THE KIDNEY AND HYPERTENSION IN DIABETES MELLITUS

THE KIDNEY AND HYPERTENSIONIN DIABETES MELLITUS

EDITED BY

CARL ERIK MOGENSENMedical Department M(Diabetes & Endocrinology)Aarhus KommunehospitalUniversity Hospitals in AarhusAarhus C, Denmark

Editorial secretary

ANETTE ANDERSEN

.....

"Springer Science+Business Media, LLC

Library of Congress Cataloging-in-Publication Data

A C.I.P. Catalogue record for this book is available fromthe Library of Congress.

ISBN 978-1-4757-6748-3 ISBN 978-1-4757-6746-9 (eBook)

DOI 10.1007/978-1-4757-6746-9

Copyright © 1994 by Springer Science+Business Media New YorkSoftcover reprint of the hardcover 2nd edition 1994Originally published by Kluwer Academic Publishers in 1994.

All rights reserved . No part of this publication may be reproduced, stored ina retrieval system or transmitted in any form or by any means, mechanicai,photo-copying, recording, or otherwise, without the prior written permission ofthe publisher, Springer Science+Business Media, LLC

Printed on acid-free paper.

This book is dedicated to Knud Lundbrek, distinguished diabetologist, myfriend and mentor, and a great inspiration for all of us. He is now, over theage of 80 years, strongly engaged in exciting and penetrating new studies inthe field of sinology, his new science.

CEM

CONTENTS

Some Keys to the Literature

Contributing Authors

Prefaces

1 Definition of diabetic renal disease in insulin-dependentdiabetes mellitus based on renal function testsCARL ERIK MOGENSEN

2 Albuminuria and renal disease in NIDDM-patientsANITA SCHMITZ

3 Familial factors in diabetic nephropathyDAVID J. PETTITT and WILLIAM C. KNOWLER

4 Hypertension, cardiovascular disease, diabetes mellitus,and diabetic nephropathy: role of insulin resistanceANNA SOLINI and RALPH A. DEFRONZO

Xlll

xvii

xxiii

1

15

27

37

viii Contents

5 Diabetes, hypertension, and kidney disease in the PimaIndians compared with other populations 53WILLIAM C. KNOWLER , ROBERT G. NELSON and DAVID J . PEITJIT

6 Economic evaluations of strategies for preventing renaldisease in non-insulin dependent diabetes mellitus 63DlANE L. MANNINEN, ERIK J . DASBACH, FREDERICK B. DONG,RONALD E. AUBERT, STEVEN M. TEUTSCH and WILLIAM H. HERMAN

7 Incidence of nephropathy in insulin-dependent diabetesmellitus as related to mortality and cost-benefit of earlyintervention 75KNUT BORCH-JOHNSEN

8 Measurement of albumin and other urinary proteins inlow concentration in diabetes mellitus: techniques andc1inical significance 85D.J .F . ROWE and W. GATLING

9 Office tests for microalbuminuria 95PER L0GSTRUP POULSEN

10 Risk factor for progression of microalbuminuria inrelatively young NIDDM-patients 103

RYUICHI KIKKAWA and MASAKAZU HANEDA

11 The c1inical course of renal disease in caucasianNIDDM-patients 111S0REN NIELSEN and ANITA SCHMITZ

12 Von Willebrand factor and the development of renaland vascular complications in diabetes 123COEN D.A. STEHOUWER

13 Smoking and diabetic nephropathy 133PETER T. SAWICKI

14 Light microscopy of diabetic glomerulopathy: the c1assiclesion 141STEEN OLSEN

15 Haematuria and diabetic nephropathy 151PRISCILLA KINCAID-SMITH and JUDlTH A. WHITWORTH

16 Glomerular ultrastructural changes in microalbuminuricIDDM-patients 161HANS-JACOB BANGSTAD and RUTH 0STERBY

ix

17 Understanding of diabetic nephropathy from kidney andpancreas transplantation 171PAOLA FIORETTO and MICHAEL MAUER

18 Sodium-hydrogen antiport, cell function and susceptibilityto diabetic nephropathy 181ROBERTO TREVISAN and GIANCARLO VIBERTI

