details
    ISSN: 1432-0428
    Keywords: Key words Autonomic function, diabetes mellitus, 24-h heart rate variability, microalbuminuria, sudden cardiac death, vagal function, autonomic neuropathy.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The appearance of microalbuminuria in diabetic patients predicts development of macroalbuminuria and coronary heart disease. Autonomic dysfunction in ischaemic heart disease is related to an increased incidence of arrhythmic deaths. To assess sympathovagal balance in relation to microalbuminuria we performed 24-h spectral analysis of RR interval oscillations in 37 insulin-dependent diabetic patients. Patients were divided according to urinary albumin excretion as normo-(〈20 µg/min) (n =12), micro-(〉20 and 〈200 µg/min) (n =14) and macro-albuminuria (〉200 µg/min) (n =11). None had symptoms or signs of ischaemic heart disease at clinical examination or during stress testing. Fourteen matched healthy subjects served as controls. Overall RR interval variability was calculated as the 24-h standard deviation. The square root of power of the low-frequency (0.04–0.15 Hz) and high-frequency (0.15–0.40 Hz) component were considered indices of the sympathovagal interaction and vagal function, respectively. Patients with micro and macroalbuminuria had, compared to control subjects, significantly reduced 24-h standard deviation, a much smaller day/night difference in mean RR level and a significantly reduced amplitude of the low frequency and high frequency oscillations, which were even more reduced in macroalbuminuria. The differences in vagal function were also present after correction for mean RR level, and differences in physical training level and smoking. Insulin-dependent diabetic patients who develop microalbuminuria have significantly impaired vagal function and abnormal sympathovagal interaction, which is further deranged in macroalbuminuria. This early autonomic dysfunction may later contribute to a increased risk for sudden cardiac death. [Diabetologia (1994) 37: 788–796]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00404336
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  • 5
    Electronic Resource
    Electronic Resource
    Low birth weight – is it associated with few and small glomeruli in normal subjects and NIDDM patients? (1996)
    Springer
    Diabetologia 39 (1996), S. 1634-1637 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Birth weight ; diabetes mellitus ; glomerulus ; kidney ; stereology.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary These studies were undertaken to ascertain if there is any association between low birth weight, and low kidney weight, few and/or small glomeruli, in kidneys from a control group and a group of non-insulin-dependent diabetic (NIDDM) patients. The background for this study comes from findings suggesting a correlation between low birth weight and the development of NIDDM and high blood pressure. Furthermore, Brenner has postulated that humans born with a low number of glomeruli, thereby having a low glomerular filtration surface area, have a greater tendency to develop high blood pressure. We examined 79 autopsy kidneys, with known weight from normal and NIDDM patients, which had previously been used for studies of glomerular number and volume. In the archives of the Danish midwives we were able to find birth weight for 26 NIDDM patients and an age- and sex-matched sample of 19 control persons. The kidney weight (g) (Control: 137 ± 36; NIDDM: 150 ± 38; 2p = 0.26), glomerular number (103) (Control: 670 ± 176; NIDDM: 673 ± 200; 2p = 0.95), glomerular volume (106μm3) (Control: 6.25 ± 1.48; NIDDM: 5.71 ± 1.74; 2p = 0.28) or birth weight (g) (Control: 3577 ± 400; NIDDM: 3489 ± 429; 2p = 0.49) were not different between the groups. There was no significant correlation between birth weight and glomerular number (Control: 2p = 0.80; r = 0.06 and NIDDM: 2p = 0.10; r = –0.33), glomerular volume (Control: 2p = 0.43; r = 0.19 and NIDDM: 2p = 0.78; r = 0.06) or kidney weight (Control: 2p = 0.56; r = 0.14 and NIDDM: 2p = 0.81; r = 0.05). Our results on a limited number of subjects in Denmark do not support the hypothesis that there is any association between low birth weight and low kidney weight or low birth weight and few and/or small glomeruli in NIDDM patients. [Diabetologia (1996) 39: 1634–1637]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050627
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  • 6
    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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  • 7
    Electronic Resource
    Electronic Resource
    Early functional and morphologic vascular renal consequences of the diabetic state (1980)
    Springer
    Diabetologia 18 (1980), S. 176-177 
    Details
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00290499
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  • 8
    Electronic Resource
    Electronic Resource
    Functional and morphological renal manifestations in diabetes mellitus (1981)
    Springer
    Diabetologia 21 (1981), S. 89-93 
    Details
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00251272
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  • 9
    Electronic Resource
    Electronic Resource
    The relationship between kidney size and function in short-term diabetic patients (1981)
    Springer
    Diabetologia 21 (1981), S. 498-499 
    Details
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00257793
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  • 10
    Electronic Resource
    Electronic Resource
    Circadian variation of blood pressure in patients with diabetic nephropathy (1992)
    Springer
    Diabetologia 35 (1992), S. 1074-1079 
    Details
    ISSN: 1432-0428
    Keywords: Type 1 (insulin-dependent) diabetes mellitus ; diabetic nephropathy ; ambulatory blood pressure ; circadian ; variation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The association between diurnal blood pressure variation and diabetic nephropathy was assessed in four groups of Type 1 (insulin-dependent) diabetic patients who underwent 24-h ambulatory blood pressure monitoring using an oscillometrie technique. Patients with nephropathy, who had never been treated for hypertension (group D3,n = 13), were individually matched for age, sex and diabetes duration to a group of microalbuminuric patients (D2,n = 26), to normoalbuminuric patients (D1,n = 26) and to healthy control subjects (C,n = 26). Group D3 was also compared to patients with advanced nephropathy receiving treatment for hypertension, mainly a combination of angiotensin converting enzyme inhibitors, metoprolol and diuretics (D4,n = 11). In group D3 24-h diastolic blood pressure (85 ± 8 mm Hg) was comparable to the results obtained in D4 (85 ± 8 mm Hg) but significantly higher than in D2 (78 ± 7 mm Hg), D1 (73 ± 7 mm Hg) and C (73 ± 7 mm Hg,p 〈 0.05, Tukey's test). The night/day ratio of diastolic blood pressure was higher in D3 (86 ± 5 %) and D2 (85 ± 7%) than in C (80 ± 7 %,p 〈 0.02). This ratio was also elevated in group D4 (94 ± 8%) compared to D3 (p 〈 0.05) corresponding to a marked smoothing of the diurnal blood pressure curve. The 24-h heart rate (beats per min) was significantly elevated in D3 (84 ± 8) and D2 (80 ± 10) compared with C (73 ± 11,p 〈 0.05 Tukey's test), suggesting the presence of parasympathetic neuropathy In conclusion the normal circadian variation of blood pressure was moderately disturbed in a group of microalbuminuric patients and patients with less advanced overt nephropathy. Patients with advanced diabetic nephropathy receiving antihypertensive therapy showed a marked reduction of nocturnal blood pressure fall, which can only be identified by the application of ambulatory blood pressure measurements to verify the 24-h effectiveness of blood pressure control.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02221684
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