title: von Willebrand factor and development of diabetic nephropathy in IDDM.
abstract: We tested the hypothesis that dysfunction of vascular endothelium, indicated by an increase in plasma level of von Willebrand factor (vWF), is present in patients with insulin-dependent diabetes mellitus (IDDM) who develop diabetic nephropathy (DN). DN was classified as absent (urinary albumin excretion [UAE] rate less than 15 microgram/min), incipient (UAE rate 15-200 micrograms/min), or clinical (UAE rate greater than 200 micrograms/min). We followed a cohort of 59 patients for a median of 3 yr. At baseline, 52 patients had no DN, 6 had incipient DN, and 1 had clinical DN. At follow-up, 38 patients had no DN (group 1). Incipient DN had developed in 14 patients and worsened in 3 patients. Clinical DN had worsened in 1 patient. Together, these 18 patients comprised group 2. A decrease in UAE was observed in the remaining three patients with incipient DN at baseline (group 3). In group 1, vWF--measured by immunoelectrophoresis and expressed as a percentage of normal--increased slightly (median 10%, range -43 to 145, P = 0.009). In group 2, vWF increased in all patients (median 80%, range 14 to 206 [corrected], P = 0.0002 vs. baseline and group 1). In group 3, vWF decreased (median -19%, range -44 to -18). After correction for possible confounders, i.e., age, varying duration of follow-up, and initial level of vWF, the difference in vWF change between groups 1 and 2 remained significant (P = 0.009). Poor glycemic control at baseline, estimated by glycosylated hemoglobin, was a significant predictor of increases in vWF in both group 1 and groups 1 and 2 combined.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Internal Medicine, Bergweg Municipal Hospital, Rotterdam, Netherlands.
authors.forename: C D
authors.initials: CD
authors.lastname: Stehouwer
authors.forename: E S
authors.initials: ES
authors.lastname: Stroes
authors.forename: W H
authors.initials: WH
authors.lastname: Hackeng
authors.forename: P G
authors.initials: PG
authors.lastname: Mulder
authors.forename: G J
authors.initials: GJ
authors.lastname: Den Ottolander
mesh_terms: D000328:Adult; D000419:Albuminuria; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000503:physiopathology* / Q000652:urine; D003928:Diabetic Nephropathies / Q000097:blood / Q000503:physiopathology* / Q000652:urine; D005169:Factor VIII / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012907:Smoking; D014841:von Willebrand Factor / Q000032:analysis*
chemical_list: D015415:Biomarkers; D002784:Cholesterol; D003404:Creatinine; D005169:Factor VIII; D006442:Glycated Hemoglobin; D014841:von Willebrand Factor