The Physiologic Basis for Renal Functional Reserve Testing

  • Francis B. Gabbai
  • Luca De Nicola
  • Roland C. Blantz


Early studies by Pitts demonstrated that protein intake (meat meal) or intravenous administration of amino acid (glycine) to dogs were associated with significant increases in glomerular filtration rate (GFR) and renal plasma flow (RPF) (1, 2). Variations in daily protein intake are also capable of modifying GFR and RPF in both man and experimental animals, with increments in GFR and RPF paralleling the increase in quantity of protein (1–3). Although the acute and chronic effects of protein loading on renal function have been established for nearly 50 years, it is not until recently that major interest has accumulated with respect to the potential role of protein in the progression of renal disease. Pioneer work by Hostetter et al (4) demonstrated in a model of radical subtotal nephrectomy in rats that increased protein intake was associated with hyperfiltration secondary to glomerular hypertension and hyperperfusion. Reducing protein intake in this experimental model decreased hyperfiltration and prevented albuminuria and glomerular sclerosis. Further studies in different experimental models, which include streptozotocininduced diabetes mellitus, hypertension and partial renal ablation, confirmed previous findings by Hostetter et al and supported the concept that hyperfiltration may play an important role in the progression of kidney disease (5–7). The presence of hyperfiltration in experimental models led many investigators to evaluate the role of hyperfiltration as a mechanism for progression of renal disease in man. Normal pregnancy, early stages of insulin-dependent diabetes mellitus and sickle cell disease are a few clinical conditions associated with absolute increases in GFR (8–10). Since most patients with renal disease have normal or low values of GFR, it is impossible to detect the presence of hyperfiltration by evaluation of absolute GFR values under normal conditions.


Renal Plasma Flow Renal Response Amino Acid Infusion Meat Meal Renal Vasodilation 
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Copyright information

© Springer-Verlag London Limited 1991

Authors and Affiliations

  • Francis B. Gabbai
    • 1
  • Luca De Nicola
    • 1
  • Roland C. Blantz
    • 1
  1. 1.Division of Nephrology-HypertensionUniversity of California, San Diego School of Medicine and Veterans Affairs Medical CenterLa JollaUSA

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