19 Biochemical aspects of diabetic nephropathy 191ERWIN D. SCHLEICHER

20 The Steno hypothesis and glomerular basement membranebiochemistry in diabetic nephropathy 203ALLAN KOFOED -ENEVOLDSEN

21 Volume homeostasis and blood pressure in diabetic states 213JAMES A. O'HARE and J. BARRY FERRISS

22 Pathogenesis of diabetic glomerulopathy: the role ofglomerular hemodynamic factors 223JITEN P. VORA , SHARON ANDERSON and BARRY M. BRENNER

23 Roles of growth factors in diabetic kidney disease 233ALLAN FLYVBJERG, BIRGITTE NIELSEN , CHRISTIAN SKJiERBfEK,JAN FRYSTYK , HENNING GR0NBiEK and HANS 0RSKOV

24 Blood pressure elevation in diabetes: results from 24-hambulatory blood pressure recordings in diabetes 245KLAVS WÜRGLER HANSEN and PER L0GSTRUP POULSEN

25 Insulin and blood pressure 261RIJK O.B. GANS and AB J.M. DONKER

26 Cation transport, hypertension and diabetic nephropathy 273RUGGERO MANGILI

27 Microalbuminuria in young patients with type 1 diabetes 285HENRIK BINDESB0L MORTENSEN

28 Early renal hyperfunction and hypertrophy in IDDMpatients including comments on early intervention 297MARGRETHE MAU PEDERSEN

29 The concept of incipient diabetic nephropathy andeffect of early antihypertensive intervention 309MICHEL MARRE, GlLLES BERRUT and BEATRICE BOUHANICK

x Contents

30 Comparative study of the effect of ACE-inhibitors andother antihypertensive agents on proteinuria indiabetic patients 319M. DE COURTEN, L. BÖHLEN and P. WEIDMANN

31 C1inical trials in overt diabetic nephropathy 333STAFFAN BJÖRCK

32 Antihypertensive treatment in NIDDM, with specialreference to abnormal albuminuria 341PAUL G. MCNALLYand MARK E. COOPER

33 The course of incipient and overt diabetic nephropathy:the perspective of more optimal insulin treatment 353BO FELDT-RASMUSSEN

34 Meta-analysis of the effect of intensive therapy onnephropathy in type I diabetes mellitus 361PING H. WANG, JOSEPH LAU and THOMAS C. CHALMERS

35 Non-glycaemic intervention in diabetic nephropathy:the role of dietary protein intake 369JAMES D. WALKER

36 Microalbuminuria and diabetic pregnancy 381CARL ERIK MOGENSEN and JOACHIM G. KLEBE

37 Diabetic nephropathy and pregnancy 389C. ANDREW COMBS and JOHN L. KITZMILLER

38 Urinary tract infection and diabetes: diagnosis and treatment 401RENE VEJLSGAARD

39 Acute renal failure in diabetics 407ANA GRENFELL

40 Contrast media-induced nephropathy in diabetic renal disease 421INDRA D. DANIELS, EU A. FRIEDMAN

41 Renal papillary necrosis in diabetic patients 433GARABED EKNOYAN

42 Problems related to the start of renal replacement therapyin diabetic patients 443GUDRUN NYBERG

xi

43 Evolution worldwide of the treatment of patients withadvanced diabetic nephropathy by renal replacement therapy 449

ANTHONY E.G. RAINE

44 Haemodialysis in type 1 and type 2 diabetic patientswith end stage renal failure 459

EBERHARD RITZ, ANTONY RAINE and DANIEL CORDONNIER

45 Continuous ambulatory peritoneal dialysis in uremicdiabetics 469

ELIAS V. BALASKAS and DIMITRIOS G. OREOPOULOS

46 Simultaneous pancreas and kidney transplantation:indication and results 487INGE BJ0RN BREKKE, GUNNAR S0DAL, HALLVARD HOLDAAS,PER FAUCHALD and JAK JERVELL

47 Renal transplantation for diabetic nephropathy 495

ELI A. FRIEDMAN

St Vincent Declaration, 1994: Guidelines for the prevention ofdiabetic renal failure 515

GIAN CARLO VIBERTI , CARL ERIK MOGENSEN , PHILIPPE PASSA,RUDY BILOUS and RUGERO MANGILI (External adviser: Anthony Raine)

SOME KEYS TO THE LITERATURE

Carl Erik Mogensen (00). Diabetes Mellitus and the Kidney. Kidney lnt 1982; 21:673-791.

