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Glomerular charge selectivity in non-insulin-dependent diabetes mellitus
1First Department of Internal Medicine, Niigata University, School of Medicine, Japan.
The Journal of Diabetic Complications
|April 1, 1991
Summary
Diabetic nephropathy impairs kidney charge selectivity early. In non-insulin-dependent diabetes mellitus (NIDDM), increased IgG4 excretion, not IgG1, indicates this defect when urinary albumin excretion exceeds 10 micrograms/min.
Area of Science:
- Nephrology
- Immunology
- Diabetology
Background:
- Diabetic nephropathy is a common complication of diabetes mellitus.
- Kidney damage in diabetic nephropathy involves impaired charge selectivity.
- Understanding the stage of this defect is crucial for early intervention.
Purpose of the Study:
- To determine the stage at which charge selectivity is impaired in diabetic nephropathy.
- To investigate the differential urinary excretion of IgG1 and IgG4 in patients with non-insulin-dependent diabetes mellitus (NIDDM).
Main Methods:
- Measured urinary excretion rates of IgG1 and IgG4 in NIDDM patients and healthy controls.
- Compared IgG1 and IgG4 excretion rates with urinary albumin excretion rates (AER).
- Utilized differences in isoelectric points of IgG1 and IgG4 to assess charge selectivity.
Main Results:
- Urinary IgG4 excretion rate (ER) increased significantly when AER surpassed 10 micrograms/min.
- Urinary IgG1 ER did not show a significant increase in the AER range of 10-100 micrograms/min.
- These findings indicate an early-stage charge selectivity defect.
Conclusions:
- The charge selectivity defect in NIDDM patients is detectable at AER levels greater than 10 micrograms/min.
- Differential excretion of IgG subclasses (IgG1 and IgG4) serves as a marker for early kidney damage in diabetic nephropathy.