Kidney function and size in diabetics before and during initial insulin treatment

Christiansen, Jens Sandahl; Gammelgaard, Jens; Tronier, B.; Svendsen, P.; Parving, Hans‐Henrik

doi:10.1038/ki.1982.81

Cited by 199 publications

(83 citation statements)

References 26 publications

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“…Table 3 shows that mean bloodglucose and 24-hour urinary glucose excretion were significantly lower in the IDD patients with normal RPF compared with the two other groups. This suggests that strict metabolic control decreases GFR and RPF in agreement with previous findings [17].…”

Section: Discussionsupporting

confidence: 82%

Increased kidney size, glomerular filtration rate and renal plasma flow in short-term insulin-dependent diabetics

et al. 1981

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Summary. Glomerular filtration rate (GFR), renal plasma flow (RPF) and kidney volume were measured in thirteen male subjects (mean age 30 years) with short-term insulin-dependent diabetes (mean duration of disease 2.4 years) and fourteen normal male subjects (mean age 29 years). GFR and RPF were measured by constant infusion technique using I125-iothalamate and 13q-hippuran. Kidney size was determined by means of ultrasound. GFR, RPF and kidney volume were increased in the diabetic patients compared to the normal controls, 144 versus 113 ml/ min • 1.73 m 2 (p < 0.0005), 627 versus 523 ml/ min x 1.73 m 2 (p < 0.0025) and 278 versus 224 ml/ 1.73 m 2 (p < 0.0005) respectively. Combining results from diabetic patients and controls revealed a positive correlation between kidney size and GFR (r = 0.70, p < 0.001) and between kidney size and RPF (r = 0.61, p < 0.001). Within the groups kidney size and RPF correlated significantly in the diabetics (p < 0.01) and the same was found for kidney size and GFR (0.025< p < 0.05), while no correlations were found in the normal group. GFR and RPF correlated in the diabetics when evaluated separately (r = 0.81, p < 0.001) and in the controls (r = 0.73, p < 0.001). The previous and present data suggest that the mechanisms of the elevated GFR in insulin-dependent diabetics are enhanced RPF, increased transglomerular hydrostatic pressure gradient and increased glomerular ultrafiltration coefficient. The increased kidney size is probably the main cause of the above alterations in the GFR determinants.

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Section: Discussionsupporting

confidence: 82%

Increased kidney size, glomerular filtration rate and renal plasma flow in short-term insulin-dependent diabetics

et al. 1981

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“…Plasma glucose decreased from 13.9mmol/1 to 6.5 mmol/l. These findings suggest that the lack of insulin either per se or secondary to the change in blood glucose, may contribute to the elevated GFR and RPF demonstrated in short-term IDD [2,3].…”

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confidence: 87%

The effect of intravenous insulin infusion on kidney function in insulin-dependent diabetes mellitus

1981

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Summary. Glomerular filtration rate, renal plasma flow, urinary excretion of fl-2-microglobulin and albumin, heart rate and blood pressure were studied in eight young male insulin-dependent diabetics. Measurements were performed before and during insulin infusion at 2 mU/kg/min: No patient had discernible insulin antibodies. Two studies were performed at random in each patient. In series A blood glucose concentration was allowed to decline, while in series B it was maintained at a constant level. Ten 20 min clearance periods were performed, four before and six during insulin infusion. Results are given as mean+SEM of .values from the first four (control) and last four (test) clearance periods. Blood glucose declined in series A experiments from 10.8_+0.8 mmol/1 in the control period to 5.8+0.5 mmol/1 during the test period, but remained constant during experiment B (9.8+ 1.1 and 9.5_+ 1.1 mmol/1). Plasma insulin levels were comparable in the two series. GIomerular filtration rate fell from 141+7 ml/ min • 1.73 m 2 to 132_+7 ml/min X 1.73 m 2 (p < 0.01) in series A but did not change significantly during series B. Similarily renal plasma flow declined with declining glucose but remained constant when glucose was maintained at a constant level. In series A the magnitude of decrease in renal plasma flow was correlated with the magnitude of decrease in glomerular filtration rate (r = 0.95, p < 0.001). fl-2-microglobulin excretion decreased significantly (p < 0.05) in both series (A: 89+17 to 60_+13 ng/min, B: 117_+46 to 62_+17ng/min). Albumin excretion increased in five out of six patients with normal control values (not significant) in series A and in four out of six in series B. No significant changes in heart rate or blood pressure were observed. Thus insulin infusion reduced renal plasma flow and glomerular filtration rate, but this effect could be completely abolished by keeping blood glucose constant. This suggests that it is not the lack of insulin but the associated hyperglycaemia which contributes to the elevated renal plasma flow and glomerular filtration rate in insulin-dependent diabetics.

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“…These findings suggest that insulin may induce abnormalities in vascular smooth muscle contractility, a factor that may contribute to or exacerbate the abnormal haemodynamics observed in the capillary microcirculation of numerous vascular beds in diabetes. [Diabetologia (1995) injury [1,2,8]. The mechanisms underlying these changes are not known; however, a change in the vascular reactivity of the resistance vessels may play a contributory role by permitting alterations in regional haemodynamics.…”

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confidence: 99%

The effect of insulin on the vascular reactivity of isolated resistance arteries taken from healthy volunteers

et al. 1995

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Summary Impaired reactivity of the resistance vasculature may contribute to the development of diabetic microangiopathy by altering microvascular haemodynamics. This study investigates the acute effects of insulin on the contractility and relaxation properties of isolated human resistance arteries (< 300 ~tm internal diameter) taken from gluteal subcutaneous fat of 33 (18 male: 15 female) normotensive healthy volunteers (supine blood pressure 115.6 + 1.6/ 70.0 + 1.5 mmHg [mean + SEM], with no family history of hypertension or diabetes mellitus. Resistance arteries were mounted in a small vessel myograph to measure isometric tension. Contractile responses to noradrenaline were reduced after incubation in 1 mU/ml of insulin for 20 min (p < 0.01; Group 1). Increasing concentrations of insulin were found to reduce the contractile response to noradrenaline in a dose-dependent manner (Group2; 0.1mU/ml by 8% [p

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Kidney function and size in diabetics before and during initial insulin treatment

Cited by 199 publications

References 26 publications

Increased kidney size, glomerular filtration rate and renal plasma flow in short-term insulin-dependent diabetics

Increased kidney size, glomerular filtration rate and renal plasma flow in short-term insulin-dependent diabetics

The effect of intravenous insulin infusion on kidney function in insulin-dependent diabetes mellitus

The effect of insulin on the vascular reactivity of isolated resistance arteries taken from healthy volunteers

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