Nephropathy of type II diabetes: evidence for hereditary factors?

Family studies point to an important genetic element in the genesis of diabetic nephropathy, but it is not known whether renal abnormalities are present prior to the onset of diabetes. To address this issue we examined all consecutive patients suffering from type II diabetes with a duration of more than 10 years who attended a diabetes outpatient clinic. Ninety-four patients had nephropathy, 307 did not. All offspring who were phenotypically normal (no hypertension, normal oral glucose tolerance, non-smoking) and agreed to participate were examined, 26 from nephropathic and 30 from non-nephropathic diabetic parents. They were compared with 30 offspring matched for age, gender and BMI from non-diabetic parents as controls. We measured urinary albumin excretion under baseline conditions and at several time points after ingestion of 300 g cooked beef and submaximal treadmill exercise, respectively. In addition, casual blood pressure, ambulatory blood pressure, urinary albumin and urinary alpha-1-microglobulin were measured. Primary renal disease was excluded by clinical examination. Under baseline conditions, median urinary albumin excretion rate (AER; microgram/min) was significantly (P < 0.005) higher in offspring of nephropathic type II diabetic patients (7.8; range 1.04 to 19.5) than in the offspring of non-nephropathic type II diabetic patients (4.8; 0.36 to 17.5) and controls (4.4; 0.16 to 18.4). Submaximal treadmill exercise caused a greater proportional increase of AER in offspring of nephropathic type II diabetics (median 16-fold) than in offspring of non-nephropathic diabetic patients (6.3-fold) or controls (4.8-fold). In offspring of nephropathic diabetic patients casual and particularly ambulatory systolic blood pressures were significantly higher, but AER was not correlated with blood pressure. In summary, higher values, albeit within the normal range, for baseline and postexercise albuminuria were noted in phenotypically normal offspring of parents with type II diabetes and nephropathy. The observation suggests that changes in transglomerular albumin traffic are demonstrable prior to the onset of diabetes and diabetic nephropathy in subjects with a potential genetic predisposition to these conditions.

[Does an association between angiotensin I converting enzyme gene polymorphism and the prevalence of diabetic nephropathy in patients with diabetes type II exist?]. / Czy istnieje zwiazek pomiedzy polimorfizmem genu konwertazy angiotensyny I a wystepoaniem nefropatii u chorych na cukrzyce typu II?

In type I diabetic patients association has been found between the insertion/deletion (I/D) polymorphism in the gene of angiotensin converting enzyme and the presence of diabetic nephropathy. The aim of that study was to assess this association in a cohort of type II diabetics. We examined 109 patients of more than 10 years duration of type II diabetes. Nephropathy (defined as at least confirmed albuminuria > 30 mg/24h) was present in 37 subjects. The I/D polymorphism was analyzed with PCR technique. Allele frequencies in the overall diabetic population did not differ significantly from the normal population. Distribution of genotypes was not significantly different between examined patients with and those without nephropathy. We conclude that the distribution of ACE gene polymorphism is similar in diabetic subjects and in general population and there is not association between I/D polymorphism and nephropathy in type II diabetic patients.

[C14-aminopyrine breath test and enzymatic liver tests in workers employed by the coke tar distillation department]. / Test oddechowy z C14-aminopiryna i klasyczne enzymatyczne testy watrobowe u pracowników zatrudnionych w wydziale weglopochodnych zakladów koksochemicznych.

A group of 400 subjects divided into three sub-groups was examined. Group I consisted of 130 persons employed at the coke tar distillation department. Group II (controls) consisted of 70 persons also employed at the coke plant but free from occupational exposure. Group III was composed of 200 workers employed at the Building Factory. C14-aminopyrine breath test (ABT) was performed in 30 subjects randomly assigned from each group. A standard enzymatic liver test was assessed in all subjects examined. The range of tests performed did not permit to indicate the toxic effect of occupational environment on the liver tissue. Abnormal enzymatic liver test found in all groups could results, among others, from alcohol abuse among those tested. However, it was revealed that aromatic hydrocarbons to which workers of the coke tar distillation department were exposed to, stimulated the activity of the liver microsomal oxygenase assessed by ABT.

