Nephrology Dialysis Transplantation, Vol 13, Issue 1 72-75, Copyright © 1998 by Oxford University Press
R Boize, P Benhamou, P Corticelli, K Valenti, J Bosson and S Halimi
Background: Chronic hyperglycaemia stands with
diabetes duration as the main predicting factor for the development of
nephropathy in insulin dependent diabetes mellitus (IDDM). In contrast,
nephropathy in non-insulin-dependent diabetes mellitus (NIDDM) present with
a different natural history and, as well as atherosclerosis, can precede
diabetes diagnosis and even the onset of patient hyperglycaemia. The role
of lipid abnormalities in this matter remains debated.
Methods: We studied the prevalence of nephropathy
(N+=urinary albumin excretion rate (UAE) >20 mg/d) in 134 Caucasian
NIDDM patients ranked according to alipoprotein E
(apoE) genotype (same distribution in 132 controls).
Age, diabetes duration and sex ratio did not differ between N+ and N-. A
patient with E2E4 (n=1) was excluded from the analysis.
Results: The prevalence of nephropathy was
significantly reduced in E2 allele carriers (36%, 8/22)
vs 69% (77/111) in E2 non-carriers (P <0.01).
Relative risk (RR) of E2 carriers developing nephropathy was 0.52 (95%
CI=0.35-0.80). Both groups were comparable in terms of age
(55±11 vs 57±11 years), diabetes
duration (15 ±9vs 14±10 years)
and prevalence of retinopathy (59 vs 48%). Similar
results were observed when patients with diabetes duration longer than 8
years were studied (n=94). Conclusions: It has been
largely established that low-density lipoprotein (LDL)-cholesterol level in
E2 allele carriers (whether diabetic or not) was lower than in E2
non-carriers. The 2-fold increase of nephropathy in E2 non-carriers with
NIDDM argues for a role for LDL in the development of human nephropathy in
NIDDM patients. This result is in agreement with previous data established
both in vitro and in vivo in
animal models. These findings support evidence for the pathogenic and
morphologic similarities between kidney disease and atherosclerosis in
NIDDM patients. Key words: apolipoprotein E;
coronaropathy; microalbuminuria; diabetic nephropathy; NIDDM
ORIGINAL ARTICLES
ApoE polymorphism and albuminuria in diabetes mellitus: a role for LDL in the development of nephropathy in NIDDM?
Department of Endocrinology, Department of Biochemistry and Department of Biomathematics, University Hospital, Grenoble, France; Corresponding author at: Service d'Endocrinologie Diabetologie Nutrition, CHU, BP217X, F-38043 Grenoble Cedex, France
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