Enhanced erythrocyte Na+/H+ exchange predicts diabetic nephropathy in patients with IDDM.
Diabetic nephropathy develops in a subset of patients with an apparently hereditary predisposition. Microalbuminuria and elevated arterial pressure have been proposed as predictors of nephropathy but both appear when renal damage is impending. Enhanced sodium-hydrogen exchange in the cell membranes of diabetic patients is an early marker of diabetic nephropathy but its predictive value has not been assessed. In this study, sodium-hydrogen exchange was measured in erythrocytes as an initial velocity of amiloride-inhibited H+ efflux (pH 6.35-6.45) into a Na+ - containing medium (pH 7.95-8.05) in 156 non-microalbuminuric insulin-treated diabetic patients (98 women, 58 men, age 33+/-8 years, diabetes duration prior to enrollment 15+/-4 years) during 8 years of follow-up. Enhanced erythrocyte sodium-hydrogen exchange predicted diabetic nephropathy alone and in association with a familial tendency to hypertension/nephropathy with 86 and 96% sensitivity, and 80% specificity. Thus, sodium-hydrogen exchange appears to detect a subset of diabetic patients prone to develop renal damage, in whom a more intensive treatment modality might be considered.
Koren
W
W
Hypertension Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Koldanov
R
R
Pronin
V S
VS
Postnov
I Y
IY
Peleg
E
E
Rosenthal
T
T
Berezin
M
M
Postnov
Y V
YV
D000328:Adult; D000419:Albuminuria / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications; D003928:Diabetic Nephropathies / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000235:genetics; D004912:Erythrocytes / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D017923:Sodium-Hydrogen Exchangers / Q000097:blood*
D017923:Sodium-Hydrogen Exchangers