Donald E. McMiIland, Jern Ditzel (00). Proceedings of a Conference on DiabeticMicroangiopathy. Diabetes 1983; 32: suppl. 2: 1-104.

Peter Weidmann, Carl Erik Mogensen, Eberhard Ritz (00). Diabetes and Hyperten ­sion. Proceedings of the First International Symposium on Hypertension Associatedwith Diabetes Mellitus . June 22-23, 1984. Hypertension 1985; 7: Part II: S1-S174.

P. Passa, C.E. Mogensen (00). Microalbuminuria in Diabetes Mellitus . Proceedingsof an international workshop. Chantilly, France, May 8-9, 1987. Diabete Metab1988; 14: suppl. : 175-236.

H.U. Janka, E. Standl (00). Hypertension in Diabetes Mellitus: Pathogenesis andclinical impact. Proceedings of an International Symposium. Munich, Germany, May3, 1989. Diabete Metab 1989; 15: suppl.: 273-366.

xiv Some keys to the literatures

Barry M. Brenner, Jay H. Stein (00). The Kidney in Diabetes Mellitus. New York,Edinburgh, London, Melbourne: Churchill Livingstone; 1989.

Ralph A. DeFronzo (00). DiabeticNephropathy. Semin Nephrol1990; 10: 183-304 .

Wm . James Howard , Gian Carlo Viberti (00). When to treat? A workshop toaddress the threshold of treatment of hypertension in diabetes . Diabetes Care 1991;14: suppl. 4: 1-47.

R.A. DeFronzo, E. Ferrannini (00). Diabetes Care 1991; 14: 173-269.

Proceedings of the International Symposium on Diabetic Nephropathy, July 24-251990, Otsu, Japan. J Diabetic Complications 1991; 5: 49-203 .

R.A. DeFronzo (00). Diabetes Care 1992; 15: 1125-1238 .

G. Crepaldi, R. Nosadini, R. Mangili (00). Proceedings of the International Meeting»State of the art and new perspective sin Diabetic Nephropathy- University ofPadua, 6-7 March, 1992. Acta Diabetol 1992; 29: 115-279.

S. Michael Mauer, Carl Erik Mogensen, GianCario Viberti (00). Symposium on theProgress in Diabetic Nephropathy. Kidney Int 1992: 41: 717-929

G.C. Viberti, W.B. White (00). What to treat? The structural basis for renal andvascular complications and hypertension, and the role of angiotensin convertingenzyme inhibition. J Hypertens 1992; 10: suppl. 1: SI-S51.

B. Charbonnel, J.M. Mallion, A. Mimran, Ph. Passa, P.F. Plouin, G. Tchobroutsky(00). Hypertension, diabete et systemes renine-angiotensine tissulaires . Aspectsfondamentaux et consequences therapeutiques. Diabete Metab 1992; 18: 127-186.

Andrzej S. Krolewski (00). Third International Symposium on HypertensionAssociated with Diabetes Mellitus. J Am Soc Nephrol 1992; 3: suppl. : SI-S139.

E. Ferrannini (00). Insulin Resistance and Disease. Bailliere's Clinical Endocrinolo­gy and Metabolism. International Practice and Research. Vol. 7. London,Philadelphia. Sydney, Tokyo, Toronto: Bailliere Tindall: 1993.

C. Hasslacher, C.G . Brilla (00). Renin-angiotensin-systemand collagen metabolismin diabetes mellitus and arterial hypertension. Clin Investig 1993; 71: suppl. : S1­S50.

xv

Eie Ferrannini (00). Insulin Resistance Syndrome. Cardiovasc Risk Factors 1993;3: 1-81.

Daniel Batlle (00). The Diabetes/Hypertension Connection. Cardiovasc Risk Factors1993; 3: 145-187.

