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Hemorheology, plasma protein composition and von Willebrand factor in type I diabetic nephropathy

J Zimmermann1, L Schramm, C Wanner

  • 1Department of Medicine, University of Würzburg, Germany.

Clinical Nephrology
|October 1, 1996
PubMed

Insights

Altered blood flow properties (hemorheology) are significantly linked to diabetic nephropathy in patients with type 1 diabetes. These changes, including increased plasma viscosity and erythrocyte aggregation, may worsen vascular complications.

Area of Science:

  • Endocrinology
  • Nephrology
  • Hematology

Background:

  • Patients with type 1 diabetes mellitus (IDDM), particularly those with albuminuria, face a high risk of macrovascular and microvascular complications.
  • Beyond established risk factors, altered hemorheology (blood flow properties) may contribute to these complications.

Purpose of the Study:

  • To evaluate hemorheological parameters and plasma protein composition in IDDM patients with varying degrees of nephropathy (none, incipient, and overt).
  • To investigate plasma levels of von Willebrand Factor (vWF) as an indicator of endothelial injury.

Main Methods:

  • Studied 58 IDDM patients categorized by albuminuria levels (N0, N1, N2).
  • Assessed plasma viscosity, erythrocyte aggregation, erythrocyte deformability, and plasma protein levels (fibrinogen, alpha 2-macroglobulin, haptoglobin, albumin).
  • Measured plasma vWF levels to estimate endothelial injury.

Main Results:

  • Patients with incipient and overt nephropathy showed increased fibrinogen, alpha 2-macroglobulin, and haptoglobin levels, with a decrease in serum albumin.
  • Erythrocyte aggregation, plasma viscosity, and erythrocyte rigidity were elevated, especially in overt nephropathy.
  • Erythrocyte aggregation correlated positively with fibrinogen and alpha 2-macroglobulin, and negatively with albumin.
  • Plasma viscosity correlated positively with fibrinogen and haptoglobin.
  • Von Willebrand Factor levels were higher in patients with overt nephropathy.

Conclusions:

  • Blood rheology is significantly altered in IDDM patients with nephropathy.
  • Elevated vWF suggests endothelial damage, while changes in viscosity and aggregation may stem from altered plasma proteins due to proteinuria.
  • These hemorheological abnormalities could exacerbate microvascular and macrovascular damage in type 1 diabetes with nephropathy.

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