SIZE SELECTIVITY AND CHARGE SELECTIVITY OF GLOMERULAR-FILTRATION IN TYPE-1 (INSULIN-DEPENDENT) DIABETIC-PATIENTS WITH AND WITHOUT ALBUMINURIA
SIZE SELECTIVITY AND CHARGE SELECTIVITY OF GLOMERULAR-FILTRATION IN TYPE-1 (INSULIN-DEPENDENT) DIABETIC-PATIENTS WITH AND WITHOUT ALBUMINURIA
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DOI：
10.1007/bf00399958
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发表时间：
1993-03-01
期刊：
影响因子：
8.2
通讯作者：
FELDTRASMUSSEN, B
中科院分区：
文献类型：
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作者：
DECKERT, T;KOFOEDENEVOLDSEN, A;FELDTRASMUSSEN, B
蛋白尿是糖尿病肾病发生发展过程中的第一临床事件。我们评估了51名幼年型1型(胰岛素依赖型)糖尿病患者和11名健康人的肾小球电荷和大小的选择性。患者被分成五组。DI组尿白蛋白排泄率正常，D2组30~100 mg/24 h，D3组101~300 mg/24 h，D4、D5组>300 mg/24 h。D5组血肌酐升高(>110mumol/L)。肾小球滤过率和肾血浆流量用持续输注技术测定，肾小管蛋白重吸收用β2-微球蛋白排泄法测定。电荷选择性由Ig G/Ig G4选择性指数估算。用右旋糖苷清除法测定其尺寸选择性。葡聚糖经体积排阻色谱分离(2埃，26埃-埃)后，折射率检测法测定葡聚糖。蛋白尿组Ig G/Ig G4选择性指数显著降低(p<；0.001)。微量白蛋白尿(D2)患者的Ig G/Ig G4选择性指数下降，且不伴有肾小管功能或肾小球血流动力学的任何改变。只有最晚期肾病患者(D5)的大小选择性显著改变，反映在62埃葡聚糖清除增加(p<；0.04)。我们得出结论，在糖尿病肾病的发展过程中，肾小球电荷选择性的丧失先于或伴随着新的肾小球大分子通路的形成。
Albuminuria is the first clinical event in the development of diabetic nephropathy. We assessed glomerular charge- and size selectivity in 51 patients with Type 1 (insulin-dependent) diabetes mellitus of juvenile onset and 11 healthy individuals. Patients were allocated to five groups. The urinary albumin excretion rate was normal in group DI; 30-100 mg/24 h in group D2; 101-300 mg/24 h in group D3 and greater than 300 mg/24 h in groups D4 and D5. Group D5 had elevated serum creatinine (above 110 mumol/l). Glomerular filtration rate and renal plasma flow were determined by constant infusion techniques and tubular protein reabsorption by excretion of beta2-microglobulin. Charge selectivity was estimated from the IgG/IgG4 selectivity index. Size selectivity was measured by dextran clearance. Dextran was measured by refractive index detection after fractionation (2 angstrom fractions in the range 26-64 angstrom) by size exclusion chromatography. IgG/IgG4 selectivity index was significantly decreased in patients with albuminuria (p < 0.001). The drop in IgG/IgG4 selectivity index was found in patients with minimal albuminuria (D2) and was not accompanied by any changes in tubular function or glomerular haemodynamics. Size selectivity was significantly altered only in patients with the most advanced nephropathy (D5) as reflected by an increase in the clearance of 62 angstrom dextran (p < 0.04). We conclude that loss of glomerular charge selectivity precedes or accompanies the formation of new glomerular macromolecular pathways in the development of diabetic nephropathy.