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Glomerular dysfunction in diabetic nephropathy.

P Zucchelli1, A Zuccalà, A Sturani

  • 1Divisione de Nefrologia e Dialisi, Ospedale M. Malpighi, Bologna, Italy.

Postgraduate Medical Journal
|January 1, 1988
PubMed
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Hyperfiltration in insulin-dependent diabetes mellitus (IDDM) may not solely cause kidney damage. Both low-protein diets and captopril reduce proteinuria, but without a direct link to decreased glomerular filtration rate (GFR), suggesting other factors are involved.

Area of Science:

  • Nephrology
  • Endocrinology
  • Diabetology

Background:

  • Early-stage insulin-dependent diabetes mellitus (IDDM) is associated with elevated renal plasma flow (RPF) and glomerular filtration rate (GFR).
  • Microalbuminuria, an early sign of kidney dysfunction in IDDM, is linked to increased glomerular hydraulic pressure and hyperfiltration.
  • The precise role of hyperfiltration in initiating diabetic nephropathy is debated, with other factors like prostaglandin synthesis and abnormal polyamino-acid production also implicated.

Purpose of the Study:

  • To investigate the causal link between increased GFR and proteinuria in IDDM patients.
  • To evaluate the effects of a low-protein diet versus captopril administration on GFR and albuminuria in IDDM patients with microalbuminuria and hypertension.

Main Methods:

  • A randomized study involving 12 IDDM patients with elevated GFR, microalbuminuria, and moderate hypertension.

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  • Patients underwent two 4-week treatment periods: a low-protein diet with standard antihypertensive therapy, and their usual diet with captopril (25-50 mg/day).
  • Measurements included GFR, albuminuria, and filtration fraction before and after each treatment period.

    • Main Results:

    • A low-protein diet significantly decreased both GFR (P<0.05) and albuminuria (P<0.01).
    • Captopril administration resulted in a significant decrease in albuminuria (P=0.05) but only a small, statistically insignificant decrease in GFR, with a moderate increase in filtration fraction.
    • No significant correlation was observed between changes in GFR and albuminuria during either the low-protein diet or captopril treatment.

    Conclusions:

    • Both low-protein diets and captopril effectively reduce protein excretion in IDDM patients with microalbuminuria.
    • The reduction in proteinuria does not correlate with changes in GFR, indicating that mechanisms beyond hyperfiltration play a significant role in IDDM-related proteinuria.