[25 years old woman with nocturia]. / Donna di 25 anni con nicturia.

A 25 years old lady presented to our outpatient clinic complaining nicturia, polyuria and polydipsia. On the basis of clinical assessment and the results of a simple test, a diagnosis of Nephrogenic Diabetes Insipidus (NDI) was made. The diagnosis of NDI is often missed, and appropriate treatment therefore delayed, with severe consequences especially in elderly and bed restricted people.

Cross-reactivity of anti-ssDNA antibodies with heparan sulfate in patients with type I diabetes mellitus.

Anti-single-stranded-DNA antibodies cross-reactive with heparan sulfate were detected in serums of patients with type I (insulin-dependent) diabetes mellitus. The results suggested that heparan sulfate, the major glycosaminoglycan constituent of the glomerular basement membrane, may serve as a target antigen in vivo for cross-reactive anti-DNA antibodies. These polyreactive antibodies, directed toward repeating negatively charged units, may neutralize the heparan sulfate-associated polyanionic sites in the glomerulus, leading to an abnormal permeability of anionic plasma proteins.

Detection of anti-phospholipid (cardiolipin, phosphatidylserine) antibodies in the serum of patients with non insulin-dependent (type 2) diabetes mellitus and macroangiopathy. Coexistence of anti-platelet reactivity.

IgA and IgG antibodies against cardiolipin and/or phosphatidylserine were detected in the sera of patients with non insulin-dependent (type 2) diabetes mellitus. The highest prevalence was observed in particular in patients with macrovascular complications (86%). A significant increase of platelet bound IgA and IgG was observed also in patients with sera positive for anti-phospholipid antibodies suggesting the coexistence of reactivity against phospholipid and platelets. Several reports have focused on a new clinical entity characterized by the presence of anti-phospholipid and by a tendency to venous and arterial thrombosis. In addition to their acute thrombogenic effects, we suggest that anti-phospholipid antibodies may play a role in the impairment of the thromboresistant property of vascular endothelium and in the enhancement of platelet aggregation leading to the pathogenesis and/or progression of the macrovascular diabetic complications.

Serum levels of type III procollagen peptide in diabetes mellitus.

Serum levels of type III procollagen peptide (P-III-P) were investigated in 19 patients with type 1 (insulin-dependent) and in 48 (25 orally treated, 23 insulinized) patients with type 2 (non insulin-dependent) diabetes mellitus. Among patients with type 2 diabetes, 16 orally treated and 14 insulin-treated subjects had macrovascular complications. P-III-P levels were not correlated with the duration of diabetes and with glucose control, nor were there any significant sex and age differences in the levels. P-III-P values were significantly higher in the sera of insulin-treated non insulin-dependent diabetic patients with macroangiopathy. These high values (18.5 +/- 10.8 ng/ml) were in contrast with normal values in healthy subjects (8.5 +/- 2.5, P less than 0.001), insulin-dependent diabetics (9.9 +/- 3.4 ng/ml, P less than 0.01), non insulin-dependent diabetics treated with oral agents (8.2 +/- 2.6 ng/ml, P less than 0.001) and insulin-treated non insulin-dependent patients without macroangiopathy (8.2 +/- 4.9 ng/ml, P less than 0.001). Although this study does not demonstrate that an increase in type III collagen synthesis is responsible for the pathogenesis of macroangiopathy, it suggests that insulin-dependent fibroblast sensitization may play a role in the acceleration and progression of macroangiopathy.

Analysis of IgA1 and IgA2 subclass distribution in IgA- containing circulating immune complexes in patients with diabetes mellitus.

Immune complexes (IC) containing IgA1 and IgA2 have been detected in diabetes mellitus. In particular IgA1 and IgA2-IC are equally distributed in type 2 diabetes. On the other hands IgA1-IC are prevailingly found in type 1 diabetes mellitus. IgA2-IC (immune complexes of "mucosal" origin?) seen to be of relevance in the pathogenesis of diabetic microangiopathy.

Autoantibodies to albumin in the plasma of patients with diabetes mellitus. Relationship with circulating immune complexes.

Anti-albumin antibodies that recognize glutaraldehyde treated albumin have been detected in diabetes mellitus, belonging to all immunoglobulin classes. Anti-albumin antibodies have been found to be closely associated with circulating immune complexes, suggesting a role in their formation. It is suggested that such immune complexes may account for the positive immunofluorescence findings of albumin, immunoglobulin and complement in blood vessels previously reported in diabetes mellitus.