Imipenem/cilastatin reduces cyclosporin-induced tubular damage in kidney transplant recipients.
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Acetylglucosaminidase↗
Biomedical subjects
O Giampietro
Publications and source records attributed to O Giampietro.
Urinary excretion rates of multiple renal indicators after kidney transplantation: clinical significance for early graft outcome.
Post-reperfusion inflammation as well as anti-allograft response occur following kidney transplantation. We evaluated tissue damage by multiple renal indicators and searched for rejection predictors forewarning serum creatinine upturns. Twenty recipients (43 +/- 9 y; donors' age 35 +/- 16 y) of first renal grafts were studied. All through their hospital stay (35 +/- 18 d, range 17-75 d) we measured serum levels of urea, creatinine and electrolytes along with urinary excretion rates of total protein, albumin, enzymes (GGT, NAG, AAP) and electrolytes. During the period of observation, peaks were seen on the 1st day for serum creatinine, serum K+ and urine albumin output; on the 2nd day for urine Na+, GGT, AAP and protein excretion rates; on the 4th day for urea and creatinine outputs; on the 5th day for NAG output. On the 14th day, serum urea and creatinine as well as urine GGT, NAG, AAP, albumin and total protein were still elevated compared to 20 healthy control subjects. Delayed/slow graft function was observed in six recipients with higher pre-transplantation plasma lipids and lower donor HDL cholesterol. Hospital stay time was correlated with need for post-transplantation dialysis (p = 0.01) and recipient proteinuria by time 0 (TO) to day 3 (p = 0.02). Cold ischemia time was positively associated with 0-3 d serum creatinine, 0-3 d urinary urea and protein outputs (multiple r 0.9, p < 0.001). Multivariate analysis of longitudinal data showed that recipients' serum creatinine was positively correlated (p < 0.001) with urine AAP and negatively correlated with urine albumin, with diuresis volume and urine creatinine (p < 0.01). Serum creatinine elevations were preceded (previous 1-7 d) by increases in urinary indicators, the probability being higher in the presence of multiple simultaneous abnormalities. Useful parameters predictive of favorable graft outcome prior to transplantation included a brief cold ischemia time and a normal donor/recipient serum lipoprotein profile. Following transplantation, useful parameters were a high diuresis volume at time zero along with low urine NAG and high albumin outputs; early (first opst-graft 3 d) polyuria, low urea and GGT, high K, NAG and total protein excretions.
Adult↗
[Ultrasonic tissue characterization analysis in type 1 diabetes: a very early index of diabetic cardiomyopathy?].
BACKGROUND: Based on various epidemiological observations, it has been hypothesized that there is a "diabetic cardiomyopathy" strictly related to diabetes per se and probably due to an increase in the collagen content at the myocardial level, to microangiopathy or to complex alteration of myocardial metabolic pattern. Ultrasonic tissue characterization has recently been applied with different methodological approaches in order to identify early structural alterations of the myocardium. METHODS: We used two different methods of myocardial tissue characterization, i.e. integrated backscatter and videodensitometry, to analyze 26 type I diabetics without clinical symptoms, without hypertension or coronary artery disease, which were excluded on the basis of a negative exercise ECG, and in whom conventional echocardiographic parameters were normal. Seventeen healthy age- and sex-matched subjects were evaluated as the control group. RESULTS: Of the common left ventricular functional indexes, only E/A ratio (expression of global diastolic function) was lower in diabetics compared with controls (p < 0.01). The integrated backscatter index (IBI%) at the septum and posterior wall was significantly higher in diabetics as compared to controls, expressing an increased collagen content on a myocardial level. The cyclic variation index (%) of the mean gray level (videodensitometry) was significantly lower in diabetics in comparison with controls, both for the septum (p < 0.0001) and posterior wall (p < 0.002). This probably expresses an altered intrinsic myocardial contractility, due to an increase in myocardial collagen content and/or impairment of micro-circulatory function. CONCLUSION: In agreement with previous studies, we found an altered behavior in myocardial tissue reflectivity in type I diabetics. The real significance of this finding in the "normal" heart is the subject of intense debate. One hypothesis is that these findings could be considered a very early index of a "diabetic cardiomyopathy".
Adult↗
The reliability of urinary albumin assay by immunonephelometry in the clinical practice. The critical role of medical surveillance on laboratory routine.
