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Microalbuminuria. Implications for micro- and macrovascular disease
T Deckert1, A Kofoed-Enevoldsen, K Nørgaard
1Steno Diabetes Center, Gentofte, Denmark.
Diabetes Care
|September 1, 1992
Summary
Microalbuminuria, a marker of kidney disease in diabetics, also signals increased cardiovascular risk. Alterations in the extracellular matrix may link microalbuminuria and atherosclerosis, suggesting new avenues for preventing diabetic complications.
Area of Science:
- Nephrology
- Diabetology
- Cardiology
Background:
- Microalbuminuria (UAER 20-200 µg/min) affects 15-20% of diabetics.
- It's a risk marker for renal disease, retinopathy, and cardiovascular issues in diabetics and non-diabetics.
- Established cardiovascular risk factors don't fully explain increased mortality in microalbuminuric diabetics.
Purpose of the Study:
- To explore the common pathogenetic mechanisms linking microalbuminuria and premature atherosclerosis.
- To investigate the role of extracellular matrix alterations in these conditions.
Main Methods:
- Review of accumulating evidence on microalbuminuria and atherosclerosis.
- Analysis of the impact of diabetes on extracellular matrix composition and structure.
- Consideration of genetic factors in HS-PG biosynthesis and sulfation.
Main Results:
- Qualitative alterations in extracellular matrix, specifically decreased density and sulfation of HS-PG, are implicated in both microalbuminuria and atherosclerosis.
- Reduced glomerular HS density may cause albuminuria and mesangial proliferation.
- Intimal HS alterations may promote premature atherosclerosis.
Conclusions:
- A common pathogenetic mechanism involving extracellular matrix changes links microalbuminuria and premature atherosclerosis.
- Diabetes significantly impacts extracellular matrix, leading to decreased HS-PG density and sulfation.
- Identifying susceptibility genes could improve prevention of severe diabetic complications.