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dc.contributor.authorJerums, Georgeen
dc.contributor.authorAllen, Terri Jen
dc.contributor.authorCooper, Mark Een
dc.identifier.citationDiabetic Medicine : A Journal of the British Diabetic Association; 6(9): 772-9en
dc.description.abstractTwo indices of the selectivity of proteinuria, the immunoglobulin G (IgG)/albumin and the IgG/transferrin clearance ratios, were studied cross-sectionally and serially over 7 years in a cohort of 52 Type 1 and 60 Type 2 diabetic patients without established diabetic nephropathy. In Type 1 and Type 2 diabetic patients with albuminuria less than 30 micrograms min-1, both protein clearance ratios were significantly higher than in 27 control subjects. As albuminuria increased, there was a decrease in both protein clearance ratios. However, at albumin clearances above 90 nl s-1, equivalent to albumin excretion rates of greater than 250 micrograms min-1, a positive correlation was found in Type 2 diabetic patients between protein clearance ratios and albuminuria. In individual Type 1 and Type 2 diabetic patients with progressively increasing proteinuria, serial measurements of selectivity showed a decline in both protein clearance ratios with the onset of microalbuminuria. Episodes of transient microalbuminuria were also associated with a fall in the IgG/albumin clearance ratio. The results suggest that the selectivity of proteinuria undergoes a triphasic change with the development of diabetic nephropathy. In the first phase, proteinuria is non-selective with IgG clearance equal to or exceeding transferrin or albumin clearance. As microalbuminuria develops, there is a progressive increase in selectivity reflecting the preferential excretion of transferrin and albumin compared with IgG. In later stages of nephropathy, as shown in Type 2 diabetic patients with macroalbuminuria, there is a return to non-selective proteinuria.en
dc.subject.otherBlood Glucose.analysisen
dc.subject.otherBlood Pressureen
dc.subject.otherCohort Studiesen
dc.subject.otherDiabetes Mellitus, Type 1.physiopathology.urineen
dc.subject.otherDiabetes Mellitus, Type 2.physiopathology.urineen
dc.subject.otherDiabetic Nephropathies.urineen
dc.subject.otherFollow-Up Studiesen
dc.subject.otherHemoglobin A, Glycosylated.analysisen
dc.subject.otherImmunoglobulin G.metabolismen
dc.subject.otherKidney Function Testsen
dc.subject.otherMetabolic Clearance Rateen
dc.titleTriphasic changes in selectivity with increasing proteinuria in type 1 and type 2 diabetes.en
dc.typeJournal Articleen
dc.identifier.journaltitleDiabetic medicine : a journal of the British Diabetic Associationen
dc.identifier.affiliationDepartment of Medicine, Austin Hospital, Heidelberg, Australiaen
dc.type.austinJournal Articleen
item.openairetypeJournal Article-
item.fulltextNo Fulltext-
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