Abstract
In diabetics, microalbuminuria reflects a multifactorial reversible glomerular dysfunction, announcing further development of overt nephropathy. This study aimes to determine whether microalbuminuria and its rise during a standardized exercise test are related to blood rheology. A cross-sectional study of 47 insulin dependent diabetics showed that impaired values of whole blood filterability (as found in 26 subjects) were associated with an increased resting microalbuminuria (21.755 ± 3.91 µg/min vs 8.125 ± 1.226, p < 0.03) whereas exercise induced rise in microalbuminuria did not differ between the two subgroups and showed no relationship with exercise-induced changes in filterability. Resting microalbuminuria correlated with blood pressure only in the subgroup exhibiting reduced blood filterability (r = 0.549 ; p < 0.01). Preliminary results of an open study with pentoxifylline (800 mg/day during 3 months) suggest that this drug reduces resting microalbuminuria but not its exercise-induced increase. Those data might be consistent with the following working hypotheses: (a) hemorheologic disorders detectable with blood filterability measurement could impair glomerular microcirculation, increasing its sensitivity to blood pressure. Therefore, they could be an additional risk factor, as previously stated by Solerte. (b) microalbuminuria rise during exercise is not likely to be an artifact resulting from exercise-induced hemorheologic changes, but might be an improved index of abnormalities already existing at rest. (c) our findings seem to be consistent with previous reports suggesting a beneficial effect of pentoxifylline in this process. However, this latter concept requires further investigations.
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