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  • 1
    Electronic Resource
    Electronic Resource
    Increased kidney size, glomerular filtration rate and renal plasma flow in short-term insulin-dependent diabetics (1981)
    Springer
    Diabetologia 20 (1981), S. 451-456 
    Details
    ISSN: 1432-0428
    Keywords: Glomerular filtration rate ; renal plasma flow ; kidney size ; insulin-dependent diabetes mellitus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Glomerular filtration rate (GFR), renal plasma flow (RPF) and kidney volume were measured in thirteen male subjects (mean age 30 years) with short-term insulin-dependent diabetes (mean duration of disease 2.4 years) and fourteen normal male subjects (mean age 29 years). GFR and RPF were measured by constant infusion technique using I125-iothalamate and 131I-hippuran. Kidney size was determined by means of ultrasound. GFR, RPF and kidney volume were increased in the diabetic patients compared to the normal controls, 144 versus 113 ml/ min×1.73m2 (p〈0.0005), 627 versus 523 ml/ min×1.73 m2 (p〈0.0025) and 278 versus 224 ml/ 1.73 m2 (p〈0.0005) respectively. Combining results from diabetic patients and controls revealed a positive correlation between kidney size and GFR (r= 0.70, p〈0.001) and between kidney size and RPF (r=0.61, p〈0.001). Within the groups kidney size and RPF correlated significantly in the diabetics (p〈 0.01) and the same was found for kidney size and GFR (0.025〈 p〈0.05), while no correlations were found in the normal group. GFR and RPF correlated in the diabetics when evaluated separately (r=0.81, p〈0.001) and in the controls (r=0.73, p〈0.001). The previous and present data suggest that the mechanisms of the elevated GFR in insulin-dependent diabetics are enhanced RPF, increased transglomerular hydrostatic pressure gradient and increased glomerular ultrafiltration coefficient. The increased kidney size is probably the main cause of the above alterations in the GFR determinants.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00253406
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  • 2
    Electronic Resource
    Electronic Resource
    A prospective study of glomerular filtration rate and arterial blood pressure in insulin-dependent diabetics with diabetic nephropathy (1981)
    Springer
    Diabetologia 20 (1981), S. 457-461 
    Details
    ISSN: 1432-0428
    Keywords: Diabetic nephropathy ; glomerular filtration rate ; hypertension ; proteinuria ; insulin-dependent diabetes ; serum creatinine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Glomerular filtration rate (GFR, single bolus 51Cr-EDTA technique), serum creatinine, proteinuria and arterial blood pressure have been measured prospectively in 14 young onset insulin-dependent diabetics selected by of persistent proteinuria (〉 0.5 g/day) secondary to diabetic nephropathy. Twelve of the 14 patients had normal serum creatinine levels. None of the patients received antihypertensive treatment. During the mean observation period of 26 months (range 23 to 33 months) GFR decreased from 107 to 87 ml/min/1.73 m2 (p〈 0.001), serum creatinine remained unchanged: 107 and 112/gmmol/l (NS), proteinuria increased from 1.8 to 3.3 g/day (p〈0.001) and arterial blood pressure rose from 132/88 to 153/101 mmHg (p〈0.001). Glomerular filtration rate decreased linearly with time (slope=−0.75, r=0.99, p〈0.001) by a mean of 0.75 ml/min/month (range 0.1 to 1.5 ml/ min/month). The decrease in GFR did not correlate with sex, age at onset, duration of diabetes, arterial blood pressure, proteinuria, insulin requirement, postprandial blood glucose or the initial GFR, but numbers were small. The decline in GFR in each individual was constant, but varied considerably between patients. Increase in arterial blood pressure to a hypertensive level is an early feature of diabetic nephropathy in young insulin-dependent diabetics.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00253407
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  • 3
    Electronic Resource
    Electronic Resource
    Haemodynamic changes during graded exercise in patients with diabetic autonomic neuropathy (1982)
    Springer
    Diabetologia 22 (1982), S. 318-323 
    Details
    ISSN: 1432-0428
