REVERSIBLE TUBULAR PROTEINURIA PRECEDES MICROALBUMINURIA AND CORRELATES WITH THE METABOLIC STATUS IN DIABETIC CHILDREN

被引：52

作者：

GINEVRI, F

PICCOTTI, E

ALINOVI, R

DETONI, T

BIAGINI, C

CHIGGERI, GM

GUSMANO, R

机构：

[1] Department of Nephrology, G. Gaslini Institute, Genoa, 16 148

[2] Department of Paediatrics, G. Gaslini Institute, Genoa, 16 148

[3] Institute of Clinical Medicine and Nephrology, University of Parma, Parma

来源：

PEDIATRIC NEPHROLOGY | 1993年 / 7卷 / 01期

关键词：

DIABETES-MELLITUS; TUBULAR CHANGES; ALBUMINURIA; METABOLIC CONTROL; BRUSH BORDER ANTIGENS;

D O I：

10.1007/BF00861555

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

Early tubular alterations were studied in 53 children with insulin-dependent diabetes mellitus (IDDM), 32 of whom were followed at regular 6-monthly intervals for 3 years. The urinary levels of retinol-binding protein (RBP), beta2-microglobulin and brush border antigens (BBA) (determined by monoclonal enzyme immunoassay) were taken as indices of functional and cellular tubular alterations; urinary albumin was considered an early marker of glomerular alterations. All indices of tubular alterations were higher in IDDM children than in 368 normal children, while albuminuria was unchanged. Urinary levels of BBA, however, varied widely during follow-up, with 25 of the 32 IDDM patients who were followed at regular intervals having pathological values for BBA on at least one occasion, followed by normalization. Metabolic alteration was found to be the main cause of this variability, since a high statistical correlation was found between urinary BBA and fructosamine (P <0.001) and between RBP and the stable fraction of glycosylated haemoglobin (P <0.001). The data confirm that transient tubular proteinuria occurs in diabetic children before any other marker of renal involvement such as microalbuminuria. The maintenance of good metabolic control is essential to normalize this early abnormality that can be considered a reversible sign of functional renal involvement.

引用

页码：23 / 26

页数：4

共 25 条

[1]

Keen H., Choluiverkas C., Urinary albumin excretion and diabetes mellitus, Lancet, 2, pp. 1155-1156, (1964)

[2]

Viberti G.C., Hill R.D., Jarret R.J., Agyropulos A., Mahmud V., Keen H., Microalbuminuria as a predictor of clinical nephropathy in insulin dependent diabetes mellitus, Lancet, 2, pp. 1430-1432, (1982)

[3]

Mogensen C.E., Microalbuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes, N Engl J Med, 910, pp. 356-360, (1984)

[4]

Park C.H., Maack T., Albumin absorption and catabolism by isolated and perfused proximal tubule of rabbit, J Clin Invest, 73, pp. 767-777, (1984)

[5]

Bernard A., Viau C., Ouled A., Lawerys R., Competition between low and high molecular weight proteins for renal tubular uptake, Nephron, 45, pp. 115-118, (1987)

[6]

Lopes-Virella M.F., Virella G., Rosebrock G., Sorgel J., Gonroles J., Calwell J., Early diagnosis of renal manifestations in diabetics, Diabetologia, 16, pp. 165-171, (1979)

[7]

Teppol M., Groop L., Urinary excretion of plasma proteins in diabetic subjects. Increased excretion of kappa light chains in diabetic patients with and without proliferative retinopathy, Diabetes, 34, pp. 585-594, (1985)

[8]

Holm J., Hemmingsen L., Nielsen N.V., Thoen M., Increased urinary excretion of the retinol-binding protein in IDDM in the absence of microalbuminuria, Clin Chim Acta, 170, pp. 345-350, (1987)

[9]

Gibb D.M., Tombinson P.A., Dalton N.R., Turner C., Shoh V., Barret T.M., Renal tubular proteinuria and microalbuminuria in diabetic patients, Arch Dis Child, 64, pp. 129-134, (1988)

[10]

Pun K., Ho P., Lau P., Wong F.H., Eight-month lingitudinal study of urinary excretion of albumin and tubular proteins in diabetes mellitus, Am J Nephrol, 10, pp. 475-481, (1990)

← 1 2 3 →