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Hyperfiltration in patients with type I diabetes mellitus: a prevalence study
P Cotroneo1, A Manto, L Todaro
1Department Internal Medicine and Geriatric, Università Cattolica del Sacro Cuore, Roma, Italy.
Clinical Nephrology
|November 3, 1998
Summary
Hyperfiltration is common in insulin-dependent diabetes, linked to poor metabolic control. However, long-term hyperglycemia, not hyperfiltration, predicts diabetic nephropathy progression.
Area of Science:
- Nephrology
- Endocrinology
- Diabetology
Background:
- Diabetic nephropathy is a major complication of diabetes.
- Hyperfiltration, an elevated glomerular filtration rate (GFR), is a potential prognostic factor.
- The predictive value of hyperfiltration for developing diabetic nephropathy remains unclear.
Purpose of the Study:
- To investigate the prevalence of hyperfiltration in normotensive adults with insulin-dependent diabetes mellitus (IDDM).
- To assess the effect of long-term metabolic control on glomerular hemodynamics in these patients.
Main Methods:
- Measured GFR and effective renal plasma flow (ERPF) in 177 normotensive, normoalbuminuric IDDM patients and 30 healthy controls.
- Utilized [51Cr]-EDTA and [125I]-Hippuran for GFR and ERPF measurements.
- Correlated GFR with metabolic control (HbA1c), age, sex, and diabetes duration.
Main Results:
- Hyperfiltration (GFR > 135 ml/min/1.73 m2) was observed in 55.9% of IDDM patients.
- Significant correlations were found between GFR and ERPF (p < 0.001) and between GFR and average HbA1c levels (p = 0.016).
- No correlation was found between GFR and diabetes duration.
Conclusions:
- Long-term hyperglycemia significantly contributes to elevated GFR.
- Poor metabolic control is predictive of overt nephropathy.
- Hyperfiltration itself may not be the primary driver of diabetic nephropathy; further follow-up is needed.