caa a22 4500 469128488 CHVBK 20180323133157.0 cr unu---uuuuu 170328e19920901xx s 000 0 eng 10.1007/BF00573487 doi (NATIONALLICENCE)springer-10.1007/BF00573487 Clearance rate of immunoglobulins and diabetic nephropathy [Elektronische Daten] [U. Di Mario, R. Romano, S. Morano, P. Pietravalle] The interaction between the electrostatic charge of macromolecules and the fixed charges of glomerular basement membrane pores is of importance in protein permselectivity in addition to a number of other factors. In normal conditions anionic proteins are filtered to a lesser extent than cationic proteins of similar size and shape. In the early stages of diabetic nephropathy there are biochemical changes in the glomerulus, i.e. a decrease in glomerular fixed anionic charges, which lead to an increased vascular permeability to macromolecules. Attention has been focused on methods for detecting the initial permselectivity defects, to monitor the early preclinical stages of diabetic nephropathy over time. A promising methodological approach is the parallel evaluation of the clearance of two proteins similar in all main characteristics but differing in their electrostatic charge, i.e. the different subclasses of immunoglobulins. A preferential excretion of anionic molecules would be expected when a diabetic loss of charge selectivity is present. Studies have been performed in normal subjects and in type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetic patients both in basal conditions and after pharmacological challenges. In normal subjects in basal state anionic and cationic immunoglobulins were found to be excreted in a ratio of about 1 : 10 and the anionic/cationic ratio could be only minimally influenced by orthostatism or physical exercise. In diabetic patients of both type 1 and 2 the clearance of anionic immunoglobulins and the anionic/cationic immunoglobulin ratio were clearly increased in several randomly selected patients; in particular several normoalbuminuric patients showed enhanced immunoglobulin G4 clearances. The acute intravenous administration of an angiotensin-converting enzyme inhibitor in diabetic patients induced marked modifications of kidney haemodynamics and quantitative alterations of protein permselectivity, together with a selective decrement of anionic immunoglobulins in comparison with the excretion of total immunoglobulins. In conclusion, disproportions in the anionic/cationic immunoglobulin G ratio which are present in microalbuminuric and in a number of normoalbuminuric patients appear to detect initial abnormalities in diabetic kidney disease. Springer-Verlag, 1992 ACE inhibitor nationallicence Diabetic nephropathy nationallicence Immunoglobulin subclasses nationallicence Kidney permselectivity nationallicence Proteinuria nationallicence Di Mario U. Department of Clinical and Experimental Medicine, University of RC-Catanzaro, Italy aut Romano R. Department of Clinical and Experimental Medicine, University of RC-Catanzaro, Italy aut Morano S. Clinica Medica 2 (Endocrinology), University "La Sapienza”, Rome, Italy aut Pietravalle P. Clinica Medica 2 (Endocrinology), University "La Sapienza”, Rome, Italy aut Acta Diabetologica Springer-Verlag 29/3-4(1992-09-01), 191-195 0940-5429 29:3-4<191 1992 29 592 https://doi.org/10.1007/BF00573487 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF00573487 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Di Mario U. Department of Clinical and Experimental Medicine, University of RC-Catanzaro, Italy aut NATIONALLICENCE 700 1- Romano R. Department of Clinical and Experimental Medicine, University of RC-Catanzaro, Italy aut NATIONALLICENCE 700 1- Morano S. Clinica Medica 2 (Endocrinology), University "La Sapienza”, Rome, Italy aut NATIONALLICENCE 700 1- Pietravalle P. Clinica Medica 2 (Endocrinology), University "La Sapienza”, Rome, Italy aut NATIONALLICENCE 773 0- Acta Diabetologica Springer-Verlag 29/3-4(1992-09-01), 191-195 0940-5429 29:3-4<191 1992 29 592 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer