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Related Experiment Videos

Triphasic changes in selectivity with increasing proteinuria in type 1 and type 2 diabetes.

G Jerums1, T J Allen, M E Cooper

  • 1Department of Medicine, Austin Hospital, Heidelberg, Australia.

Diabetic Medicine : a Journal of the British Diabetic Association
|December 1, 1989
PubMed
Summary

Proteinuria selectivity changes in diabetic nephropathy. Initially non-selective, it becomes selective with microalbuminuria, then non-selective again in advanced stages, impacting kidney health.

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Area of Science:

  • Nephrology
  • Diabetology
  • Clinical Chemistry

Background:

  • Diabetic nephropathy is a major complication of diabetes mellitus.
  • Assessing proteinuria selectivity is crucial for understanding kidney damage progression.
  • Existing methods for evaluating proteinuria selectivity in diabetic patients require further investigation.

Purpose of the Study:

  • To investigate the changes in proteinuria selectivity using immunoglobulin G (IgG)/albumin and IgG/transferrin clearance ratios in patients with Type 1 and Type 2 diabetes.
  • To examine the relationship between proteinuria selectivity and the stage of diabetic nephropathy, from microalbuminuria to macroalbuminuria.

Main Methods:

  • Cross-sectional and serial studies over 7 years in 52 Type 1 and 60 Type 2 diabetic patients without established nephropathy.

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  • Measurement of IgG, albumin, and transferrin clearance ratios.
  • Comparison with 27 healthy control subjects.

    • Main Results:

    • In early diabetes (albuminuria < 30 µg/min), both clearance ratios were higher than controls, indicating non-selective proteinuria.
    • As albuminuria increased, selectivity generally increased (preferential excretion of albumin/transferrin over IgG).
    • In Type 2 patients with macroalbuminuria (>250 µg/min), a return to non-selective proteinuria was observed.

    Conclusions:

    • Proteinuria selectivity exhibits a triphasic pattern during diabetic nephropathy development.
    • The initial phase shows non-selective proteinuria, followed by increased selectivity with microalbuminuria.
    • Advanced nephropathy, particularly in Type 2 diabetes, may revert to non-selective proteinuria.