Measurement of the urinary albumin excretion rate (UAER) is essential for the early diagnosis and monitoring of diabetic nephropathy; immunonephelometry is a procedure used worldwide for routine screening of diabetic patients. Since we have met with occasional inconsistent values of UAER in serial urine collections, we searched for possible sources of analytic error. To assess the best working conditions of the instrument in use, the stability of urine samples during storage and the need for previous urine centrifugation, we assayed repeatedly the six automatically diluted points of the standard curve (55.6 to 1.7 mg/l), four control samples of human albumin in saline (100 to 1 mg/l) and 24-h urine collections from outpatient diabetic subjects. The last were also assayed with and without previous centrifugation, and both immediately after collection as well as after storage at -20 degrees C for 7, 42, 79, 97, 128 and 161 days. We concluded that: (1) pre-analytic centrifugation of urine samples in unnecessary; (2) the intra-assay coefficient of variation (CV) of the standard curve changed from 2.4% to 9.3% when moving from the highest to the lowest concentration; the inter-assay CV changed from 4.1% to 14.4%, respectively; (3) the intra-assay CV of the control samples (manually prepared) changed from 5.7% to 10.2% and the inter-assay CV from 7.7% to 22.9%; there was a constant and significant (P < 0.01) underestimation (from -9% to -30%) of the obtained values compared with the expected concentrations; (4) a progressive decrease in recovered albumin by multiple freezing and thawing of urine samples did occur, which became significant after 161 days of storage. In the BNA workbook (menu 7.1, assay protocols), a 7-day validity of the reference curve is reported. Moreover, to economize, pre-dilution cuvettes were often recycled in our hospital central laboratory. We observed that: the intra-assay CV for urine samples was 79.4% with recycled cuvettes and stored standard curve, 11.3% with new cuvettes and stored standard curve, 4.9% with both new cuvettes and newly performed standard curve; the inter-assay CV was 32.6%, 10.5% and 6.4%, respectively. These data emphasize, from the laboratory viewpoint, the need for both accurate calibration of BNA and use of native urines; in addition, they stress the importance of careful supervision of laboratory routine and interpreting analytic results in the clinical setting.
Albuminuria↗
Erythrocyte Na+/H+ exchange and preclinical abnormalities of the left ventricular diastolic function in normotensive type 1 (insulin-dependent) diabetic patients.
We assessed the relationship between erythrocyte Na+/H+ antiport activity and myocardial anatomical-functional parameters (by Doppler echocardiography) in normotensive IDDM patients, with and without microalbuminuria. We studied 33 normotensive IDDM subjects and 14 matched healthy controls (group 4). Based on urinary albumin excretion rate (UAER), 23 diabetics were normoalbuminuric, 10 microalbuminuric (group 3). Normoalbuminurics were divided up for normal (group 1, n = 13) or high (group 2, n = 10) antiport activity. We evaluated fasting glycaemia and 24-h urine glucose output, HbA1c, plasma lipids, urea, creatinine and electrolyte clearances, UAER, erythrocyte Na+/H+ countertransport, M-Mode and 2D echocardiograms with Doppler analysis. Antiport, which was higher in diabetics than controls, was significantly overactive in groups 2 and 3 vs group 4, independently from UAER. Diabetics showed left ventricular volume, cardiac mass and systolic function within the control range. In left ventricular diastolic filling, while peak E was similar in diabetic and healthy people, the late peak transmitral flow velocity (peak A) was significantly higher in diabetics than controls, and this was also true in groups 2 and 3 vs group 4. Antiport activity was positively related to peak A (p < 0.03). These observations suggest that (a) the Na+/H+ antiport may be overactive in diabetes, apart from microalbuminuria; (b) increased Na+/H+ antiport activity, in normotensive IDDM people, may be associated with preclinical diastolic myocardial dysfunction ("incipient diabetic cardiomyopathy"?).
Adult↗
Role of donor/recipient Na+/H+ antiport activity as a nonimmunologic predictor of kidney graft outcome.
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Adult↗
Activity of erythrocyte sodium-hydrogen exchange in normal pregnancy.
