Impaired autoregulation of GFR in hypertensive non-insulin dependent diabetic patients
Impaired autoregulation of GFR in hypertensive non-insulin dependent diabetic patients
复制标题
DOI：
10.1038/ki.1997.463
复制
发表时间：
1997-11-01
影响因子：
19.6
通讯作者：
Parving, HH
中科院分区：
文献类型：
--
作者：
Christensen, PK;Hansen, HP;Parving, HH
我们研究了高血压非胰岛素依赖型糖尿病（NIDDM）患者（14例糖尿病肾病患者和12例正常白蛋白尿患者）急性降压对肾小球滤过率（GFR）的影响。研究进行两次，受试者接受可乐定（150 - 225 μ g）或盐水（0.154 mmol/L）的静脉注射。我们评估GFR、蛋白尿和BP。两组在人口统计学数据、基线GFR和BP方面匹配良好。可乐定在有肾病和无肾病的患者中分别诱导平均动脉血压降低19（SE +/- 4）和21（SE +/- 3）mm Hg。在肾病组中，GFR平均值从90（SE +/- 6）降至81（SE +/- 7）ml/min/1.73 m2（P = 0.006），白蛋白清除率（X10（-6））从几何平均值219（反对数SE ./除以1.3）到186（反对数SE ./除以1.3）（P = 0.04），4例患者具有完全压力被动血管系统，定义为Δ GFR% = Δ MABP%。蛋白尿患者MABP的相对降低与GFR的降低呈显著相关（r = 0.78，P < 0.001）。正常白蛋白尿患者中没有一个有完整的压力被动血管系统，两种检查之间的GFR无显著差异，但5例GFR自动调节异常。肾病组和正常蛋白尿组之间GFR变化的平均差异（95%置信区间）为5.5（除以2.7 ~ 13.7）ml/min/1.73 m2（P = 0.18）。我们的研究表明，高血压NIDDM患者，特别是肾病患者，经常遭受损害或取消GFR的自动调节。
We investigated the effect of acute lowering of blood pressure (BP) upon glomerular filtration rate (GFR) in hypertensive non-insulin-dependent diabetes mellitus (NIDDM) patients, 14 with diabetic nephropathy and 12 with normoalbuminuria. The study was performed twice with the subjects receiving an intravenous injection of either clonidine (150 to 225 mu g) or saline (0.154 mmol/liter). We assessed GFR, albuminuria, and BP. The two groups were well matched with respect to demographic data, baseline GFR and BP. Clonidine induced similar reductions in mean arterial blood pressure 19 (SE +/- 4) and 21 (SE +/- 3) mm Hg in patients with and without nephropathy, respectively. In the nephropathy group GFR diminished in average from 90 (SE +/- 6) to 81 (SE +/- 7) ml/min/1.73 m(2) (P = 0.006), fractional clearance of albumin (X 10(-6)) declined from a geometric mean of 219 (antilog SE ./divided by 1.3) to 186 (antilog SE ./divided by 1.3) (P = 0.04), and four patients had a complete pressure-passive vasculature, defined as Delta GFR% = Delta MABP%. A significant correlation between relative reductions in MABP and GFR (r = 0.78, P < 0.001) was demonstrated in albuminuric patients. None of the normoalbuminuric patients had a complete pressure-passive vasculature and there were no significant differences in GFR between the two examinations, but five had abnormal autoregulation of GFR. Mean difference between changes in GFR (95% confidence interval) between the nephropathic and normal albuminuric group was 5.5 (divided by 2.7 to 13.7) ml/min/1.73 m(2) (P = 0.18). Our study suggests that hypertensive NIDDM patients, particularly patients with nephropathy, frequently suffer from impaired or abolished autoregulation of GFR.