Decreased urinary concentration of Tamm-Horsfall protein is associated with development of renal failure and cardiovascular death within 20 years in type 1 but not in type 2 diabetic patients.
OBJECTIVE
The first changes in the diabetic kidney are glycogen deposits in the epithelial cells of the thick ascending limb of Henle. These cells produce Tamm-Horsfall protein (THP). Is low excretion of THP associated with the development of renal insufficiency or cardiovascular disease?


METHODS
Urine samples were collected at baseline in patients with type 1 (n = 131) and type 2 (n = 108) diabetes who were followed for a mean of 14 years (range 1-20 years) and 4.5 years (range 1-15 years), respectively.


RESULTS
Twenty percent of type 1 and 54% of type 2 diabetic patients died and 24% and 29%, respectively developed uraemia. A decreased urinary concentration of THP (u-THP) was associated with an eight-fold increased risk of renal failure and cardiovascular death in type 1 but not in type 2 diabetic patients, irrespective of the degree of albuminuria and glycosylated haemoglobin and blood pressure levels. There were no differences in the degrees of albuminuria, serum creatinine or u-THP between the two types of diabetic patients at baseline. Low u-THP occurred in 8% and 9% of normoalbuminuric type 1 and type 2 diabetic patients, respectively.


CONCLUSIONS
A decreased u-THP was associated with an eight-fold increased risk of cardiovascular death and uraemia in type 1 but not in type 2 diabetic patients.
Sejdiu
Ilir
I
Department of Emergency Medicine, Institution of Clinical Sciences, University Hospital, Lund, Sweden.
Torffvit
Ole
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000652:urine; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000652:urine; D002423:Cause of Death / Q000639:trends; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000652:urine*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009088:Mucoproteins / Q000652:urine*; D011379:Prognosis; D012372:ROC Curve; D051437:Renal Insufficiency / Q000209:etiology* / Q000401:mortality / Q000652:urine; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D058949:Uromodulin
D015415:Biomarkers; D009088:Mucoproteins; C548612:UMOD protein, human; D058949:Uromodulin