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Renin Secretion in Advanced Diabetic Nephropathy.
Staffan Björck1, Krister Delin1, Hans Herlitz1
1a From the Department of Nephrology, Sahlgrenska Sjukhuset , University of Göteborg , S-413 45 Göteborg , Sweden.
Scandinavian Journal of Urology and Nephrology
|July 1, 1984
Summary
Patients with diabetic nephropathy (DN) show higher plasma renin activity (PRA) responses to captopril than controls, indicating preserved renin secretion capacity. This challenges previous findings of low PRA in DN, suggesting overhydration might be a factor.
Area of Science:
- Nephrology
- Endocrinology
- Cardiovascular Physiology
Background:
- Diabetic nephropathy (DN) is often associated with low basal and stimulated plasma renin activity (PRA).
- Previous studies reported diminished PRA levels in patients with DN, but the underlying mechanisms remain unclear.
Purpose of the Study:
- To investigate plasma renin activity (PRA) responses to captopril and dihydralazine in patients with diabetic nephropathy (DN).
- To compare PRA levels and responses between patients with DN and healthy controls.
- To explore the implications of PRA findings for understanding hypertension in DN.
Main Methods:
- Measured PRA before and after captopril administration in 28 DN patients and 25 controls.
- Assessed PRA response to dihydralazine in 19 DN patients.
- Ensured comparable renal function impairment and furosemide treatment across groups.
Main Results:
- PRA levels before and after captopril were significantly higher in the DN group (P < 0.001).
- PRA increased from 4.6 ± 3.6 to 6.3 ± 5.3 in DN patients and from 1.8 ± 2.7 to 2.7 ± 3.4 in controls.
- PRA did not increase after dihydralazine in DN patients despite blood pressure reduction, suggesting impaired baroreceptor function and sympathetic innervation.
Conclusions:
- Patients with DN exhibit preserved renin secretion capacity, with higher PRA responses to captopril than controls.
- Overhydration may explain previously reported low PRA in DN.
- Findings suggest selective lesions in sympathetic innervation and renal baroreceptor function in DN, implicating the renin-angiotensin-system in DN-related hypertension.
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