Morrell M. Avram, Saulo Klahr (00). Proceedings from the Long lsland CollegeHospital. Symposium on Lipids and Vasoactive Agents in Renal Disease. Am JKidney Dis 1993; 22: 64-239.

F. Belfiore, R.N. Bergman, G.M. Molinatti (00). Current Topics in DiabetesResearch. 4th International Diabetes Conference, Florence, March 18-20, 1992.Frontiers in Diabetes, Vol. 12. Basel, Freiburg, Paris, London, New York, NewDelhi, Bangkok, Singapore, Tokyo,. Sydney: Karger; 1993.

C.E. Mogensen, C. Berne, E. Ritz, G.-C. Viberti (00). Proceedings of theSymposium Diabetic Renal Disease in Type 2 Diabetic Patients. A major worldwidehealth problem. Prague, 7 September, 1992. Diabetologia 1993; 36: 977-1117.

CONTRIBUTING AUTHORS

Elias V. Balaskas, MDUniversity of TorontoDivision of NephrologyToronto, OntarioCANADA

Hans-Jacob Bangstad, MDBarneavd .Aker sykehus0514 Oslo 5NORGE

Staffan Björck, MDNjurmottagningenSahlgrenska sjukhusetS-413 45 GöteborgSVERIGE

Knut Borch-Johnsen, MDBefokningsundersegelserneAmtssygehuset i GlostrupDK-26oo GlostrupDENMARK

Inge Bjern Brekke, MDRikshospitaletMedicinsk afdeling0027 Oslo 1NORGE

C. Andrew Combs, MDThe Good Samaritan Hospital2425 Samaritan DriveSan Jose, CA 95124USA

xviii Contributing Authors

Mark E. Cooper, MDDepartment of MedicineHeidelberg Repatriation HospitalsWest Heidelberg VIC 3081AUSTRALIA

Maximilian de Courten, MDMedizinische UniversitätspoliklinikInselspital BernCH-3010 BernSWITZERLAND

Indra D. Daniels, MDDepartment of MedicineState University of New York

Health Science Center atBrooklyn

NY 11203-2098USA

Ralph A. DeFronzo, MDUniversity of Texas HealthScience Center7703 Floyd Curl DriveSan Antonio, Texas 78231USA

Garabed Eknoyan, MDRenal SectionDepartment of MedicineBaylor College of MedicineHouston, Texas 77030-34USA

Bo Feldt-Rasmussen, MDNefro-Endokrinologisk afd. P 2132RigshospitaletDK-2100 Kabenhavn 0DENMARK

Paola Fioretto, MDDepartment of Internal MedicineUniversity of Padova35128 PadovaITALY

Allan Flyvbjerg, MDMedical Department MInstitute of Experimental Clinical

ResearchAarhus KommunehospitalDK-8000 Aarhus CDENMARK

Eli. A. Friedman, MDDepartment of MedicineState University of New York

Health Science Center atBrooklyn

NY 11203-2098USA

Rijk O.B. Gans, MDDepartment of Internal MedicineFree University Hospital1081 HV AmsterdamTHE NETHERLANDS

Ana Grenfell, MD MRCPThe Jeffrey Kelson Diabetic CentreCentral Middlesex HospitalNHS TrustLondon NWI0 7NSUNITED KINGDOM

Klavs Würgler Hansen, MDMedical Department MAarhus KommunehospitalDK-8000 Aarhus CDENMARK

Ryuichi Kikkawa , MDThe Third Department of MedicineShiga University of Medical

ScienceSeta, Otsu, Shiga 520-21JAPAN

Priscilla Kincaid-Smith, MDDepartment of PathologyThe University of MelboumeVictoria 3052AUSTRALlA

Allan Kofoed-Enevoldsen, MDHillered CentralsygehusDK-3400 HillemdDENMARK

William C. Knowler, MD, Dr.P.H.Diabetes and Arthritis

Epidemiology SectionNational Institute of Diabetes and

Digestive and Kidney DiseasesPhoenix, Arizona 85014USA

Ruggero Mangili , MDIstituto di Ricovero e Cura a

Carattere ScientificoCattedra di Clinica Medica

Generale20132 MilanoITALY

Diane L. Manninen, MDBattelle Center for Public Health

Research and EvaluationSeattle WashingtonUSA

Michel Marre, MDUnite de DiabetologieCentre Hospitalier Regional et

Universitaire d' AngersCHR-49033 Angers Cedex 01FRANCE

Margrethe Mau Pedersen, MDMedical Department MAarhus KommunehospitalDK-8000 Aarhus CDENMARK

