Clinical Investigation

Kidney International (1993) 44, 127–133; doi:10.1038/ki.1993.222

Sodium-lithium countertransport and triglycerides in diabetic nephropathy

Ruggero Mangili1, Gianpaolo Zerbini1, Cristina Barlassina1, Daniele Cusi1 and Guido Pozza1

1Department of Medicine, Renal Pathophysiology Laboratory, and Department of Nephrology, Dialysis and Hypertension, Scientific Institute San Raffaele, University of Milan, Italy

Correspondence: Ruggero Mangili MD, Divisione Medicina I, Istituto Scientifico San Raffaele, Via Olgettina, 60, I-20132 Milano, Italy.

Received 4 November 1992; Revised 3 February 1993; Accepted 4 February 1993.

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Abstract

Sodium-lithium countertransport and triglycerides in diabetic nephropathy. Elevated erythrocyte sodium-lithium countertransport (SLC) activity is an intermediate phenotype of essential hypertension among Caucasians, and is controversially associated with nephropathy in Type 1 (insulin-dependent) diabetes. Hypertriglyceridemia is a frequent concomitant of elevated SLC in the general population, and may be found in diabetic nephropathy. The present study was designed to investigate the influence of kidney disease, serum triglycerides and blood pressure on the interindividual variability of SLC in Type 1 diabetes. SLC and fasting major serum lipids were studied in 35 Type 1 diabetic patients with persistently elevated urinary albumin excretion and in a group of patients matched for age, sex and duration of diabetes, but with normoalbuminuria. SLC was elevated in patients with clinical nephropathy (N = 10; median: 420 micromol dot 1RBC-1 dot hr-1) and in patients with microalbuminuria (N = 25; median: 405 micromol dot 1RBC-1 dot hr-1) compared with normoalbuminuric patients (median: 296 micromol dot 1RBC-1 dot hr-1; P < 0.01 vs. both groups). Hypertriglyceridemia and hypercholesterolemia were found only among patients with macroalbuminuria. Analysis of covariance indicated that the association of elevated SLC with kidney disease (P < 0.006 in all models) was largely independent of serum triglycerides, but also of total cholesterol, insulin dose and measures of glycemie control. Only diastolic blood pressure was positively associated with SLC (P < 0.02) independently from nephropathy (P < 0.005) also after restricting analysis to the normoalbuminuric patients. Kidney disease and raised blood pressure remain major concomitants of elevated SLC in Type 1 diabetics.

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