Nature of proteinuria in diabetic nephropathy. I- evaluation of albuminuria in various types of diabetes mellitus

ABSTRACT

By use of a radial immunodiffusion technique for determination of urinary albumin, it was noted that the diabetic patients studied excrete albumin in urine as much as 9 times the normal control values, although the majority of the diabetics have negative results for albumin as tested by the classical procedures for detecting urinary albumin. The juvenile onset diabetics [JOD] have a higher degree of albuminuria than that observed in maturity-onset diabetes [MOD] and maturity.onset diabetes of the young [MODY]. Moreover it has been noted that the extent of urinary albumin excretion is proportionatl to the degree of glucose intolerance. These results implies that the biochemical derrangernent in diabetes particularly hyperglycemia have a direct influence in promoting transglomerular passage of albumin. The higher level of albuminuria in JOD denotes greater detonation of glomerular function. This has been ascribed to result from the consequences of poor metabolic control notably ketosis and ketonuria which has been observed in most of these patients. In diabetics of more than 5 years duration, albuminuria is significantly greater than in diabetics of shorter duration, denoting the progressive nature of the underlying mechanism responsible for albuminuria