Nephropathy in remnant kidneys: pathological proteinuria after unilateral nephrectomy

It is a matter of dispute as to whether and to what extent hyperfiltrative nephropathy occurs in a contralateral remnant kidney after unilateral nephrectomy. This question was investigated in a retrospective progress observation using urinary electrophoresis among other methods. Of 106 patients who underwent nephrectomy between 1963 and 1984 because of unilateral kidney diseases, only 39 fulfilled all of the requisite criteria for a followup examination 2 to 23 years later. Whereas there was arterial hypertension or decreased kidney function in 4 cases (10.3%), pathological proteinuria was found in 32 of the remnant kidneys (82.1%): tubular in 13 (40.6%) and glomerular in 19 (59.4%). In contrast to that of arterial hypertension or decreased kidney function, this incidence is far greater than the expected risk in the normal population, which in our opinion indicates that hyperfiltrative nephropathy occurs in the contralateral remnant kidney after unilateral nephrectomy without causing relevant restriction of kidney function or increasing the arterial pressure.

The associations of apolipoprotein E and angiotensin-converting enzyme polymorphisms and cognitive function in Type 1 diabetes based on an 18-year follow-up of the DCCT cohort

AIMS

Specific polymorphisms of the apolipoprotein E (APOE) and angiotensin-converting enzyme (ACE) genes appear to increase risk for Alzheimer's disease and cognitive dysfunction in the general population, yet little research has examined whether genetic factors influence risk of cognitive dysfunction in patients with Type 1 diabetes. The long-term follow-up of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) population provides an opportunity to examine if specific genetic variations in APOE and ACE alter risk for cognitive decline.

METHODS

Neurocognitive function in Type 1 diabetic subjects from the DCCT/EDIC study was assessed at DCCT entry and re-assessed approximately 18 years later, using a comprehensive cognitive test battery. Glycated haemoglobin (HbA(1c)) and the frequency of severe hypoglycaemic events leading to coma or seizures were measured over the 18-year follow-up. We determined whether the APO epsilon4 and ACE intron 16 indel genotypes were associated with baseline cognitive function and with change over time, and whether they conferred added risk in those subjects experiencing severe hypoglycaemic events or greater glycaemic exposure.

RESULTS

None of the APOE or ACE polymorphisms were associated with either baseline cognitive performance or change in cognition over the 18-year follow-up. Moreover, none of the genotype variations altered the risk of cognitive dysfunction in those subjects with severe hypoglycaemic episodes or high HbA(1c).

CONCLUSIONS

In this sample of young and middle-aged adults with Type 1 diabetes, APO epsilon4 and ACE D alleles do not appear to increase risk of cognitive dysfunction.