Capillary permeability is increased in normo‐ and microalbuminuric Type 1 diabetic patients: amelioration by ACE‐inhibition

Abstract

Capillary permeability, as determined by NaF leakage, is elevated in normoalbuminuric Type 1 diabetic patients with long-standing disease, and the excess elevation in microalbuminuric Type 1 diabetic patients is ameliorated by ACE-inhibition. Skin NaF videodensitometry seems a useful tool to document capillary permeability in intervention studies.

Sympathetic mediated vasomotion and skin capillary permeability in diabetic patients with peripheral neuropathy

“…Although microalbuminuria was highly prevalent among the patients with neuropathy, it was not related to a higher NaF leakage. A previously reported association between microalbuminuria and NaF leakage [15] could have had neuropathy as an important intermediary factor. In that study, neurography and blood flow variability were not measured, as ACE-inhibition therapy reduces NaF leakage [15], the true NaF leakage could have even been higher in the neuropathy group as more of these patients were on ACE-inhibitors.…”

“…A previously reported association between microalbuminuria and NaF leakage [15] could have had neuropathy as an important intermediary factor. In that study, neurography and blood flow variability were not measured, as ACE-inhibition therapy reduces NaF leakage [15], the true NaF leakage could have even been higher in the neuropathy group as more of these patients were on ACE-inhibitors. The finding that the use of an ACE-inhibitor did not contribute to the NaF leakage, does not exclude this possibility, but is probably beyond the scope of this study.…”

“…The amount of interstitial NaF is proportional to the rate of NaF diffusion through the skin capillaries [15,21], since NaF delivery to the interstitial space is relatively fast, reaching a maximal interstitial concentration after 5 to 10 min, while NaF clearance from the interstitium takes at least several hours. Estimation of the transcapillary escape rate of albumin [13,16], the transcapillary diffusion gradient [14] and NaF leakage [15] showed an increase in capillary permeability in Type 1 diabetic patients, particularly when complicated by microalbuminuria. No previous studies have evaluated the role of neuropathy in the increased capillary permeability.…”

“…With different visualizing techniques, an increased NaF leakage has been found in the capillary beds of the retina [19], the nailfold [12] and the foot skin [20] of diabetic patients. With an improved technique [21], we found that angiotensin-converting enzyme inhibitors, independent from its blood pressure lowering effect, reduced NaF leakage in microalbuminuric diabetic patients, suggesting that changes that at the microcirculatory level influence capillary NaF permeability [15].…”

Angiotensin converting enzyme inhibiting therapy is associated with lower vitreous vascular endothelial growth factor concentrations in patients with proliferative diabetic retinopathy

“…A strong association between these complications is shown by epidemiological studies [35], probably based on microvascular dysfunction. In diabetic patients ACE-inhibition reduces microalbuminuria and normalizes an increased skin capillary permeability [38]. It also attenuates the increased retinal blood flow [39], which parallels the progression of nonproliferative diabetic retinopathy [40].…”