1. Pregnancy is associated with a 30-50% rise in cardiac output and a 50% increase in blood volume. The contribution of changes in the activity of primary and secondary active transporters to these haemodynamic adaptations remains unknown. For the first time, we measured sodium-hydrogen exchange activity over the course of normal pregnancy. 2. Eighteen healthy pregnant women were studied at 14, 24 and 33 weeks of gestation and compared with 18 non-pregnant healthy women. None of the pregnancies was complicated by hypertension. At each antenatal visit, body weight and blood pressure were recorded, blood and 24 h-urine samples were taken to control renal function and metabolic equilibrium, maternal glucose tolerance was evaluated by oral glucose test and glycated haemoglobin testing, and erythrocyte sodium-hydrogen antiport was also measured. 3. Erythrocyte antiport activity values were 10.0 +/- 3.0, 9.6 +/- 2.9 and 8.4 +/- 3.5 mmol h-1 (litre of cells)-1 in the three gestational trimesters respectively, significantly higher at each trimester than in control women [6.8 +/- 2.5 mmol h-1 (litre of cells)-1]. The clearances of urea and creatinine were constantly elevated in pregnant women; at each trimester their serum concentrations were lower than in non-pregnant women. Serum potassium significantly decreased during pregnancy. Serum total cholesterol and triacylglycerol levels, already above the normal range from the first trimester, further increased until the third trimester. The area under the glycaemic curve became larger during pregnancy, and the area under the insulinaemic curve increased to a lesser extent. There was a significant association between antiport activity and serum triacylglycerol levels. 4. The observed hyperactivity of the transporter, peaking at the fourteenth week of gestation, may be a contributing factor to the haemodynamic adjustments attending upon normal pregnancy.
Adult↗
Na(+)-H+ exchange activity throughout pregnancy: the proper experimental approach.
Pregnancy is associated with a 30-50% rise in cardiac output and a close to 50% increase in blood volume. The Na(+)-H+ exchanger is a key mediator of tubular NaCl absorption and a stimulus-response coupling mediator. We measured erythrocyte Na(+)-H+ exchange activity over the course of normal pregnancy in 18 healthy pregnant women (mean age 32 +/- 4 years) at 14, 24 and 33 weeks of gestation and 15 nonpregnant healthy women (mean age 32 +/- 9 years). No pregnancy was complicated by hypertension. Serum urea, creatinine and sodium did not change through gestation, while serum potassium slightly but significantly decreased. Urinary excretion rates of both sodium and potassium remained unchanged. Urea and creatinine clearances were constantly elevated in pregnant vs non-pregnant control women. Erythrocyte Na(+)-H+ exchanger reached the highest activity at about the 14th week of gestation, when cardiac output also peaked. Thereafter, it tended to decrease, yet remaining above the normal values until the 34th week. Conceivably, the observed hyperactivity of the transporter may be a contributing factor to the hemodynamic adjustments attending to normal pregnancy.
Erythrocytes↗
Gestational diabetes mellitus (GDM) and macrosomia: a controversial story.
Increased perinatal morbidity-mortality are associated with gestational diabetes mellitus (GDM). We studied 69 non-diabetic pregnancies (age 30 +/- 5 years) by repeating oral glucose tolerance test (OGTT, 100 g; area under glycemic, AUGC as g min/dl, and insulinemic, AUIC as mU min/ml, curves were calculated) and HbA1c measurement at 14, 24 and 33 weeks. In the 3rd trimester, 7 women had abnormal OGTT, but none of the 12 mothers of large babies (> 3.9 kg) had GDM. Among 15 pregnants with basal body mass index (BMI) > 25 kg/m2, 2 developed GDM, 5 had babies > 3.9 kg, 8 had normal birthweight babies. Those pregnants who showed after-load hyperglycemia despite normal insulin secretory response (insulin resistance) developed GDM, but delivered normal birthweight babies. Large neonates were delivered from women with the greatest both gestational weight gain and insulin sensitivity, but normal glucose tolerance. The heaviest pregnants with normal both glucose tolerance and insulin sensitivity had normal weight gain and normal birthweight infants. Neonatal body weight was correlated with maternal gestational weight gain, placental weight, 3rd trimester AUIC/AUGC ratio and 1st-2nd trimester HbA1c.
Adult↗
An early diagnosis of kidney involvement in immunologically-mediated multisystem diseases.
Kidney involvement in immuno-mediated diseases is a life threatening complication to be early detected. Glomerulo-tubular functional indices, kidney-released enzymes and metabolic profiles were assessed in 21 patients with systemic lupus erythematosus, progressive systemic sclerosis and mixed cryoglobulinaemia, without overt nephropathy at a current laboratory examination, and in 31 age-sex-matched healthy controls. All patients had a urinary total protein excretion rate higher than controls (353.6 +/- 182.4 vs 243.0 +/- 108.2 mg/24 h, p < 0.01); 12 of them resulted albuminuric (775.5 +/- 1192.4 mg/24 h), while 9 were normoalbuminuric (16.6 +/- 7.6 mg/24 h). Urinary enzyme excretion rates (GGT and NAG) were significantly heightened compared to healthy subjects, both in albuminuric and in normoalbuminuric patients. Serum albumin resulted significantly lower in all patients, independent of their urinary albumin leakage. Finally, all subjects with connective tissue diseases had significantly higher triglycerides, lower HDL cholesterol and double serum fasting insulin than normals. In conclusion, all patients with collagen diseases show signs of subclinical nephropathy, not always detectable by albuminuria. They also provide evidence of insulin-resistance, a conceivable forerunner of cardiovascular complications.
