Scandinavian Journal of Clinical and Laboratory Investigation
ISSN: 0036-5513 (Print) 1502-7686 (Online) Journal homepage: http://www.tandfonline.com/loi/iclb20
The effect of exercise on urinary excretion of different size proteins in patients with insulindependent diabetes mellitus L. Groop, S. Stenman, P. H. Groop, A. Makipernaa & A. M. Teppo To cite this article: L. Groop, S. Stenman, P. H. Groop, A. Makipernaa & A. M. Teppo (1990) The effect of exercise on urinary excretion of different size proteins in patients with insulindependent diabetes mellitus, Scandinavian Journal of Clinical and Laboratory Investigation, 50:5, 525-532 To link to this article: http://dx.doi.org/10.3109/00365519009089167
Published online: 08 Jul 2009.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=iclb20 Download by: [Universität Osnabrueck]
Date: 07 February 2016, At: 01:46
Scand J Clin Lab Invest 1990: 50: 525-532
The effect of exercise on urinary excretion of different size proteins in patients with insulin-dependent diabetes mellitus L. GROOP, S. STENMAN, P. H . GROOP, A. MAKIPERNAA* & A . M. T E P P O
Downloaded by [Universität Osnabrueck] at 01:46 07 February 2016
Fourth Department of Medicine, Helsinki University Hospital, and :Department of Paediatrics, Helsinki University Hospital, Helsinki, Finland
Groop L, Stenman S,Groop PH, Makipernaa A, Teppo AM. Scand J Clin Lab Invest 1990; 50: 527-532.
To examine whether exercise-induced proteinuria in diabetes is dependent upon the size of the excreted protein, we measured urinary excretion of p2microglobulin, kappa light chains, albumin and IgG before and after 20 min of moderate ergometer exercise in 34 patients with insulin dependent diabetes mellitus (IDDM) and in eight healthy control subjects. Seventeen patients with newly diagnosed IDDM and 17 patients (seven of which had elevated albumin excretion rate) with longstanding IDDM were studied. Exercise did not significantly influence protein excretion in control and newly diagnosed IDDM subjects. In contrast, exercise enhanced excretion of ~2-microglobulin(p20 kg/min is considered a marker for early diabetic nephropathy [ 2 , 7-91. The AER increases during physical stress [lo, 111, and vigorous exercise prior to urine sampling can increase AER also in healthy individuals [ll]. We have previously demonstrated that urine
525
Downloaded by [Universität Osnabrueck] at 01:46 07 February 2016
526
L. G r o o p et al.
patients with IDDM of less than 6 months’ duration; (2) 10 patients with longstanding IDDM but with normal AER; (3) seven patients with longstanding IDDM and elevated A E R ; and (4) eight control subjects (Table I). None had coronary heart disease or proliferative retinopathy. Informed consent was obtained from all subjects and the study protocol was approved by the Ethics committee of the Fourth Department o f Medicine, Helsinki University Hospital.
excretion of kappa light chains is a common finding in patients with longstanding IDDM but who have normal A E R 1121. However, it is not known whether the urinary excretion of kappa light chains is influenced by exercise. Alterations in thesizeandchargeselectivity of theglomerular membrane have been considered as possible mechanisms responsible for the development of proteinuria in a diabetic individual [13- 151. Impaired barrier size-selectivity has been reported in diabetic patients with gross proteinuria [14], but it is not known whether proteinuria will influence size selectivity. In addition, the glomerular capillary wall contains negatively charged sites that provide an electrostatic barrier to the filtration of anionic proteins like albumin [16]. It has been suggested that glycosylation of basement membrane proteins may influence their isoelectric point, thereby attenuating the electrostatic barrier function [ 17, 181. Alternatively, glycosylation of circulating proteins may influence their isoelectric points and thereby change their retardation by the glomerular capillary wall fly]. To address these questions, we examined the effect of moderate exercise on the urinary excretion of P2-microglobulin (Mw 12 000, Stokes radius 16 A), kappa light chains (Mw 22000, Stokes radius 28 A), albumin (Mw 69000, Stokes radius 36 A) and IgG (Mw 160 000, Stokes radius SO A) in IDDM and in healthy control subjects.