[The ankle-arm index and whole blood viscosity in patients with type II diabetes mellitus with ischemia of the lower extremities]. / Wskaznik kostkowo-ramieniowy a lepkosc krwi u chorych na cukrzyce typu II z choroba niedokrwienna konczyn dolnych.

The relationship was studied between the ankle-arm index (K/R) and whole blood and plasma viscosity in patients suffering from diabetes mellitus type II with ischemia of lower extremities. The measurements were carried out in 96 patients (80 males and 16 females), of whom 72 were in stage II of Fontaine progression. Immediately after determination of the K/R index blood was taken from vena mediana cubiti adding Na2EDTA for rheological test. Whole blood viscosity was measured with a Low-Shear 100 Contraves viscometer immediately after sampling, and plasma viscosity was measured with a capillary viscometer of Ubbvelohd within 2 hours after sampling. By the method of regression analysis and linear correlation it was found that increased whole blood and plasma viscosity significantly correlated with reduced K/R value in the patients. The obtained results are analysed in biophysical and clinical aspects.

[Cytoenzymatic and ultramicroscopic investigations of blood in coke oven workers]. / Badania cytoenzymatyczne i ultramikroskopowe granulocytów krwi obwodowej u pracowników zatrudnionych przy produkcji koksu.

White blood cell count, cytoenzymology (acid and alkaline phosphatase, beta-glucuronidase and myeloperoxidase of granulocytes) and ultrastructure of granulocytes and NBT reduction test were performed in peripheral blood obtained from cokery plant workers. All the subjects were divided into groups according to degree of exposure to BaP. Occupational exposure to many factors during coke production, especially to high concentration of BaP cause perceptible changes of NBT reduction test in the group more exposed workers. A statistically significant of the totally activity of the acid phosphatase and beta-glucuronidase of granulocytes were found in this risk group. The changes in granulocyte function correlated with ultrastructural changes. The coking plant environment represent a strong stimulator of the neutrophil metabolism.

[Clinical assessment of treatment results for atherosclerotic ischemia of the lower extremities with intraarterial ozone injections]. / Ocena kliniczna skutecznosci leczenia miazdzycy zarostowej konczyn dotetniczym wstrzykiwaniem ozonu.

Ten injections of O3 into femoral arteries were administered to 50 patients with atherosclerotic ischemia of the lower extremities and to 49 diabetic patients. All patients were assessed clinically with the ankle-arm index, measurement of intermittent claudication distance prior to and after the treatment. The treatment showed a significant improvement in both groups manifested by an increase in ankle-arm index, and prolongation of the intermittent claudication distance by more than twice. The treatment of atherosclerotic ischemia of the lower extremities with O3 is both valuable and safe.

[Analysis of the causes and clinical course of anemia in elderly patients]. / Analiza przyczyn i przebiegu niedokrwistosci u osób w wieku podeszlym.

Anamnesis of patients treated for anemia at the Department of Internal and Occupational Diseases in Zabrze in 1984-1988 were analysed. It was found that the incidence of anemia in patients over 60 years of age was significantly higher. Decreased function of hematopoietic system, more frequent deficits of factors indispensable for the normal erythropoiesis, i.e. iron and vitamin B12, and coexisting diseases, especially neoplasms and uremia, predispose to anemia in this age group. Anemia seen in the group of patients with diabetes mellitus type 2 was most probably a result of the chronic treatment with sulfonylurea derivatives.

[Some hemostatic parameters after treatment with ozone in a group of patients with obliterative atherosclerosis of the lower extremities and in a group of patients with diabetes]. / Niektóre parametry hemostazy po leczeniu ozonem w grupie chorych na miazdzyce zarostowa tetnic konczyn dolnych oraz w grupie chorych na cukrzyce.

