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- Title
Protein intake and blood glucose as modulators of GFR in hyperfiltering diabetic patients.
- Authors
Jones, Sharon L.; Kontessis, Panayotis; Wiseman, Martin; Dodds,, Rosemary; Bognetti, Emilio; Pinto, Jose; Viberti, Giancarlo
- Abstract
Glomerular hyperfiltration has been claimed to be a risk factor for the development of diabetic nephropathy. Protein intake and hyperglycemia can both increase GFR in diabetic and normal subjects. Our study was designed to explore the relative importance of short-term changes in protein intake and glycemia on the modulation of renal hemodynamics in insulin-dependent diabetic (IDDM) patients with and without glomerular hyperfiltration. The renal hemodynamic response to a protein challenge was studied in eight hyperfiltering (HF) and eight normofiltering (NF) patients after a three week period of tow or normal protein diet (LPD, NPD), each study being conducted twice, in random order, under conditions of prevailing hyperglycemia (H) and euglycemia (E). In HF patients GFR failed to increase significantly in response to protein challenge during NPD tinder conditions of either H or E (Baseline vs. 2 hr H: 151 ± 4 vs. 155 ± 6, NS; E 147 ± 4 vs. 157 ± 7 ml/min/1.73 m2, NS). A more normal response was restored following LPD with GFR increasing in all but one patient after challenge during H and in all patients during E (Baseline vs. 2 hr H: 130 ± 1 vs. 145 ± 8, P < 0.07; E: 127 ± 7 vs. 143 ± 7 ml/min/1.73 m2, P < 0.01). Changes in RPF paralleled the changes in GFR and filtration fraction remained stable under all study conditions. RVR was significantly lower by two hours in HF patients only after the low protein diet (Baseline vs. 2 hr: H: 93 ± 10 vs. 79 ± 4 mm Hg/min/liter, P < 0.05: E: 84 ± 5 vs. 73 ± 3 mm Hg/min/liter, P < 0.02). In NF patients GFR increased significantly under all study conditions. KPF also increased and RVR fell. In IDDM patients with glomerular hyperfiltration on a normal dietary protein intake, the renal hemodynamic response to a meat meal is altered. Short-term changes in protein intake appear more important than acute changes in glycemia in the regulation of renal function in response to protein ingestion in these patients.
- Subjects
PEOPLE with diabetes; GLOMERULAR filtration rate; PHYSIOLOGICAL control systems; PROTEIN metabolism; BLOOD sugar; KIDNEY glomerulus
- Publication
Kidney International, 1992, Vol 41, Issue 6, p1620
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1038/ki.1992.234