Exercise test The subjects came to the Metabolic Unit between 0800 and 0900 hours after having had their breakfast and regular medication. They voided their urine and rested in sitting position for I h while drinking 250 nil of water every 20 min to increase urine output. All urine from this period was collected before the exercise was started. Thereafter, they exercised on a bicycle ergometer for 20 min. The exercise load was adjusted over 5 min not to exceed 75% of the age-adjusted maximum heart rate. The details of the exercise test in the four groups are given in Table 11. This work-load does not provoke albuminuria in healthy individuals [ 10, 1 I , 201. The subjects rested for 10 min after the exercise test before the second urine sample was obtained. Analytical methods
SUBJECTS AND METHODS Subjects
Four groups of patients were studied; ( I ) 17 TABLE
Concentrations of fiz-microglobulin (Phadebas [3?-microtest, Pharmacia, Uppsala, Sweden) and albumin (Albumin RIA LOO, Pharmacia) were measured by specific radio-immunoassays
I. Clinical characteristics of‘ suhjects ~~
Inwlin-dcpendent dinhetic patient\ ~~
Ixng%mding
Controls
New Onsct
Normal AER
Elevated AER
8 (50) 31 ( I )
17 (7/10)
10 ( S / S )
12 (1) 0.1 ( 0 .I ) 20.2 ( 0 . 8 ) 12. I (0.4) 13 ( 5 )
40 (2) 17 ( 2 ) 22. I (0.8) 10.0 (0.3) 8 (3)
7 (5/2) 46 (2) 23 (2) 23.1 (0.9) 9.8 (0.5) 1246 (678)*
~
N (F/M) Age (years) Duration (years) BMI (kg/m2) H b A , (Yo) A E R (pglrnin)
-
21.4 (0.5) 6.1 (0.1)
1 0 (4)
Values are mean and (SEM). *p
ISSN: 0036-5513 (Print) 1502-7686 (Online) Journal homepage: http://www.tandfonline.com/loi/iclb20
The effect of exercise on urinary excretion of different size proteins in patients with insulindependent diabetes mellitus L. Groop, S. Stenman, P. H. Groop, A. Makipernaa & A. M. Teppo To cite this article: L. Groop, S. Stenman, P. H. Groop, A. Makipernaa & A. M. Teppo (1990) The effect of exercise on urinary excretion of different size proteins in patients with insulindependent diabetes mellitus, Scandinavian Journal of Clinical and Laboratory Investigation, 50:5, 525-532 To link to this article: http://dx.doi.org/10.3109/00365519009089167
Published online: 08 Jul 2009.
Submit your article to this journal
Article views: 1
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=iclb20 Download by: [Universität Osnabrueck]
Date: 07 February 2016, At: 01:46
Scand J Clin Lab Invest 1990: 50: 525-532
The effect of exercise on urinary excretion of different size proteins in patients with insulin-dependent diabetes mellitus L. GROOP, S. STENMAN, P. H . GROOP, A. MAKIPERNAA* & A . M. T E P P O
Downloaded by [Universität Osnabrueck] at 01:46 07 February 2016
Fourth Department of Medicine, Helsinki University Hospital, and :Department of Paediatrics, Helsinki University Hospital, Helsinki, Finland
Groop L, Stenman S,Groop PH, Makipernaa A, Teppo AM. Scand J Clin Lab Invest 1990; 50: 527-532.
