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Effect of intravenous glucose infusion on renal function in normal man and in insulin-dependent diabetics

Summary

The effect of intravenous glucose infusion on glomerular filtration rate and renal plasma flow (constant infusion technique using 125I-iothalamate and 131I-hippuran) and on urinary excretion of albumin and β-2-microglobulin were studied in ten normal subjects and seven metabolically well-controlled insulin-dependent diabetics. Following glucose infusion in normal subjects (n = 10) blood glucose increased from 4.7±0.1 to 10.9±0.4 mmol/1 (SEM) (p ⩽ 0.01). Glomerular filtration rate increased from 116±2 to 123±3ml/min x 1.73 m2 (p ⩽ 0,01), while no change in renal plasma flow was seen 552±11 versus 553±18 ml/min × 1.73 m2. Volume expansion with intravenous saline infusion in six of the normal subjects induced no changes in blood glucose or kidney function. In seven strictly controlled insulin-dependent diabetics, blood glucose values were raised from 4.6±0.4 to 16.0±0.6 mmol/1 and clamped by means of an ‘artificial beta cell’. Glomerular filtration rate increased in all patients, from 133 ±5 to 140±6 ml/min × 1.73 m2 (p ⩽ 0.02), as did renal plasma flow from 576±26 to 623±38 ml/ min × 1.73 m2 (p ⩽ 0.02). Urinary albumin excretion remained unchanged in both normal subjects and diabetics. β-2-microglobulin excretion rate increased significantly in the diabetics following glucose infusion, while no significant change was seen in the normal subjects. Our results show that hyperglycaemia per se contributes to the increased glomerular filtration rate and renal plasma flow in insulin-dependent diabetes.

References

  1. 1.

    Stalder G, Schmid R, Wolff MV (1960) Funktionelle Mikroangiopathie der Nieren beim behandelten Diabetes Mellitus im Kindesalter. Dtsch Med Wochenschr 85:346–350

  2. 2.

    Mogensen CE (1972) Kidney function and glomerular permeability to macromolecules in juvenile diabetes. Dan Med Bull 19: (Suppl 3): 1–40

  3. 3.

    Ditzel J, Junker K (1972) Abnormal glomerular filtration rate, renal plasma flow, and renal protein excretion in recent and short-term diabetics. Br Med J II: 13–19

  4. 4.

    Christiansen JS, Gammelgaard J, Tronier B, Svendsen PAa, Parving H-H (1981) Kidney function and size in diabetics before and during initial insulin treatment. Kidney Int (in press)

  5. 5.

    Parving H-H, Rutili F, Granath K, Noer I, Deckert T, Lyngsøe J, Lassen NA (1979) Effect of metabolic regulation on renal leakiness to dextran molecules in short-term insulin-dependent diabetics. Diabetologia 17:157–160

  6. 6.

    Kroustrup JP, Gundersen HJG, Østerby R (1977) Glomerular size and structure in diabetes mellitus III. Early enlargement of the capillary surface. Diabetologia 13:207–210

  7. 7.

    Parving H-H, Christiansen JS, Noer I, Tronier B, Mogensen CE (1980) The effect of glucagon infusion on kidney function in short-term insulin-dependent juvenile diabetes. Diabetologia 19:350–354

  8. 8.

    Brøchner-Mortensen J (1973) The glomerular filtration rate during moderate hyperglycaemia in normal man. Acta Med Scand 194:31–37

  9. 9.

    Mogensen CE (1971) Glomerular filtration rate and renal plasma flow in normal and diabetic man during elevation of blood sugar levels. Scand J Clin Lab Invest 28:177–182

  10. 10.

    Fox M, Thier S, Rosenberg L, Segal S (1964) Impaired renal tubular function induced by sugar infusion in man. J Clin Endocrinol 24:1318–1327

  11. 11.

    Faber OK, Binder C (1977) C-peptide response to glucagon. A test for the residual β-cell function in diabetes mellitus. Diabetes 26:605–610

  12. 12.

    Mogensen CE (1971) Glomerular filtration rate and renal plasma flow in short-term and long-term juvenile diabetes mellitus. Scand J Clin Lab Invest 28:91–100

  13. 13.

    Miles DW, Mogensen CE, Gundersen HJG (1970) Radioimmunoassay for urinary albumin using a single antibody. Scand J Clin Lab Invest 26:5–11

  14. 14.

    Evrin PE, Peterson PA, Wide L, Berggård J (1971) Radioimmunoassay of β-2-microglobulin in human biological fluids. Scand J Clin Lab Invest 28:439–444

  15. 15.

    Pfeiffer EF, Thum C, Clemens AH (1974) The artificial betacell. A continuous control of blood sugar by external regulation of insulin infusion (Glucose controlled insulin infusionsystem). Horm Metab Res 487:339–342

  16. 16.

    Clemens AH (1979) Control algorithms for artificial betacell. Horm Metab Res 8 (Suppl): 35–38

  17. 17.

    Mogensen CE, Christensen NJ, Gundersen HJG (1978) The acute effect of insulin on renal hemodynamics and protein excretion in diabetics. Diabetologia 15:153–157

  18. 18.

    Christiansen JS, Frandsen M, Parving H-H (1981) The effect of intravenous insulin infusion on kidney function in insulin-dependent diabetes mellitus. Diabetologia 20:199–204

  19. 19.

    Christiansen JS, Gammelgaard J, Frandsen M, Parving H-H (1981) Increased kidney size, glomerular filtration rate and renal plasma flow in short-term insulin-dependent diabetics. Diabetologia 20:451–456

  20. 20.

    Baylis C, Ichikawa I, Willis WT, Wilson CB, Brenner BM (1977) Dynamics of glomerular ultrafiltration. IX. Effects of plasma protein concentration. Am J Physiol 232: F58-F71

  21. 21.

    Brenner B, Humes HD (1977) Mechanisms of glomerular ultrafiltration. N Engl J Med 297:148–154

  22. 22.

    Aurell M (1969) Renal response in man to plasma volume expansion and angiotensin. Scand J Clin Lab Invest 24: (Suppl. 112) 1–59

  23. 23.

    Viberti GC, Jarrett JR, McCartney M, Keen H (1978) Increased glomerular permeability to albumin induced by exercise in diabetic subjects. Diabetologia 14:293–300

  24. 24.

    Baladimos MC, Chlouverakis C, Gleason RE, Jarrett RJ, Kahn CB, Keen H, Soeldner JS (1971) Urinary albumin excretion in the offspring of conjugal diabetics. Lancet 2:295–300

  25. 25.

    Mogensen CE (1971) Urinary albumin excretion in early and long-term juvenile diabetes. Scand J Clin Lab Invest 28: 183–193

  26. 26.

    Hegedüs L, Christensen NJ, Mogensen CE, Gundersen HJG (1980) Oral glucose increases urinary albumin excretion in normal subjects but not in insulin-dependent diabetics. Scand J Clin Lab Invest 40:479–482

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Christiansen, J.S., Frandsen, M. & Parving, H.-. Effect of intravenous glucose infusion on renal function in normal man and in insulin-dependent diabetics. Diabetologia 21, 368–373 (1981). https://doi.org/10.1007/BF00252683

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Key words

  • Insulin-dependent diabetes
  • blood glucose concentration
  • glomerular filtration rate
  • renal plasma flow
  • albumin, β-2-microglobulin