Endothelial Dysfunction Precedes Development of Microalbuminuria in IDDM

C. D. A. Stehouwer, H. R. Andreas Fischer, A. W. R. Van Kuijk, B. C. P. Polak, A. J. M. Donker
1995 Diabetes  
In patients with insulin-dependent diabetes niellitus (IDDM), microalbuminuria is a predictor of widespread severe microangiopathy and maeroangiopathy. Patients with microalbuniimiria show generalized dysfunction of tiie vascular endothelium, but it Is unknown whether endothelial dysfunction precedes the development of mi croalbuminuria. We examined a cohort of 17 IDDM pa tients at baseline and on three occasions during a follow-up of (median) 64 months (range 51-89). All had normal (<15
more » ... ) urinary albumin excretion (UAE) at the iirst three examinations, At the fourth examina tion, 11 patients had normal UAE and 6 had microal buminuria (median 25,7 jxg/min [range 15,3-42.8]), Compared with patients with normal UAE, microalbuminuric patients had significantly higher plasma levels of von Willebrand factor (vWF), a marker of endothelial dys function, at the second (200% [168-274] vs. 131% [69-186]), third (208% [188-270] vs, 125% [82-190]), and fourth examinations (231% [202-269] vs, 132% [88-208], JP < 0.0001), but not at baseline (128% [98-161] vs* 122% [87-210] ). An increase in vWF preceded the occurrence of microalbuminuria by -3 years. The groups did not differ with regard to age, diabetes duration, blood pressure, mean glycated hemoglobin and cholesterol, smoking hab its, or extent of retinopathy* Endothelial dysfunction, as estimated by plasma vWF concentration, precedes and may predict the development of microalbuminuria in IDDM. January IW H. ANOVA, analysis of variance; HP, blood pressure; BMI, body mass index; IDDM, iasuliiMlopendent diabetes mellitus; NIDDM, non-insuliiMlepondom diabetes mel litus; UAE, urinary albuntin excretion; vWP, von Willebrand factor.
doi:10.2337/diab.44.5.561 pmid:7729616 fatcat:v2wrlq5mf5filkcvwa43z4cccy