Carl Erik Mogensen, MDMedical Department MAarhus KommunehospitalDK-8000 Aarhus CDENMARK

Henrik Bindesbel Mortensen, MDBerneafdelingen LKebenhavns Amts SygehusDK-2600 GlostrupDENMARK

Seren Nielsen, MDMedical Department MAarhus KommunehospitalDK-8000 Aarhus CDENMARK

Gudrun Nyberg, MDTransplant DivisionDepartment of SurgerySahlgrenska University HospitalS-413 45 GöteborgSWEDEN

xix

xx Contributing Authors

James A. O'Hare, MD FRCPI MRCPRegional General HospitalDooradoyle, LimerickIRELAND

Steen Olsen, MDPatologisk InstitutAarhus KommunehospitalDK-8000 Aarhus CDENMARK

David J. Pettitt, MDDepartment of Healthy & Human

ServicesNational Institute of Diabetes and

Digestive and Kidney DiseasesPhoenix, Arizona 85014USA

Per Legstrup Poulsen, MDMedical Department MAarhus KommunehospitalDK-8000 Aarhus CDENMARK

Anthony E.G . Raine, D. Phil FRCPDepartment of NephrologyThe Royal Hospital of St.

BartholomewLondon ECIA 7BEUNITED KINGDOM

Eberhard Ritz, MDSektion NephrologieKlinikum der Universität

Heidelberg6900 Heidelberg 1GERMANY

D.J.F. Rowe, MDSouthampton General HospitalTremona RoadSouthampton S09 4XYUNITED KINGDOM

Peter T. Sawicki, MDMedizinische Einrichtungender Heinrich-Heine UniversitätAbteilung für Ernährung und

StoffwechselW-4000 Düsseldorf 1GERMANY

Erwin D. Schleicher, MDInstitut für Diabetesforschung8 München 40Kölner Platz 1GERMANY

Anita Schmitz, MDMedical Department MAarhus KommunehospitalDK-8000 Aarhus CDENMARK

Coen D.A. Stehouwer, MDDepartment of Internal MedicineFree University Hospital1081 HV AmsterdamTHE NETHERLANDS

Roberto Trevisan, MDInstituto di Medicina ClinicaCattedra Malattie del RicambioUniversitä di PadovaDivisione Malattie deI Ricambio35128 PadovaITALY

Rene Vejlsgaard, MDKlinisk Mikrobiologisk afdeling,

lokal 3856Arntssygehuset i HerlevDK-2730 HerlevDENMARK

Jiten P. Vora, MDDepartment of MedicineRoyal Liverpool University

HospitalLiverpool L7 8XPUNITED KINGDOM

James D. Walker, MDDepartment of EndocrinologySt. Bartholomew's HospitalLondon ECIA 7BEUNITED KINGDOM

Ping H. Wang, MDJoslin Diabetes CenterOne Joslin PlaceBoston, MA 02215USA

xxi

PREFACE, first edition

The first sporadic observations describing renal abnonnalities in diabetes werepublished late in the 19th century, but systematic studies of the kidney in diabetesstarted only half a century aga after the paper by Cambier in 1934 and the muchmore famous study by Kimmelstiel and Wilson in 1936. These authors described twodistinct features of renal involvement in diabetes: early hyperfiltration and latenephropathy. Diabetic nephropathy is, despite half a century of studies, still a verypertinent problem, renal disease in diabetes now being a very common cause of end­stage renal failure in Europe and North America and probably throughout the world .It is a very important part of the generalized vascular disease found in long-termdiabetes as described by Knud Lundbeek in his monograph Lang-term Diabetes in1953, published by Munksgaard, Copenhagen.

Surprisingly, there has not been a comprehensive volume describing all aspectsof renal involvement in diabetes, and the time is now ripe for such a volumesummarizing the very considerable research activity within this field during the lastdecade and especially during the last few years.

