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Higher urinary IgM excretion in type 2 diabetic nephropathy compared to type 1 diabetic nephropathy.

Bakoush, Omran LU ; Tencer, Jan LU ; Tapia, Juan LU ; Rippe, Bengt LU and Torffvit, Ole LU (2002) In Kidney International 61(1). p.203-208
Abstract
BACKGROUND: Proteinuria, due to impairment of the charge- and/or size selectivity of the glomerular capillary wall (GCW) is the earliest clinical evidence of diabetic nephropathy (DN). To study the pathophysiological differences between patients with DN in type 1 diabetes mellitus (type 1 DN) and type 2 diabetes mellitus (type 2 DN), we compared the patterns of urinary proteins of different size and charge in the two entities of diabetic kidney disease. METHODS: Urine concentrations of albumin, IgG2, IgG4 and IgM were assessed in 22 (15 males and 7 females) patients with type 1 DN, and in 20 (18 males and 2 females) patients with type 2 DN. Comparisons with one control group of 13 (12 males and one female) patients with nephrosclerosis due... (More)
BACKGROUND: Proteinuria, due to impairment of the charge- and/or size selectivity of the glomerular capillary wall (GCW) is the earliest clinical evidence of diabetic nephropathy (DN). To study the pathophysiological differences between patients with DN in type 1 diabetes mellitus (type 1 DN) and type 2 diabetes mellitus (type 2 DN), we compared the patterns of urinary proteins of different size and charge in the two entities of diabetic kidney disease. METHODS: Urine concentrations of albumin, IgG2, IgG4 and IgM were assessed in 22 (15 males and 7 females) patients with type 1 DN, and in 20 (18 males and 2 females) patients with type 2 DN. Comparisons with one control group of 13 (12 males and one female) patients with nephrosclerosis due to systemic hypertension and a second control group of 16 (14 males and 2 females) healthy controls were made. RESULTS: The urine excretion of IgG2 and IgM and the ratio of IgG2 to IgG4 (IgG2/IgG4), were significantly higher in type 2 DN compared to type 1 DN (P < 0.01). Patients with type 2 DN and patients with nephrosclerosis had significantly higher urine excretion of IgG and IgM compared to the age-matched healthy subjects (P < 0.001). The IgG2/IgG4 ratio was higher in type 2 DN compared to nephrosclerosis and healthy controls (P < 0.01). CONCLUSION: The increased urine excretion of IgG and IgM that accompanies albuminuria in type 2 DN suggests that the dominant pathophysiological mechanism of proteinuria in type 2 DN might be an alteration of the size selective properties of the glomerular capillary wall, including the occurrence of non-discriminatory "shunt pathways." The charge selective properties of the glomerular capillary wall seem to be intact in type 2 DN, as indicated by the high IgG2/IgG4 ratio. The mechanisms of proteinuria in type 1 DN seem to be merely a consequence of an impaired charge selectivity of the glomerular capillary wall. (Less)
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organization
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publication status
published
subject
keywords
Diabetes Mellitus Non-Insulin-Dependent : immunology : urine, Adult, Comparative Study, Diabetes Mellitus Insulin-Dependent : immunology : urine, Immunoglobulin G : urine, Human, Female, Diabetic Nephropathies : immunology : urine, Male, Immunoglobulin M : urine, Support Non-U.S. Gov't, Middle Age
in
Kidney International
volume
61
issue
1
pages
203 - 208
publisher
Nature Publishing Group
external identifiers
  • pmid:11786102
  • wos:000172904900024
  • scopus:0036145377
ISSN
1523-1755
DOI
10.1046/j.1523-1755.2002.00108.x
language
English
LU publication?
yes
id
20cbdc77-161d-46b1-86db-8260c8fce8c6 (old id 106740)
date added to LUP
2007-06-27 11:02:29
date last changed
2017-10-22 04:29:31
@article{20cbdc77-161d-46b1-86db-8260c8fce8c6,
  abstract     = {BACKGROUND: Proteinuria, due to impairment of the charge- and/or size selectivity of the glomerular capillary wall (GCW) is the earliest clinical evidence of diabetic nephropathy (DN). To study the pathophysiological differences between patients with DN in type 1 diabetes mellitus (type 1 DN) and type 2 diabetes mellitus (type 2 DN), we compared the patterns of urinary proteins of different size and charge in the two entities of diabetic kidney disease. METHODS: Urine concentrations of albumin, IgG2, IgG4 and IgM were assessed in 22 (15 males and 7 females) patients with type 1 DN, and in 20 (18 males and 2 females) patients with type 2 DN. Comparisons with one control group of 13 (12 males and one female) patients with nephrosclerosis due to systemic hypertension and a second control group of 16 (14 males and 2 females) healthy controls were made. RESULTS: The urine excretion of IgG2 and IgM and the ratio of IgG2 to IgG4 (IgG2/IgG4), were significantly higher in type 2 DN compared to type 1 DN (P &lt; 0.01). Patients with type 2 DN and patients with nephrosclerosis had significantly higher urine excretion of IgG and IgM compared to the age-matched healthy subjects (P &lt; 0.001). The IgG2/IgG4 ratio was higher in type 2 DN compared to nephrosclerosis and healthy controls (P &lt; 0.01). CONCLUSION: The increased urine excretion of IgG and IgM that accompanies albuminuria in type 2 DN suggests that the dominant pathophysiological mechanism of proteinuria in type 2 DN might be an alteration of the size selective properties of the glomerular capillary wall, including the occurrence of non-discriminatory "shunt pathways." The charge selective properties of the glomerular capillary wall seem to be intact in type 2 DN, as indicated by the high IgG2/IgG4 ratio. The mechanisms of proteinuria in type 1 DN seem to be merely a consequence of an impaired charge selectivity of the glomerular capillary wall.},
  author       = {Bakoush, Omran and Tencer, Jan and Tapia, Juan and Rippe, Bengt and Torffvit, Ole},
  issn         = {1523-1755},
  keyword      = {Diabetes Mellitus Non-Insulin-Dependent : immunology : urine,Adult,Comparative Study,Diabetes Mellitus  Insulin-Dependent : immunology : urine,Immunoglobulin G : urine,Human,Female,Diabetic Nephropathies : immunology : urine,Male,Immunoglobulin M : urine,Support Non-U.S. Gov't,Middle Age},
  language     = {eng},
  number       = {1},
  pages        = {203--208},
  publisher    = {Nature Publishing Group},
  series       = {Kidney International},
  title        = {Higher urinary IgM excretion in type 2 diabetic nephropathy compared to type 1 diabetic nephropathy.},
  url          = {http://dx.doi.org/10.1046/j.1523-1755.2002.00108.x},
  volume       = {61},
  year         = {2002},
}