title: Glomerular size- and charge selectivity in type 2 (non-insulin-dependent) diabetic patients with diabetic nephropathy.
abstract: In an attempt to evaluate the mechanisms of proteinuria in diabetic kidney disease, we measured the renal clearances of albumin, total IgG, and IgG4 in 20 male Type 2 (non-insulin-dependent) diabetic patients with diabetic glomerulosclerosis (biopsy proven), in 10 male Type 2 diabetic patients without nephropathy (urinary albumin excretion rate < or = 30 mg/24 h), and in 10 healthy male subjects. The fractional clearance of albumin was increased in patients with nephropathy: 659 (42-4355) x 10(-6) (median (range)), compared to 2.6 (0.2-14.2) x 10(-6) in patients without nephropathy, and 2.3 (0.4-4.2) x 10(-6) in healthy subjects. The fractional clearance of total IgG (neutral) and of IgG4 (anionic) was 40-50 times higher in patients with nephropathy compared to the two other groups. The IgG/IgG4 selectivity index was not significantly different in the three groups, being: 1.12 (0.06-5.65), 1.16 (0.45-3.72) and 1.35 (0.65-3.34) in patients with nephropathy, patients without nephropathy, and healthy subjects, respectively. The IgG/albumin selectivity index was decreased in patients with nephropathy: 0.27 (0.01-1.26) compared to 1.29 (0.07-2.67) (p < 0.05) and 1.23 (0.76-7.84) (p < 0.001) in patients without nephropathy and healthy subjects, respectively. No significant change in IgG/albumin selectivity index was observed between patients without nephropathy and healthy subjects. The systolic blood pressure was elevated in the patients with nephropathy: 164 +/- 21 mm Hg (mean +/- SD) compared to patients without nephropathy: 145 +/- 20 mm Hg (p < 0.05) and to healthy subjects: 133 +/- 19 mm Hg (p < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: M A
authors.initials: MA
authors.lastname: Gall
authors.forename: P
authors.initials: P
authors.lastname: Rossing
authors.forename: A
authors.initials: A
authors.lastname: Kofoed-Enevoldsen
authors.forename: F S
authors.initials: FS
authors.lastname: Nielsen
authors.forename: H H
authors.initials: HH
authors.lastname: Parving
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000652:urine; D001706:Biopsy; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology / Q000503:physiopathology* / Q000652:urine; D003928:Diabetic Nephropathies / Q000473:pathology / Q000503:physiopathology* / Q000652:urine; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000145:classification / Q000652:urine; D007678:Kidney Glomerulus / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D011507:Proteinuria; D012016:Reference Values
chemical_list: D007074:Immunoglobulin G