To examine whether exercise-induced proteinuria in diabetes is dependent upon the size of the excreted protein, we measured urinary excretion of p2microglobulin, kappa light chains, albumin and IgG before and after 20 min of moderate ergometer exercise in 34 patients with insulin dependent diabetes mellitus (IDDM) and in eight healthy control subjects. Seventeen patients with newly diagnosed IDDM and 17 patients (seven of which had elevated albumin excretion rate) with longstanding IDDM were studied. Exercise did not significantly influence protein excretion in control and newly diagnosed IDDM subjects. In contrast, exercise enhanced excretion of ~2-microglobulin(p20 kg/min is considered a marker for early diabetic nephropathy [ 2 , 7-91. The AER increases during physical stress [lo, 111, and vigorous exercise prior to urine sampling can increase AER also in healthy individuals [ll]. We have previously demonstrated that urine
525
Downloaded by [Universität Osnabrueck] at 01:46 07 February 2016
526
L. G r o o p et al.
patients with IDDM of less than 6 months’ duration; (2) 10 patients with longstanding IDDM but with normal AER; (3) seven patients with longstanding IDDM and elevated A E R ; and (4) eight control subjects (Table I). None had coronary heart disease or proliferative retinopathy. Informed consent was obtained from all subjects and the study protocol was approved by the Ethics committee of the Fourth Department o f Medicine, Helsinki University Hospital.
excretion of kappa light chains is a common finding in patients with longstanding IDDM but who have normal A E R 1121. However, it is not known whether the urinary excretion of kappa light chains is influenced by exercise. Alterations in thesizeandchargeselectivity of theglomerular membrane have been considered as possible mechanisms responsible for the development of proteinuria in a diabetic individual [13- 151. Impaired barrier size-selectivity has been reported in diabetic patients with gross proteinuria [14], but it is not known whether proteinuria will influence size selectivity. In addition, the glomerular capillary wall contains negatively charged sites that provide an electrostatic barrier to the filtration of anionic proteins like albumin [16]. It has been suggested that glycosylation of basement membrane proteins may influence their isoelectric point, thereby attenuating the electrostatic barrier function [ 17, 181. Alternatively, glycosylation of circulating proteins may influence their isoelectric points and thereby change their retardation by the glomerular capillary wall fly]. To address these questions, we examined the effect of moderate exercise on the urinary excretion of P2-microglobulin (Mw 12 000, Stokes radius 16 A), kappa light chains (Mw 22000, Stokes radius 28 A), albumin (Mw 69000, Stokes radius 36 A) and IgG (Mw 160 000, Stokes radius SO A) in IDDM and in healthy control subjects.
Exercise test The subjects came to the Metabolic Unit between 0800 and 0900 hours after having had their breakfast and regular medication. They voided their urine and rested in sitting position for I h while drinking 250 nil of water every 20 min to increase urine output. All urine from this period was collected before the exercise was started. Thereafter, they exercised on a bicycle ergometer for 20 min. The exercise load was adjusted over 5 min not to exceed 75% of the age-adjusted maximum heart rate. The details of the exercise test in the four groups are given in Table 11. This work-load does not provoke albuminuria in healthy individuals [ 10, 1 I , 201. The subjects rested for 10 min after the exercise test before the second urine sample was obtained. Analytical methods
SUBJECTS AND METHODS Subjects
Four groups of patients were studied; ( I ) 17 TABLE
Concentrations of fiz-microglobulin (Phadebas [3?-microtest, Pharmacia, Uppsala, Sweden) and albumin (Albumin RIA LOO, Pharmacia) were measured by specific radio-immunoassays
I. Clinical characteristics of‘ suhjects ~~
Inwlin-dcpendent dinhetic patient\ ~~
Ixng%mding
Controls
New Onsct
Normal AER
Elevated AER
8 (50) 31 ( I )
17 (7/10)
10 ( S / S )
12 (1) 0.1 ( 0 .I ) 20.2 ( 0 . 8 ) 12. I (0.4) 13 ( 5 )
40 (2) 17 ( 2 ) 22. I (0.8) 10.0 (0.3) 8 (3)
7 (5/2) 46 (2) 23 (2) 23.1 (0.9) 9.8 (0.5) 1246 (678)*
~
N (F/M) Age (years) Duration (years) BMI (kg/m2) H b A , (Yo) A E R (pglrnin)
-
21.4 (0.5) 6.1 (0.1)
1 0 (4)
Values are mean and (SEM). *p
