The clinical investigator

, Volume 71, Issue 12, pp 972–977 | Cite as

Renal proximal and distal tubular function is attenuated in diabetes mellitus type 1 as determined by the renal excretion of α1-microglobulin and Tamm-Horsfall protein

  • S. Pfleiderer
  • L.B. Zimmerhackl
  • R. Kinne
  • F. Manz
  • G. Schuler
  • M. Brandis
Original Article


Diabetic nephropathy is usually characterized by glomerular dysfunction; the view that tubular damage occurs as a consequence, however, has been disputed. To verify this hypothesis we compared glomerular with proximal and distal tubular parameters in 62 patients with diabetes mellitus type I. The duration of disease ranged between 0 and 39 years and the glomerular, proximal tubular, and distal tubular parameters were investigated in 24-h urine samples. Excretion of albumin as a marker of the glomerulum, α1-microglobulin and N-acetyl-β-s-glucosaminidase as parameters of proximal tubule, and Tamm-Horsfall protein as parameter of distal tubule were determined by sensitive enzyme-linked immunosorbent assays. Patients were divided into five groups (D1–D5) according to the duration of diabetes as follows: D1, less than 1 year; D2, 1–4 years; D3, 5–9 years; D4, 10–14 years; D5, longer than 14 years. Healthy individuals (n = 61) aged 3–42 years served as controls. Significantly increased excretion of proximal tubular parameters were found in early course while albumin excretion was still in the normal range. In addition, proximal tubular α1-microglobulin showed an increase during the course of diabetes duration, probably indicating an early proximal tubular impairment. Distal tubular Tamm-Horsfall protein showed increasing excretion in D1–D4, which may reflect disturbance of the thick ascending loop of Henle. Our results therefore stress the importance of tubular parameters such as α1-microglobulin during early diabetes mellitus type I since they may serve as early markers of renal dysfunction and may precede albumin excretion. The thick ascending loop of Henle may play a decisive role in the course of diabetes mellitus and can be monitored by urinary THP-excretion of Tamm-Horsfall protein.

Key words

Diabetes mellitus Nephropathy Tamm-Horsfall protein α1-Microglobulin N-acetyl-β-d-glucosaminidase Albumin Tubular function Children 





enzyme-linked immunosorbent assay


insulin-dependent diabetes mellitus




thick ascending loop of Henle


Tamm-Horsfall protein


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Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • S. Pfleiderer
    • 1
  • L.B. Zimmerhackl
    • 1
  • R. Kinne
    • 3
  • F. Manz
    • 4
  • G. Schuler
    • 2
  • M. Brandis
    • 1
  1. 1.KinderklinikAlbert-Ludwigs-UniversitätFreiburgGermany
  2. 2.Klinikum für Innere MedizinAlbert-Ludwigs-UniversitätFreiburgGermany
  3. 3.Max-Planck-InstitutDortmundGermany
  4. 4.Forschungsinstitut für KinderernährungDortmundGermany

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