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Features of endothelial dysfunction in early diabetic nephropathy
T Jensen1, J Bjerre-Knudsen, B Feldt-Rasmussen
1Steno Memorial Hospital, Gentofte, Denmark.
Lancet (London, England)
|March 4, 1989
Summary
Diabetic nephropathy impairs tissue plasminogen activator (tPA) release during exercise, indicating endothelial dysfunction even in early stages. This dysfunction may contribute to cardiovascular complications in diabetes.
Area of Science:
- Cardiovascular Physiology
- Endocrinology
- Nephrology
Background:
- Insulin-dependent diabetes is associated with microvascular complications.
- Diabetic nephropathy is a common complication, characterized by albuminuria.
- Endothelial dysfunction plays a role in the pathogenesis of diabetic complications.
Purpose of the Study:
- To investigate the effect of exercise on tissue plasminogen activator (tPA) release in men with insulin-dependent diabetes and varying degrees of nephropathy.
- To assess endothelial function by measuring tPA release and albumin transcapillary escape rate.
- To evaluate basal plasma levels of von Willebrand factor in relation to diabetic nephropathy.
Main Methods:
- Study included 40 men with insulin-dependent diabetes, categorized into three groups based on urinary albumin excretion (normal, incipient nephropathy, clinical nephropathy), and 9 non-diabetic controls.
- Exercise-induced release of tPA antigen was measured.
- Albumin transcapillary escape rate was determined.
- Basal plasma levels of von Willebrand factor were analyzed.
Main Results:
- Exercise-induced rise in tPA antigen was significantly blunted in patients with incipient and clinical diabetic nephropathy compared to controls and those with normal albumin excretion.
- Albumin transcapillary escape rate was significantly elevated in patients with incipient and clinical nephropathy.
- Basal plasma von Willebrand factor levels were higher in patients with clinical nephropathy and borderline higher in incipient nephropathy.
Conclusions:
- Insulin-dependent diabetic patients with even slightly elevated urinary albumin excretion exhibit generalized endothelial cell dysfunction or damage.
- This endothelial dysfunction may be an early indicator of microvascular complications in diabetes.
- The clinical significance of these endothelial changes in the pathogenesis of thrombosis and atherosclerosis in diabetes requires further investigation.