    Keywords: Insulin-dependent diabetes ; autonomic neuropathy ; graded exercise ; heart rate ; blood pressure ; cardiac output ; cardiac stroke volume ; plasma volume ; hepato-splanchnic blood flow ; body temperature ; plasma catecholamines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Haemodynamic variables were measured during supine rest and during ergometer cycle exercise at two work loads (50 W and 100 W) in normal subjects (n = 7), in insulin-dependent diabetic subjects without neuropathy (n = 8), in insulin-dependent diabetic subjects with slight autonomic neuropathy (decreased beat-to-beat variation in heart rate, which is considered due to a cardiac parasympathetic defect; n = 8), and in insulin-dependent diabetic subjects with severe autonomic neuropathy, including orthostatic hypotension (n = 7). Compared with normal subjects, cardiac stroke volume was lower in the diabetic subjects with autonomic neuropathy, both at rest and during exercise (p 〈 0.025), whereas intermediate values were found in the diabetic subjects without neuropathy. The increase in cardiac output in response to exercise was smaller (p 〈 0.05) in both diabetic groups with autonomic neuropathy compared with the normal and diabetic subjects without autonomic neuropathy. The increase in hepato-splanchnic vascular resistance was smaller in the diabetic subjects with severe autonomic neuropathy than in the normal subjects and the diabetic subjects without autonomic neuropathy (p 〈 0.025), whereas intermediate values were found in the diabetic subjects with slight autonomic neuropathy. We conclude that, in diabetic patients with severe autonomic neuropathy, the responses of the heart and the splanchnic resistance vessels to exercise are impaired. While sympathetic neuropathy may be responsible for impaired function of splanchnic resistance vessels, both cardiac sympathetic neuropathy and diabetic cardiomyopathy may be involved in the impaired cardiac response to exercise in diabetic subjects with autonomic neuropathy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00253574
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  • 4
    Electronic Resource
    Electronic Resource
    Renal function in streptozotocin-diabetic rats (1981)
    Springer
    Diabetologia 21 (1981), S. 409-414 
    Details
    ISSN: 1432-0428
    Keywords: Streptozotocin ; diabetes ; rat ; micropuncture ; renal plasma flow ; glomerular filtration ; hydraulic pressure ; ultrafiltration coefficient
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Renal function was examined with micropuncture methods in the insulin-treated streptozotocin-diabetic rat. Kidney glomerular filtration rate was significantly higher in the diabetic rats (1.21 ml/min) than in the control group (0.84 ml/min) Nephron glomerular filtration rate increased in proportion to the rise in kidney glomerular filtration rate (diabetic rats: 37.0 nl/min; control rats: 27.9 nl/min). Likewise renal plasma flow was significantly higher in the diabetic rats (4.1 ml/min) than in the control group (3.0 ml/min). Glomerular capillary pressure was identical in both groups (56.0 and 56.0 mmHg, respectively). The proximal intratubular pressure was significantly reduced in the diabetic rats (10.4 mmHg; control value: 12.5 mmHg). The effective glomerular ultrafiltration coefficient was slightly but not significantly higher in the diabetic rats (0.027 nl s-1mmHg-1) than in the control group (0.023 nl s-1mmHg-1). Kidney weight was significantly higher in the diabetic rats (1.15 g; control rats: 0.96 g) while body weight was similar in both groups (diabetic rats: 232 g; control rats: 238 g). Calculations indicate that the increases in transglomerular hydraulic pressure, renal plasma flow and ultrafiltration co-efficient of the glomerular membrane contribute about equally to the rise in glomerular filtration rate. The increases in the values of the determinants of glomerular filtration rate may be the result of renal hypertrophy. These studies suggest that this model provides a useful method for investigating kidney function in diabetes, which may have relevance for our understanding of the kidney abnormalities in human diabetes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00252690
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  • 5
    Electronic Resource
    Electronic Resource
    The effect of strict short-term metabolic control on retinal nervous system abnormalities in newly diagnosed Type 1 (insulin-dependent) diabetic patients (1983)
    Springer
    Diabetologia 24 (1983), S. 207-209 
    Details
    ISSN: 1432-0428
    Keywords: Type 1 diabetes ; metabolic control ; dark adaptation ; electroretinography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The oscillatory potential of the electroretinogram and the initial 2-min phase of dark-adaptation were studied in seven newly diagnosed Type 1 (insulin-dependent) diabetic patients before and during initial insulin treatment. Strict metabolic control was achieved in all seven patients using multiple subcutaneous injections of insulin. Seven to 11 days of strict metabolic control improved the added amplitude value of the oscillatory potential from 236±8 to 268±8 μV (mean±SEM; p 〈 0.01) and the dark-adaptation from 90 ±5 to 67±5 s (p 〈 0.01). Our study has demonstrated reversible neurophysiological abnormalities in the diabetic retina which are related to metabolic control.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00250163