Adult↗
Erythrocyte sodium-hydrogen antiport activity is not a predictor of diabetic nephropathy.
Erythrocyte sodium-hydrogen antiport activity was measured by Orlov's method in 36 healthy volunteers (18 with negative, 18 with positive family history of hypertension) and 52 subjects with type 1 insulin-dependent diabetes mellitus: 29 patients were without known diabetic complications, 23 patients with microangiopathy (10 with diabetic retinopathy, 13 with 'incipient' diabetic nephropathy). Normotensive healthy adults had similar antiport activities independently of a positive or negative family history of hypertension (6.45 +/- 2.61 vs. 5.80 +/- 3.07 mmol/l of cells per h, respectively). Sodium-hydrogen antiport resulted 8.38 +/- 3.91 mmol/l of cells per h in the 29 uncomplicated diabetic patients, significantly higher (p < 0.05) compared to healthy subjects, both without and with family hypertension. Complicated diabetics confirmed to have an exchange rate higher than healthy controls (8.18 +/- 2.50 mmol/l of cells per h, p < 0.01): patients with retinopathy showed the highest antiport activity (8.96 +/- 2.95 mmol/l of cells per h, p < 0.01), while patients with nephropathy had milder antiport overactivity (7.58 +/- 2.02 mmol/l of cells per h), not significantly different from either uncomplicated diabetics or healthy controls. Thus, an increased sodium-hydrogen exchange rate in peripheral erythrocytes does not seem to be an early indicator of diabetic nephropathy.
Adult↗
Ultrasonic videodensitometric analysis in type 1 diabetic myocardium.
OBJECTIVE: To test the hypothesis that quantitative analysis of two-dimensional echocardiographic gray-level distributions could allow one to detect the early changes in acoustic properties of human diabetes myocardium differentiating it from normal myocardium. METHODS: We evaluated, by two-dimensional echocardiography, 28 asymptomatic type 1 insulin-dependent diabetic patients with normal ventricular function (group A) and 15 age- and sex-matched healthy controls (group B). By selection, all of the diabetics were normotensive and had a negative maximal exercise stress. Echocardiographic images were digitized by using a calibrated digitization system. Quantitative texture analysis was accomplished on data from the septum and posterior wall both at end-diastole and at end-systole. The following parameters were obtained: the mean gray level of the regions of interest, and its absolute SD, skewness, kurtosis, and cyclic variation index. RESULTS: The main result of this study was that the cyclic variation indices of the echo amplitudes of the septum and posterior wall in the diabetic group were significantly lower than those in controls (P < 0.001 and P < 0.002, respectively). Furthermore, the diabetic group had a significantly higher mean gray level of the septum [group A 54.3 +/- 22.5 (mean +/- SD) versus group B 39.7 +/- 9.8, P < 0.03] at end-diastole. The mean gray-level of the posterior wall was similar in the two groups, both at end-diastole and at end-systole. CONCLUSION: Alterations of cyclic echo amplitude (possibly related to collagen deposition) can be detected in asymptomatic diabetic patients with normal resting function. Theoretically, this finding might be considered an early preclinical alteration, potentially related to subsequent development of "diabetic cardiomyopathy'.
Adult↗
Erythrocyte sodium-hydrogen exchange and microalbuminuria in type I diabetes.
