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Endothelin excretion during ketoacidosis does not correlate with tubular dysfunction
I Máttyus1, M Miltényi, L B Zimmerhackl
1First Department of Paediatrics, Semmelweis Medical University Budapest, Hungary.
Pediatric Nephrology (Berlin, Germany)
|June 1, 1994
Summary
Diabetic ketoacidosis in children causes kidney tubular damage. Endothelin excretion, when adjusted for creatinine clearance, increases, suggesting altered kidney function despite normal excretion levels.
Area of Science:
- Nephrology
- Pediatric Endocrinology
- Diabetology
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus.
- Kidney function can be affected during DKA, with evidence of tubular injury.
- Endothelin, a potent vasoconstrictor, plays a role in kidney physiology.
Purpose of the Study:
- To investigate urinary endothelin excretion in children with DKA.
- To assess renal tubular function during DKA and recovery.
- To correlate endothelin levels with markers of tubular damage.
Main Methods:
- Radioimmunoassay was used to measure urinary endothelin excretion.
- Urinary alpha 1-microglobulin and Tamm-Horsfall protein (THP) were measured as markers of proximal and distal tubular injury, respectively.
- Glomerular filtration rate (GFR) was assessed.
Main Results:
- DKA was associated with decreased GFR and significant changes in alpha 1-microglobulin and THP excretion, indicating proximal and distal tubular damage.
- Daily urinary endothelin excretion remained unchanged during DKA.
- The ratio of endothelin to creatinine and endothelin excretion to creatinine clearance was significantly elevated during DKA.
Conclusions:
- Despite proximal and distal tubular dysfunction in children with DKA, overall urinary endothelin excretion is not elevated.
- The increased endothelin/creatinine ratio suggests a potential consequence of disturbed proximal tubular function or renal medulla dysfunction.
- These findings highlight complex alterations in renal handling of endothelin during DKA.