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  • 6
    Electronic Resource
    Electronic Resource
    The effect of intravenous insulin infusion on kidney function in insulin-dependent diabetes mellitus (1981)
    Springer
    Diabetologia 20 (1981), S. 199-204 
    Details
    ISSN: 1432-0428
    Keywords: Insulin-dependent diabetes ; glomerular filtration rate ; renal plasma flow ; insulin infusion ; hyperglycaemia ; β-2-microglobulin ; albumin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Glomerular filtration rate, renal plasma flow, urinary excretion of β-2-microglobulin and albumin, heart rate and blood pressure were studied in eight young male insulin-dependent diabetics. Measurements were performed before and during insulin infusion at 2 mU/kg/min. No patient had discernible insulin antibodies. Two studies were performed at random in each patient. In series A blood glucose concentration was allowed to decline, while in series B it was maintained at a constant level. Ten 20 min clearance periods were performed, four before and six during insulin infusion. Results are given as mean±SEM of values from the first four (control) and last four (test) clearance periods. Blood glucose declined in series A experiments from 10.8±0.8 mmol/l in the control period to 5.8±0.5 mmol/l during the test period, but remained constant during experiment B (9.8±1.1 and 9.5±1.1 mmol/l). Plasma insulin levels were comparable in the two series. Glomerular filtration rate fell from 141±7 ml/ min X 1.73m2 to 132±7ml/min X 1.73m2 (p〈 0.01) in series A but did not change significantly during series B. Similarily renal plasma flow declined with declining glucose but remained constant when glucose was maintained at a constant level. In series A the magnitude of decrease in renal plasma flow was correlated with the magnitude of decrease in glomerular filtration rate (r=0.95, p〈 0.001). β-2-microglobulin excretion decreased significantly (p 〈 0.05) in both series (A: 89±17 to 60±13 ng/min, B: 117±46 to 62±17ng/min). Albumin excretion increased in five out of six patients with normal control values (not significant) in series A and in four out of six in series B. No significant changes in heart rate or blood pressure were observed. Thus insulin infusion reduced renal plasma flow and glomerular filtration rate, but this effect could be completely abolished by keeping blood glucose constant. This suggests that it is not the lack of insulin but the associated hyperglycaemia which contributes to the elevated renal plasma flow and glomerular filtration rate in insulin-dependent diabetics.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00252628
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  • 7
    Electronic Resource
    Electronic Resource
    Effect of intravenous glucose infusion on renal function in normal man and in insulin-dependent diabetics (1981)
    Springer
    Diabetologia 21 (1981), S. 368-373 
    Details
    ISSN: 1432-0428
    Keywords: Insulin-dependent diabetes ; blood glucose concentration ; glomerular filtration rate ; renal plasma flow ; albumin, β-2-microglobulin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The effect of intravenous glucose infusion on glomerular filtration rate and renal plasma flow (constant infusion technique using 125I-iothalamate and 131I-hippuran) and on urinary excretion of albumin and β-2-microglobulin were studied in ten normal subjects and seven metabolically well-controlled insulin-dependent diabetics. Following glucose infusion in normal subjects (n = 10) blood glucose increased from 4.7±0.1 to 10.9±0.4 mmol/1 (SEM) (p ⩽ 0.01). Glomerular filtration rate increased from 116±2 to 123±3ml/min x 1.73 m2 (p ⩽ 0,01), while no change in renal plasma flow was seen 552±11 versus 553±18 ml/min × 1.73 m2. Volume expansion with intravenous saline infusion in six of the normal subjects induced no changes in blood glucose or kidney function. In seven strictly controlled insulin-dependent diabetics, blood glucose values were raised from 4.6±0.4 to 16.0±0.6 mmol/1 and clamped by means of an ‘artificial beta cell’. Glomerular filtration rate increased in all patients, from 133 ±5 to 140±6 ml/min × 1.73 m2 (p ⩽ 0.02), as did renal plasma flow from 576±26 to 623±38 ml/ min × 1.73 m2 (p ⩽ 0.02). Urinary albumin excretion remained unchanged in both normal subjects and diabetics. β-2-microglobulin excretion rate increased significantly in the diabetics following glucose infusion, while no significant change was seen in the normal subjects. Our results show that hyperglycaemia per se contributes to the increased glomerular filtration rate and renal plasma flow in insulin-dependent diabetes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00252683
