Postexercise albuminuria in children with different duration of type-1 diabetes mellitus

Abstract

About 30% of diabetic patients develop progressive renal failure. We studied albumin, IgG, and transferrin excretion during exercise in diabetic children without signs of nephropathy to investigate proteinuria under these conditions: 39 patients with insulin-dependent diabetes mellitus and 21 healthy children undertook a bicycle exercise test. Albuminuria measured by nephelometry was calculated as the albumin excretion rate (AER) and albumin-to-creatinine ratio before and after exercise. The diabetic group was divided into three subgroups according to disease duration (DI < 5 years, DII 5-10 years, DIII > 10 years). No significant difference in metabolic control (hemoglobin A1c was detected between the diabetic groups (median hemoglobin A1c: DI 7.2%, DII 7.6%, DIII 8.6%). There was no increase in AER in the healthy children after exercise. Before exercise the diabetic groups had an AER similar to controls. No significant increase in albuminuria after exercise was seen in group DI. Both groups with a disease duration of more than 5 years had a significant increase in albuminuria [median before/after: DII 7.8/16.7 (P < 0.05), DIII 0/57.9 (P < 0.05) micrograms/min per 1.73 m2). Of these patients, 43% also had a measurable urinary excretion of IgG and transferrin, indicating structural glomerular damage. There was no correlation of albuminuria and parameters of metabolic control or renal function. We conclude that in diabetic children an exercise test unveils albuminuria in certain patients, while their AER may be normal at rest.

Sex difference in the risk for exercise-induced albuminuria correlates with hemoglobin A1C and abnormal exercise ECG test findings

“…These differences were not detected by traditional biomarkers such as resting UACR and thus suggest a potential for ΔEiA as a biomarker for assessing CVD risk in women. Recent studies have shown similar patterns regarding exercise induced albuminuria and its correlation to the metabolic syndrome and diabetes in particular [5, 6, 9]. Our current study marks another step towards achieving a comprehensive understanding of dysmetabolic complications, their onset and progression throughout the disease.…”

“…Several studies have shown that exercise unmasks albuminuria in normo-albuminuric diabetic individuals (exercise induced albuminuria—EiA, measured as spot UACR before and after exercise), suggesting this as the earliest sign of DN [5, 6]. Exercise leads to albuminuria by both modulating glomerular passage and tubular reuptake of albumin [7, 8].…”

Stress Tolerance Test and SDS-PAGE for the Analysis of Urinary Proteins in Children and Youths

“…Stress tolerance test was given to adults and children with IDDM in order to predict the development of persistent microproteinuria and the risk of disease progression (19)(20)(21)(22)(23)(24)(25).…”

The Role of Physical Exercise on Lipid Peroxidation in Diabetic Complications

“…Under exercise, patients with Type 1 diabetes show a partial depletion of negative charges on the glomerular capillary wall [126] that permits the increase of urinary albumin excretion [127]. Reports indicate that urinary albumin excretion increases after exercise, without correlation with glycaemic control, renal function, disease evolution or resting urinary albumin excretion [128,129]. In contrast, postexercise albuminuria has been found to be associated with HbA1c [127,129].…”

“…Reports indicate that urinary albumin excretion increases after exercise, without correlation with glycaemic control, renal function, disease evolution or resting urinary albumin excretion [128,129]. In contrast, postexercise albuminuria has been found to be associated with HbA1c [127,129].…”