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Monitoring glomerular function in diabetic nephropathy. A prospective study.
Am J Med. 1983 Feb; 74(2):256-64.AJ

Abstract

Glomerular function was monitored prospectively in 13 patients with insulin-dependent diabetes and diabetic nephropathy for up to 51 months. Glomerular filtration rate, measured by 51Cr-EDTA clearance, showed a linear decline in all patients. Rates of fall ranged between 0.63 and 2.4 ml/minute per month (mean +/- SEM 1.2 +/- 0.16). Plasma creatinine concentration proved to be an insensitive marker of glomerular function, especially in the early phase of nephropathy. A good correlation was found between the rate of change of 51Cr-EDTA glomerular filtration rate and that of inverse creatinine levels when plasma creatinine concentrations exceeded 200 mumol/liter. Inverse plasma beta 2-microglobulin concentrations, however, showed a highly significant correlation (r = 0.93; p less than 0.001) with 51Cr-EDTA glomerular filtration rate over the whole range of values, making it sensitive in screening for early impairment of renal function. A significant relationship (r = 0.85; p less than 0.01) was found between the rates of change of the 51Cr-EDTA glomerular filtration rate and of inverse beta 2-microglobulin levels for plasma beta 2-microglobulin concentrations above 3 mg/liter. A progressive increase in the fractional clearance of albumin, IgG, and beta 2-microglobulin was noted as the glomerular filtration rate fell, indicating an evolving defect in the renal handling of proteins. The rate of decline of the glomerular filtration rate was unrelated to age, sex, duration of diabetes, duration of diabetes before onset of proteinuria, glomerular filtration rate, initial albumin clearance, blood glucose control, and arterial pressure, when diastolic values were below 100 mm Hg. The effect of therapeutic intervention (e.g., blood glucose, blood pressure, or diet) on the progression of diabetic nephropathy can be reliably evaluated by precise measures of rate of decline of glomerular filtration rate and changes in fractional clearance of plasma proteins. The factor(s) determining the individual rate of decline of renal function still remain obscure.

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Publisher Full Text

Authors

Viberti GC
No affiliation info available
Bilous RW
No affiliation info available
Mackintosh D
No affiliation info available
Keen H
No affiliation info available

MeSH

AdultCreatinineDiabetic NephropathiesEdetic AcidFemaleGlomerular Filtration RateHumansImmunoglobulin GKidneyMaleMiddle AgedPrognosisProspective StudiesSerum AlbuminTime Factorsbeta 2-Microglobulin

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

6401924

Citation

Viberti, G C., et al. "Monitoring Glomerular Function in Diabetic Nephropathy. a Prospective Study." The American Journal of Medicine, vol. 74, no. 2, 1983, pp. 256-64.
Viberti GC, Bilous RW, Mackintosh D, et al. Monitoring glomerular function in diabetic nephropathy. A prospective study. Am J Med. 1983;74(2):256-64.
Viberti, G. C., Bilous, R. W., Mackintosh, D., & Keen, H. (1983). Monitoring glomerular function in diabetic nephropathy. A prospective study. The American Journal of Medicine, 74(2), 256-64.
Viberti GC, et al. Monitoring Glomerular Function in Diabetic Nephropathy. a Prospective Study. Am J Med. 1983;74(2):256-64. PubMed PMID: 6401924.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Monitoring glomerular function in diabetic nephropathy. A prospective study. AU - Viberti,G C, AU - Bilous,R W, AU - Mackintosh,D, AU - Keen,H, PY - 1983/2/1/pubmed PY - 1983/2/1/medline PY - 1983/2/1/entrez SP - 256 EP - 64 JF - The American journal of medicine JO - Am J Med VL - 74 IS - 2 N2 - Glomerular function was monitored prospectively in 13 patients with insulin-dependent diabetes and diabetic nephropathy for up to 51 months. Glomerular filtration rate, measured by 51Cr-EDTA clearance, showed a linear decline in all patients. Rates of fall ranged between 0.63 and 2.4 ml/minute per month (mean +/- SEM 1.2 +/- 0.16). Plasma creatinine concentration proved to be an insensitive marker of glomerular function, especially in the early phase of nephropathy. A good correlation was found between the rate of change of 51Cr-EDTA glomerular filtration rate and that of inverse creatinine levels when plasma creatinine concentrations exceeded 200 mumol/liter. Inverse plasma beta 2-microglobulin concentrations, however, showed a highly significant correlation (r = 0.93; p less than 0.001) with 51Cr-EDTA glomerular filtration rate over the whole range of values, making it sensitive in screening for early impairment of renal function. A significant relationship (r = 0.85; p less than 0.01) was found between the rates of change of the 51Cr-EDTA glomerular filtration rate and of inverse beta 2-microglobulin levels for plasma beta 2-microglobulin concentrations above 3 mg/liter. A progressive increase in the fractional clearance of albumin, IgG, and beta 2-microglobulin was noted as the glomerular filtration rate fell, indicating an evolving defect in the renal handling of proteins. The rate of decline of the glomerular filtration rate was unrelated to age, sex, duration of diabetes, duration of diabetes before onset of proteinuria, glomerular filtration rate, initial albumin clearance, blood glucose control, and arterial pressure, when diastolic values were below 100 mm Hg. The effect of therapeutic intervention (e.g., blood glucose, blood pressure, or diet) on the progression of diabetic nephropathy can be reliably evaluated by precise measures of rate of decline of glomerular filtration rate and changes in fractional clearance of plasma proteins. The factor(s) determining the individual rate of decline of renal function still remain obscure. SN - 0002-9343 UR - https://www.unboundmedicine.com/medline/citation/6401924/Monitoring_glomerular_function_in_diabetic_nephropathy__A_prospective_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/0002-9343(83)90624-1 DB - PRIME DP - Unbound Medicine ER -