The potential effects of islet transplantation on the renal function of 36 patients with type I diabetes mellitus and kidney transplants were studied with 4 yr of follow-up monitoring. Kidney-islet recipients were divided into two groups, i.e., patients with successful islet transplants (SI-K group) (n = 24, fasting C-peptide levels of >0.5 ng/ml for >1 yr) and patients with unsuccessful islet transplants (UI-K group) (n = 12, fasting C-peptide levels of <0.5 ng/ml). Kidney graft survival rates and function, urinary albumin excretion rates, and sodium handling were compared. Na+/K+-ATPase activity in protocol kidney biopsies and in red blood cells was cross-sectionally analyzed. The SI-K group demonstrated better kidney graft survival rates (100, 83, and 83% at 1, 4, and 7 yr, respectively) than did the UI-K group (83, 72, and 51% at 1, 4, and 7 yr, respectively; P = 0.02). The SI-K group demonstrated reductions in exogenous insulin requirements and higher C-peptide levels, compared with the UI-K group, whereas GFR values were similar. Microalbuminuria (urinary albumin index) increased significantly in the UI-K group only (UI-K, from 92.0 ± 64.9 to 183.8 ± 83.8, P = 0.05; SI-K, from 108.5 ± 53.6 to 85.0 ± 39.0, NS). In the SI-K group, but not in the UI-K group, natriuresis decreased at 2 and 4 yr (P < 0.01). The SI-K group demonstrated greater Na+/K+-ATPase immunoreactivity in renal tubular cells (P = 0.05) and higher activity in red blood cells (P = 0.03), compared with the UI-K group. The Na+/K+-ATPase activity in red blood cells was positively correlated with circulating C-peptide levels but not with glycated hemoglobin levels. Successful islet transplantation was associated with improvements in kidney graft survival rates and function among uremic patients with type I diabetes mellitus and kidney grafts.
Islet transplantation is associated with improvement of renal function among uremic patients with type I diabetes mellitus and kidney transplants / P. Fiorina, F. Folli, G. Zerbini, P. Maffi, C. Gremizzi, V. Di Carlo, C. Socci, F. Bertuzzi, M. Kashgarian, A. Secchi. - In: JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY. - ISSN 1046-6673. - 14:8(2003), pp. 2150-2158.
|Titolo:||Islet transplantation is associated with improvement of renal function among uremic patients with type I diabetes mellitus and kidney transplants|
FOLLI, FRANCO (Secondo)
SECCHI, ANTONIO (Ultimo)
|Parole Chiave:||type 1 diabetes mellitus; islet of Langerhans transplantation; kidney transplantation; c-peptide; kidney biopsy; microalbuminuria; Na+/K+ ATPase; chronic renal insufficency|
|Settore Scientifico Disciplinare:||Settore MED/09 - Medicina Interna|
|Data di pubblicazione:||2003|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1097/01.ASN.0000077339.20759.A3|
|Appare nelle tipologie:||01 - Articolo su periodico|