Biochemistry of the Basement Membrane in Diabetes Mellitus

Abstract

In recent years, extensive investigations have demonstrated that numerous biochemical and physiological abnormalities occur in various tissues of hyperglycemic animals and humans (Brownlee and Cahill, 1979). Where the effect of treatment has been studied, many, if not all of these abnormalities, are returned towards normal with insulin, and it seems likely that some of these may play a role in the pathogenesis of diabetic renal disease. Others are likely to be mere concomitants of the microvascular disease which reflect common metabolic abnormalities of the diabetic state, but are causally unrelated. Although it appears increasingly likely that the morphological and clinical features of diabetic nephropathy result from a complex combination of interacting variables, the relative significance of individual factors is currently unknown. Whatever the sequence of events leading from abnormal glucose homeostasis to progressive renal failure with persistent proteinuria, the final clinical manifestations reflect irreversible glomerular capillary occlusion and increased permeability of the glomerular filtration barrier. Both of these result from alterations in basement membrane.