Summary
The respective rôles of arterial blood pressure and metabolic control in different stages of diabetic nephropathy were analyzed retrospectively in 52 sequentially-followed Type 1 (insulin-dependent) diabetic patients. A negative correlation was found between median post-prandial blood glucose and median duration of diabetes until onset of persistent proteinuria (p<0.01). Systolic blood pressure was higher in patients who subsequently developed persistent proteinuria than those who did not (140 versus 121 mmHg; p<0.05), but duration of the interval until onset of persistent proteinuria was not related to blood pressure. After onset of persistent proteinuria, hypertensive diabetic patients developed elevated serum creatinine concentrations more frequently than normotensive diabetic patients (67% versus 14%, p<0.05). In these patients, the delay until elevation of serum creatinine concentration was negatively correlated with blood glucose (p<0.01). Once serum creatinine was raised, decay of renal function occurred faster in patients with persistent than intermittent hypertension (p<0.05). No effect of metabolic control was demonstrable at this stage of nephropathy. It is concluded that metabolic control determines the early course of diabetic nephropathy, whereas blood pressure is more important in advanced stages of nephropathy.
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Mogensen CE (1976) Progression of nephropathy in long-term diabetics with proteinuria and effect of initial anti-hypertensive treatment. Scand J Clin Lab Invest 36: 384–388
Mogensen CE (1982) Long-term antihypertensive treatment inhibiting progression of diabetic nephropathy. Br Med J 285: 685–688
Parving HH, Andersen AR, Smidt UM, Svendsen PA (1983) Early aggressive anti-hypertensive treatment reduces rate of decline in kidney function in diabetic nephropathy. Lancet 1: 1175–1179
Hostetter THH, Troy JL, Brenner BM (1981) Glomerular hemodynamics in experimental diabetes mellitus. Kidney Int 19: 410–415
Michels LD, Davidman M, Keane WF (1981) Determinants of glomerular filtration and plasma flow in experimental diabetic rats. J Lab Clin Med 98: 869–885
Pirart J (1977) Diabéte et complications dégénératives. Présentation d'une étude prospective portant sur 4400 cas observés entre 1947 et 1973 (deuxième partie). Diabete Metab 3: 173–182
Takazakura E, Nakamoto Y, Hayakawa H, Kawai K, Muramoto S, Yoshida K, Shimizu M, Shinoda A, Takeuchi J (1975) Onset and progression of diabetic glomerulosclerosis. Diabetes 24: 1–9
Deckert T, Poulsen JE (1981) Diabetic nephropathy: fault or destiny? Diabetologia 21: 178–183
Mogensen CE, Christensen CK, Vittinghus E (1983) The stages in diabetic renal disease with emphasis on the stage of incipient diabetic nephropathy. Diabetes 32: 64–78
Tamborlane WV, Puklin JE, Bergman M, Verdonk C, Rudolf MC, Feiig P, Genel M, Sherwin R (1982) Long-term improvement of metabolic control with the insulin pump does not reverse diabetic microangiopathy. Diabetes Care 5 (Suppl 1): 58–64
Holman RR, Dornan TL, Mayon-White V, Howard-Williams J, Orde-Peckar C, Jenkins L, Steemson J, Rolfe R, Smith B, Barbour D, McPherson K, PYW Poon, Rizza C, Mann JI, Knight AH, Bron AJ, Turner RC (1983) Prevention of deterioration of renal and sensory nerve function by more intensive management of insulin-dependent diabetic patients. Lancet 1: 204–208
Viberti GC, Bilous RW, Mackintosch D, Bending JJ, Keen H (1983) Long-term correction of hyperglycaemia and progression of renal failure in insulin-dependent diabetes. Br Med J 286: 598–602
Gyure WL (1977) Comparison of several methods of semi-quantitative determination of urinary protein. Clin Chem 23: 876–879
Popper H, Mandel E, Mayer H (1937) Zur Kreatininbestimmung im Blute. Biochem Z 291: 354–358
Wiseman M, Viberti G, Mackintosh D, Jarrett RJ, Keen H (1984) Glycaemia, arterial pressure and micro-albuminuria in Type 1 (insulin-dependent) diabetes mellitus. Diabetologia 26: 401–405
Mathiesen ER, Oxenbøll B, Johansen K, Svendsen PAa, Deckert T (1984) Incipient nephropathy in Type 1 (insulin-dependent) diabetes. Diabetologia 26: 406–410
Knowler WC, Bennett PH, Ballantine EJ (1980) Increased incidence of retinopathy in diabetics with elevated blood pressure. New Engl J Med 302: 645–650
Andersen AR, Sandahl Christiansen J, Andersen JK, Kreiner S, Deckert T (1983) Diabetic nephropathy in Type 1 (insulin-dependent) diabetes: an epidemiological study. Diabetologia 25: 496–501
Jones RH, Hayakawa H, Mackay JD, Parsons V, Watkins PJ (1979) Progression of diabetic nephropathy. Lancet 1: 1105–1106
Parving H-H, Smidt UM, Friisberg B, Bonnevie-Nielsen V, Andersen AR (1981) A prospective study of glomerular filtration rate and arterial blood pressure in insulin-dependent diabetics with diabetic nephropathy. Diabetologia 20: 457–461
Viberti GC, Bilous RW, Mackintosh D, Keen H (1983) Monitoring glomerular function in diabetic nephropathy. A prospective study. Am J Med 74: 256–264
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Hasslacher, C., Stech, W., Wahl, P. et al. Blood pressure and metabolic control as risk factors for nephropathy in Type 1 (insulin-dependent) diabetes. Diabetologia 28, 6–11 (1985). https://doi.org/10.1007/BF00276992
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DOI: https://doi.org/10.1007/BF00276992