Heterogeneous nature of microalbuminuria in NIDDM

Studies of endothelial function and renal structure

P. Fioretto, C. D.A. Stehouwer, Michael Mauer, M. Chiesura-Corona, E. Brocco, A. Carraro, E. Bortoloso, V. W.M. Van Hinsbergh, G. Crepaldi, R. Nosadini

Research output: Contribution to journalArticle

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Abstract

Microalbuminuria (MA) is associated with microangiopathy (renal and retinal lesions) in insulin-dependent diabetic (IDDM) patients. In contrast MA does not reflect microvascular damage in a substantial number of non- insulin-dependent diabetic (NIDDM) patients. MA predicts cardiovascular disease in NIDDM patients with increased von Willebrand factor (vWF) plasma levels which are hypothesized to reflect endothelial dysfunction. However, it is not known whether MA is consequent to generalised endothelial dysfunction or to renal injury. Thus, this study evaluated vWF plasma levels in relation to renal and retinal structural abnormalities in NIDDM patients with MA. Kidney biopsies, fundoscopy and measures of vWF plasma levels were performed in 32 NIDDM patients with MA. These patients were allocated to two renal structural categories: A) Without renal structural abnormalities (C I, n = 10): normal or near-normal renal structure, and B) With renal structural abnormalities (n = 22), further divided into: C II (n = 12) with typical diabetic nephropathology, predominantly glomerulopathy, and C III (n = 10) with atypical patterns of renal injury (more advanced tubulo-interstitial and arteriolar than glomerular changes). vWF plasma levels were significantly higher in category B (C II: 195 ± 49% and C III: 161 ± 46%) than in category A (C I: 119 ± 42%), (chi-square, p < 0.05). Diabetic retinopathy was also related to vWF plasma levels (ANOVA, p < 0.05). These data suggest that there are two types of MA in NIDDM: one associated with increased vWF levels, established renal injury and frequently retinopathy, and the other characterized by normal vWF levels, normal renal structure and absent or mild diabetic retinopathy. We propose that vWF plasma levels in NIDDM patients with MA may help to identify patients with important renal structural changes, increased retinopathy risk and, perhaps, generalised endothelial dysfunction. Whether vWF plasma levels predict end-stage renal disease and cardiovascular events deserves longitudinal studies.

Original languageEnglish (US)
Pages (from-to)233-236
Number of pages4
JournalDiabetologia
Volume41
Issue number2
DOIs
StatePublished - Jan 1 1998

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Type 2 Diabetes Mellitus
von Willebrand Factor
Kidney
Diabetic Retinopathy
Wounds and Injuries
Insulin
Type 1 Diabetes Mellitus
Chronic Kidney Failure
Longitudinal Studies
Analysis of Variance
Cardiovascular Diseases
Biopsy

Keywords

  • Endothelial function
  • Microalbuminuria
  • Non-insulin-dependent diabetes mellitus
  • Renal structure
  • von Willebrand factor

Cite this

Fioretto, P., Stehouwer, C. D. A., Mauer, M., Chiesura-Corona, M., Brocco, E., Carraro, A., ... Nosadini, R. (1998). Heterogeneous nature of microalbuminuria in NIDDM: Studies of endothelial function and renal structure. Diabetologia, 41(2), 233-236. https://doi.org/10.1007/s001250050895

Heterogeneous nature of microalbuminuria in NIDDM : Studies of endothelial function and renal structure. / Fioretto, P.; Stehouwer, C. D.A.; Mauer, Michael; Chiesura-Corona, M.; Brocco, E.; Carraro, A.; Bortoloso, E.; Van Hinsbergh, V. W.M.; Crepaldi, G.; Nosadini, R.

In: Diabetologia, Vol. 41, No. 2, 01.01.1998, p. 233-236.

Research output: Contribution to journalArticle

Fioretto, P, Stehouwer, CDA, Mauer, M, Chiesura-Corona, M, Brocco, E, Carraro, A, Bortoloso, E, Van Hinsbergh, VWM, Crepaldi, G & Nosadini, R 1998, 'Heterogeneous nature of microalbuminuria in NIDDM: Studies of endothelial function and renal structure', Diabetologia, vol. 41, no. 2, pp. 233-236. https://doi.org/10.1007/s001250050895
Fioretto, P. ; Stehouwer, C. D.A. ; Mauer, Michael ; Chiesura-Corona, M. ; Brocco, E. ; Carraro, A. ; Bortoloso, E. ; Van Hinsbergh, V. W.M. ; Crepaldi, G. ; Nosadini, R. / Heterogeneous nature of microalbuminuria in NIDDM : Studies of endothelial function and renal structure. In: Diabetologia. 1998 ; Vol. 41, No. 2. pp. 233-236.
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