This book attempts to cover practically all aspects of renal involvement indiabetes . It is written by colleagues who are themselves active in the many fields of

xxiv Preface

medical research covered in this volume: epidemiology, physiologyand pathophysio ­logy, laboratory methodology, and renal pathology. New studies deal with thediagnosis and treatment of both incipient and overt nephropathy by metabolie,antihypertensive, and dietary invention. Considerable progress has been made in themanagement of end-stage renal failure and also in the management and treatment ofnephropathy in the pregnant diabetic woman. Diabetic nephropathy is a worldwideproblem , but it is more clearly defined in Europe and North America where facilitiesfor the diagnosis and treatment of diabetes and its complications are readilyavailable. Much more work needs to be done in other parts of the world , as itappears from this book.

It is hoped that we now have a handbook for the kidney and hypertension indiabetes and that further progress can be made in clinical work in diagnosing andtreating diabetic patients. Much more work still needs to be done regarding patienteducation with respect to complications. Many diabetics have now been trained totake part in the management of their metabolie control; they should also be trainedto take part in the follow-up and treatment of complications.

This volume also underlines the considerable need for future research. So far,research in this field has been carried out in relatively few countries and centers inthe world. The editor is sure that this volume will also stimulate further advan­cement in clinical science within the field of diabetic renal disease.

In 1952, the book Diabetic Glomerulosclerosis I The Specific Renal Disease inDiabetes Mellitus, by Harold Rifkin and coworkers, published by Charles C.Thomas, Springfield, Illinois, USA, summarized all current knowledge on thediabetic kidney in about 100 short pages, including many case histories . Much morespace is needed now and the many disciplines involved will undoubtedly attractmany readers.

Carl Erik Mogensen

PREFACE, second edition

The sum of elinical problems caused by diabetie renal disease has been steadilyinereasing sinee the first edition of this book was published in 198ft Indeed, it isnow estimated that throughout the world about 100,000 diabetie individuals arereceiving treatment for end-stage renal failure. Obviously, this means a burden withrespect to human suffering, disease and premature mortality, but additionally thesetreatment programmes are extremely eostly, so eostly that in many areas resoureesare not available for this kind of eare. It is therefore clear, that every efforts shouldbe made to prevent or postpone the development of end-stage disease.

The years sinee the first edition appeared we have seen a tremendous progressin research aetivities. Importantly, this also ineludes improvement in the treatmentprogrammes to prevent end-stage renal failure. Thus it has become elear that thediabetie kidney is extremely pressure-sensitive, responding to effective antihyperten­sive treatment by retarded progression of disease. Some agents may be morebenefieial in this respect than other, although the effective blood pressure reduetionper se is crucial throughout the stages of diabetie renal disease. However, the primecause of diabetie renal disease is related to poor metabolie eontrol and it is nowdocumented beyond doubt that good metabolie eontrol is able to postpone or perhaps

xxvi Preface

even prevent the development of renal disease. However, in many individuals weare not able to provide such a quality of control that will prevent complications, andtherefore non-glycaemic intervention remains important. Maybe in the future non­glycaemic intervention will become the most important research area in diabeticnephropathy .

With respect to the exact mechanisms behind poor metabolie control anddevelopment of renal disease, much information is now being gained. It is likely thata combination of genetic predisposition and metabolie and haemodynamicabnormalities explain the progression to renal disease, seen in about 30 % of thediabetic individuals. Much of this development probably relates to modifiable geneticfactors, such as blood pressure elevation or haemodynamic aberrations. However,mechanisms related to the response to hyperglycaemia are also of clear importanceas is the possibility that these metabolie or haemodynamic pathway may be inhibited.

This volume review older data as well as the progress seen within the researchof diabetic nephropathy over the last five years and provides astate of the art of thedevelopment. However, we are still far from the main goal, which is the abolitionof end-stage renal disease in diabetic individuals. Obviously, much work still needsto be done and one of the intentions of this book is to stimulate further research inthis area where so many sub-disciplines of medical science are involved from theextremes of genetic and molecular biology to clinical and pharmacological researchtrials .

earl Erik Mogensen