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Decreased prorenin processing develops before autonomic dysfunction in type 1 diabetes.

R D Hoeldtke1, K D Bryner, P Komanduri

  • 1Department of Medicine, West Virginia University, Morgantown 26506-9159, USA.

The Journal of Clinical Endocrinology and Metabolism
|February 26, 2000
PubMed
Summary
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Abnormal prorenin processing occurs in early type 1 diabetes before complications arise. This suggests unidentified mechanisms, not just autonomic neuropathy, impact prorenin processing in diabetic patients.

Area of Science:

  • Endocrinology
  • Nephrology
  • Diabetology

Background:

  • Diabetic patients with chronic complications exhibit reduced renin secretion and elevated prorenin.
  • The cause of abnormal prorenin processing (microvascular disease, hypertension, or autonomic neuropathy) remains unclear.
  • Previous studies suggested subclinical autonomic neuropathy in uncomplicated diabetes may cause prorenin processing abnormalities.

Purpose of the Study:

  • To investigate the relationship between prorenin processing and autonomic function in early type 1 diabetes.
  • To determine if abnormal prorenin processing precedes microvascular disease or autonomic dysfunction.
  • To test the hypothesis that subclinical autonomic neuropathy causes abnormal prorenin processing in early diabetes.

Main Methods:

Related Experiment Videos

  • Longitudinal study of 37 early type 1 diabetes patients and 41 age-matched controls over 3 years.
  • Annual measurements of plasma renin activity (PRA), prorenin, and autonomic function tests.
  • Analysis of renin-prorenin ratio and its correlation with autonomic function indices.

    • Main Results:

    • Diabetic patients showed significantly lower PRA and renin-prorenin ratios compared to controls.
    • No evidence of autonomic dysfunction or correlation with the renin-prorenin ratio in the first two evaluations.
    • Significant correlations between the renin-prorenin ratio and heart rate variability power spectra (sympathetic modulation) were observed by the third evaluation.

    Conclusions:

    • Abnormal prorenin processing is an early feature of type 1 diabetes, preceding microvascular disease and overt autonomic dysfunction.
    • While autonomic neuropathy may contribute, other unidentified mechanisms likely disrupt prorenin processing.
    • Early detection of abnormal prorenin processing may offer insights into diabetes pathophysiology.