Basic hemostasis and fibrinolysis parameters have been analysed in the group of 35 patients with obliterative atherosclerosis and in 41 patients with diabetes mellitus treated with intra-arterial ozone in concentration of O2/O3 54 micrograms/cm3 O3. Assayed parameters were within normal values. However, a tendency to decreased blood coagulation following ozone therapy was more pronounced in patients with obliterative atheromatosis, than in these with diabetes mellitus.

[Effect of occupational exposure in coke production on various parameters of the hematopoietic system]. / Wplyw narazenia zawodowego przy produkcji koksu na niektóre parametry ukladu krwiotwórczego.

The basic parameters of the erythrocytes, white blood cell and coagulation were determined in 201 workers exposed occupationally to organic substances containing benzene and its homologues. Occupational exposure to many factors during coke production, especially to high concentrations of BaP, did not cause perceptible changes in the erythrocytes. Moreover, total number of the lymphocytes was increased in the peripheral blood of exposed workers. That maybe considered as a nonspecific exposure test for the influence of the aromatic hydrocarbons. In haemostasis system the thrombocytopenia and the abnormalities of the plasma coagulation factors were revealed.

[Effect of simultaneous exposure to fluorine and manganese on health status of workers]. / Wplyw jednoczesnego narazenia na fluor i mangan na stan zdrowia narazonych pracowników.

The effect of fluorine and manganese on the health of workers continually exposed to these elements was studied. The concentration of the chemicals did not significantly exceed maximum allowable concentrations only during three hours of work daily. Thirty-six workers directly exposed to fluorine and manganese were examined and compared with the controls. The authors demonstrated that exceeding permissible norms did not cause evident intoxication symptoms even though working in exposure had lasted for many years. However, some changes in the activity of liver indicatory enzymes may be one of the first symptoms of this organ's damage. Frequently occurring ++periodontosis and leukoplakia of the mucous membrane needed careful stomatological prophylaxis .

[Various parameters of lipid metabolism after intra-arterial injections of ozone in patients with ischemia of the lower extremities and diabetes mellitus]. / Niektóre parametry gospodarki lipidowej po dotetniczych wstrzyknieciach ozonu u chorych na chorobe niedo-krwienna konczyn dolnych oraz cukrzyce.

In 50 subjects with arteriosclerotic ischaemia of the lower extremities and 41 subjects with diabetes mellitus ozone was applied intra-arterially. Before and after the treatment serum lipids concentration was examined. In the group with arteriosclerotic ischemia significant decrease in cholesterol level and both his fractions was seen. Whereas in the group with diabetes the cholesterol LDL was significantly reduced. In both groups total lipids level serum was decreased. It suggests that ++ozone therapy set back the arteriosclerosis progress, normalized some parameters of lipid metabolism and improved HDL to LDL cholesterol fractions relationship.

[Effect of occupational exposure to lead, zinc and cadmium on various indicators of the circulatory system of metallurgical workers]. / Wplyw olowiu wystepujacego na stanowisku pracy wspólnie z cynkiem i kadmem na niektóre wskazniki ukladu krazenia u pracowników przemyslu metalurgicznego.

386 workers occupationally exposed to Pb, Cd and Zn in metallurgical plants were examined to evaluate the influence of lead, cadmium and zinc on circulatory system. The workers were divided into groups according to age and degree of poisoning with metals. Control group included 325 persons, selected according to age, occupationally unexposed to metals. All groups of persons were subject to medical examinations including ECG. Significantly higher prevalence of systolic murmur and heart ventricles repolarization disorders was found in the group exposed irrespective of the age of particular individuals. The workers exposed aged up to 40 years develop more frequently arterial hypertension and heart rhythm disorders. The results obtained indicate that Pb, Cd and Zn adversely affect the circulatory system.