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      Renal Functional Response to Protein Loading in Type 1 (Insulin-Dependent) Diabetic Patients on Normal or High Salt Intake

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          Abstract

          Insulin-dependent diabetes mellitus (IDDM) patients may have an increased intrarenal angiotensin II activity. In diabetic patients, captopril increases the renal hemodynamic response to an amino acid infusion. We investigated the effects of two salt diets on arterial pressure and renal response to a protein load in 10 normotensive (blood pressure < 140/90 mm Hg) IDDM patients (aged 30 ± 3 years) who had diabetes for 7 ± 4 years and normoalbuminuria levels [albumin excretion rate 4.8 (2.5-19.1) μg/min]. After 1 week of normal (≈100 mmol/day; ≈100 mEq/l) and 1 week of high (≈300 mmol/day; ≈300 mEq/l) salt intake, renal hemodynamic studies were performed at baseline and after a protein load (meat meal) of 100 g/l.73 m<sup>2</sup>. The mean 24-hour urinary sodium excretion levels were 99 ± 27 and 293 ± 80 mmol (mEq) with normal and high salt intake, respectively. No significant changes were seen in plasma sodium and glucose control with the normal and high salt diets, respectively: plasma sodium 135 ± 3 vs. 137 ± 1 mmol/l (mEq/l), (p = 0.08) and glycated hemoglobin 9.1 ± 1.9 vs. 9.4 ± 2.1% (p = 0.36). The body weight (70.9 ± 12 vs. 71.8 ± 13 kg; p = 0.015) was significantly higher with a high salt diet. The mean arterial pressure was similar with both diets (normal vs. high salt diet 91 ± 9 vs. 89 ± 6 mm Hg, p = 0.25). The plasma renin concentration [28 ± 15 vs. 16 ± 6μU/ml(168 ± 90 vs. 96 ± 36 pmol/l), p = 0.013] and angiotensin II [8.8 ± 4.4 vs. 6.4 ± 3.5 pg/ml (0.052 ± 0.025 vs. 0.038 ± 0.021 nmol/l), p = 0.016] were significantly lower with the high salt diet. Following protein loading, the glomerular filtration rate increased with both diets: normal salt diet 114 ± 26 vs. 128 ± 30ml/min/1.73 m<sup>2</sup>(1.9 ± 0.43 vs. 2.13 ± 0.50ml/s/1.73 m<sup>2</sup>), p = 0.04; high salt diet 118 ± 23 vs. 127 ± 29 ml/min/1.73 m<sup>2</sup> (1.97 ± 0.38 vs. 2.12 ± 0.48 ml/s/1.73 m<sup>2</sup>), p = 0.13. The change in renal plasma flow was similar to that of the glomerular filtration rate with normal and high salt intake, respectively: 566 ± 94 vs. 617 ± 142 ml/min/1.73m<sup>2</sup> (9.44 ± 1.57 vs. 10.29 ± 2.37 ml/s/173m<sup>2</sup>), p = 0.0017; 572 ± 125 vs. 600 ± llθml/min/l.73 m<sup>2</sup> (9.54 ± 2.08 vs. 10.00 ± 1.83 ml/s/1.73 m<sup>2</sup>), p = 0.057. In this subset of normotensive normoalbuminuric IDDM patients, a high salt intake did not promote an exaggerated renal response to the protein load despite inhibition of the renin-angiotensin system.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          1997
          1997
          23 December 2008
          : 76
          : 4
          : 411-417
          Affiliations
          aUnit for Metabolic Medicine, Guy’s Hospital, London, bMRC Blood Pressure Unit, Glasgow, UK
          Article
          190223 Nephron 1997;76:411–417
          10.1159/000190223
          9274838
          © 1997 S. Karger AG, Basel

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          Pages: 7
          Categories
          Original Paper

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