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  • 8
    Electronic Resource
    Electronic Resource
    The relationship between kidney size and function in short-term diabetic patients (1982)
    Springer
    Diabetologia 22 (1982), S. 494-494 
    Details
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00282601
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  • 9
    Electronic Resource
    Electronic Resource
    Decreased distensibility of a passive vascular bed in diabetes mellitus: An indicator of microangiopathy? (1982)
    Springer
    Diabetologia 23 (1982), S. 411-414 
    Details
    ISSN: 1432-0428
    Keywords: Type 1 diabetes ; diabetic microangiopathy ; skeletal muscle ; blood flow measurement ; 133Xe washout ; maximal ischaemic exercise ; papaverine ; atherosclerosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This study was undertaken to determine whether the distensibility of a passive vascular bed is reduced in Type 1 (insulin-dependent) diabetic patients with microangiopathy. The change in blood flow induced by 45° head-up tilting was studied in two systems: (a) following maximal ischaemic exercise and (b) in a vascular bed locally paralysed by the injection of papaverine. Five normal subjects, six patients with long-standing Type 1 diabetes and six non-diabetic patients with severe atherosclerosis affecting the legs were studied. Blood flow was measured in the anterior tibial muscle by the isotope washout technique. The median increase in blood flow produced by tilting was greater in normal subjects than in diabetic subjects in both the locally-relaxed bed (58% and 14% respectively) and after maximal ischaemic exercise (45% and 4% respectivley). In the atherosclerotic subjects, the increase in blood flow in the locally relaxed bed was 77%. The results are consistent with the hypothesis that the reduced distensibility seen in the diabetic subjects was related to the presence of microvascular disease and that the behaviour of a vascular bed relaxed by the local injection of papaverine might be an appropriate model to study this condition.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00260953
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  • 10
    Electronic Resource
    Electronic Resource
    Effect of metabolic regulation on renal leakiness to Dextran molecules in short-term insulin-dependent diabetics (1979)
    Springer
    Diabetologia 17 (1979), S. 157-160 
    Details
    ISSN: 1432-0428
    Keywords: Dextran ; early diabetes ; glomerular filtration rate ; influence of metabolic regulation ; kidney function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Renal clearance of dextran of two ranges of molecular size and glomerular filtration rate (GFR,51Cr-EDTA) were measured in seven short-term insulin-dependent diabetics (mean age 25 years). Measurements were carried out in the same patient during good and poor metabolic regulation (plasma glucose, mean±SEM, 6.5±0.9 and 14.8±1.5 ] mmol/l, respectively). GFR was elevated in all patients during poor metabolic regulation (119±6 ml/min/1.73 m2, versus 99±2 ml/min/1.73 m2 during good control, p〈0.01). The average renal clearance of dextran with molecular weights ranging from 25,000 to 35,000 and 35,000 to 45,000 increased during poor metabolic regulation from 14.8±0.8 to 19.8±1.8 ml/min/1.73 m2, and 5.2±0.3 to 6.8±0.6 ml/min/1.73 m2, respectively (p〈 0.05). The elevated GFR and renal dextran clearance found during poor metabolic regulation were normalized within one to three weeks of effective insulin treatment. This rapid reversibility can hardly be explained by the previously demonstrated enlargement in glomerular size and filtration surface area, since these alterations remain unchanged after more than one month of insulin treatment. The metabolic regulation did not influence the size-selective properties of the glomerular wall. Therefore, we suggest that the dominating mechanism involved in the GFR and renal dextran clearance alterations is functional, viz. increased filtration pressure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01219742
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