OBJECTIVE: To evaluate the relationship between sodium-hydrogen (Na+/H+) exchange and microalbuminuria (an abnormal urinary albumin/creatinine ratio in morning collections) in IDDM patients. RESEARCH DESIGN AND METHODS: Amiloride-sensitive H+ efflux from cells acid loaded at pH 6.5 (defined as erythrocyte Na+/H+ exchange) was measured in normotensive IDDM patients with microalbuminuria and normal renal function (n = 16, serum creatinine < 106.1 mumol/l) and compared with both matched uncomplicated normoalbuminuric diabetic subjects and normal subjects (n = 16 each). RESULTS: Erythrocyte Na+/H+ exchange was elevated to a similar extent in diabetic patients with and without microalbuminuria. Blood pressure and lipids were normal in both diabetic groups. Daily insulin requirement, blood glucose, and glycated hemoglobin were higher and retinopathy more frequent in microalbuminuric patients. CONCLUSIONS: The abnormal erythrocyte Na+/H+ exchange of type I diabetic patients was unrelated to microalbuminuria and could not be ascribed to hypertension or dyslipidemia. Furthermore, the degree of metabolic control seemed to influence the progression of diabetic nephropathy, but not the abnormal antiport activity. The data imply that Na+/H+ exchange is an unlikely marker of nephropathy in type I diabetic patients.
Adult↗
Increased echodensity of myocardial wall in the diabetic heart: an ultrasound tissue characterization study.
OBJECTIVES: We sought to characterize myocardial echodensity in asymptomatic patients with insulin-dependent diabetes and normal conventional two-dimensional echocardiographic findings to determine whether ultrasound tissue characterization can detect ultrastructural changes in myocardium, such as an increase in collagen content. BACKGROUND: Fibrosis alters the acoustic properties of the heart in animals and humans, and these changes are detectable by cardiac tissue characterization with ultrasound. Early changes detected in the diabetic heart include increased interstitial collagen deposition. METHODS: Using two-dimensional echocardiography, we evaluated 26 asymptomatic patients with insulin-dependent diabetes with normal regional and global rest function, and 17 age- and gender-matched control subjects. By selection, all diabetic patients were normotensive and had negative maximal exercise stress test results to avoid the confounding effects of hypertension and coronary artery disease. Using an echocardiographic instrument implemented at the Institute of Clinical Physiology, we performed an on-line radiofrequency analysis to obtain quantitative operator-independent measurements of the integrated back-scatter signal of the ventricular septum and posterior wall. The integrated values of the radiofrequency signal from the myocardial wall were normalized for those from the pericardial interface and were expressed as percentages (integrated backscatter index). RESULTS: Diabetic patients showed a significant increase in myocardial echodensity both in the septum ([mean +/- SD] 36.6 +/- 8.1 vs. 23.6 +/- 4.4, p < 0.0001) and posterior wall (21.2 +/- 5.3 vs. 18.4 +/- 3.7, p < 0.001). By individual patient analysis, 17 patients exceeded the 95% confidence limits for normal myocardial echocardiographic reflectivity found in normal subjects, and only 3 had a relatively abnormal transmitral Doppler filling pattern (E/A ratio), mainly consisting of an abnormally increased late peak flow velocity (65% vs. 11%, p < 0.001). The increased myocardial intensity was similar in patients with (n = 16) and without (n = 10) noncardiac complications, such as retinopathy or nephropathy (37.5 +/- 7.9% vs. 35.0 +/- 8.3%, p = 0.35). CONCLUSIONS: Abnormally increased myocardial echodensity, possibly related to collagen deposition, can be detected in asymptomatic diabetic patients with normal rest function. Theoretically, this finding might be considered a very early preclinical alteration potentially related to subsequent development of diabetic cardiomyopathy.
Adult↗
Microalbuminuria and erythrocyte sodium-hydrogen exchange in essential hypertension.
Microalbuminuria (urinary albumin excretion between 20 and 200 micrograms/min) and abnormalities of red blood cell sodium-hydrogen exchange coexist in essential hypertensive patients. To evaluate how the two phenomena relate, we recruited 10 untreated microalbuminuric male essential hypertensive patients without diabetes to be compared with an equal number of matched essential hypertensive patients excreting albumin in normal amounts as well as 10 healthy control subjects. Sodium-hydrogen exchange values were increased to a comparable extent in microalbuminuric and normoalbuminuric hypertensive patients. Systolic and mean blood pressures were higher in microalbuminuric patients. Fasting insulin was greater and high-density lipoprotein cholesterol lower in patients than control subjects. Urinary albumin excretion correlated positively with both mean blood pressure and left ventricular mass values in the absence of a relationship with circulating lipid and insulin levels. In contrast with microalbuminuria, sodium-hydrogen exchange covaried only with high-density lipoprotein cholesterol and insulin levels. Thus, microalbuminuria and an abnormal sodium-hydrogen exchange are unrelated phenomena in essential hypertensive patients. Microalbuminuria appears to be a hemodynamically driven biological variable, while an accelerated sodium-hydrogen exchange seems primarily conditioned by the metabolic abnormalities of hypertension, possibly in the context of an insulin-resistant syndrome.
Aged↗
[Ultrasonic evaluation of early atherosclerotic damage in patients with type 1 diabetes mellitus].
UNLABELLED: The aim of this study was to evaluate the influence of metabolic control on the development of atherosclerotic lesions in type 1 insulin-dependent diabetic patients (IDDM). MATERIALS AND METHODS: Twenty-eight well controlled IDDM patients, without known risk factors or clinical evidence of cardiovascular disease, together with 28 age-matched healthy controls spontaneously underwent high-resolution echographic evaluation of carotid femoral arteries. A global score of atherosclerotic damage as been assigned to the four investigated vessels on the basis of 1-6 scale, which takes into account most important ultrasound atherosclerotic lesion found in every artery. RESULTS: Diabetic and healthy controls differed significantly as regard to medio-intimal carotid thickness (p < 0.001), but were similar as for score of atherosclerotic damage. CONCLUSIONS: Our results suggest that, in spite of a carotid wall medio-intimal thickness more pronounced in IDDM patients, well controlled IDDM is associated with atherosclerotic damage almost identical to that of healthy age-matched controls.
Adolescent↗
Microalbuminuria and endothelial dysfunction in essential hypertension.
Microalbuminuria (urinary albumin excretion between 20 and 200 micrograms/min) and endothelial dysfunction coexist in patients with essential hypertension. To evaluate whether the two phenomena are related and the determinants of that association, we recruited 10 untreated males with essential hypertension and microalbuminuria without diabetes to be compared with an equal number of matched patients with essential hypertension excreting albumin in normal amounts and 10 normal controls. The status of endothelial function was inferred from circulating von Willebrand Factor antigen (vWF), a glycoprotein secreted in greater amounts when the vascular endothelium is damaged. vWF concentrations were higher in hypertensive patients with microalbuminuria than in hypertensive patients without and controls. Individual vWF and urine albumin-excretion values were correlated (r = 0.55, p < 0.002). Blood pressure correlated with both urinary albumin excretion and vWF. Left ventricular mass index and minimal forearm vascular resistances were comparable in patients with hypertension and higher than in controls; total and low-density lipoprotein cholesterol, triglycerides, lipoprotein-a, Factor VII, and plasminogen activator inhibitor-1 did not differ. Fibrinogen was higher and creatinine clearance lower in microalbuminurics. Albuminuria in essential hypertension may reflect systemic dysfunction of the vascular endothelium, a structure intimately involved in permeability, haemostasis, fibrinolysis, and blood pressure control. This abnormality may have important physiopathological implications and expose these patients to increased cardiovascular risk.
Albuminuria↗
Arterial hypertension and microalbuminuria in IDDM: the Italian Microalbuminuria Study.
Arterial hypertension and poor glycaemic control are central to the development of microalbuminuria in insulin-dependent diabetes mellitus (IDDM). Recent consensus has established sensitive criteria for their detection and treatment, although the proportion of patients who may benefit is unclear. Between 1988 and 1990, we measured urinary albumin to creatinine concentration ratio (A/C) in 3,636 adult out-patients with IDDM of more than 3 years duration, serum creatinine under 133 mumol/l and who were not undergoing antihypertensive treatment. A/C indicating microalbuminuria (> or = 2.38/2.96 mg/mmol, male/female) was found in 620 of 3,451 patients without proteinuria, and associated with hypertension (blood pressure > or = 140 and/or 90 mmHg; p = 0.0016; rate: 39.6%), independent of diabetes duration (p = 0.0082) and male gender (p = 0.0350; relative risk = 1.16; 95% confidence interval: 1.01-1.32). Hypertension was less common among those with normal A/C (27.5%, p < 0.0001) but was positively related with diabetes duration. Of the 1,015 patients with A/C > or = 2.0 mg/mmol 529 were reexamined. Glycated haemoglobin levels exceeded 3 SD above the mean of normal in 84.3% of the 198 microalbuminuric patients (AER = 20-200 micrograms/min), but were comparably poor (79.2%) in normoalbuminuria. Duration of diabetes was inversely related to glycated haemoglobin only in microalbuminuria (0.05 < p < 0.1). Intervention to lower blood pressure remains mainly restricted to those patients with long-term diabetes and slower development of kidney disease. Near-normalisation of glycaemia remains the priority for the majority of patients with microalbuminuria.
Adolescent↗