Enhancement of glomerular filtration rate and renal plasma flow by oral glucose load in well controlled insulin-dependent diabetics

Abstract

Glomerular filtration rate (GFR) and renal plasma flow (RPF) were measured in 27 patients with uncomplicated insulin-dependent diabetes (IDDM) before and after an oral glucose load of 1.1 g glucose/kg body wt. In the 18 patients showing near-normoglycaemia (blood glucose >8 mmol/1) before the glucose challenge the increase in blood glucose from 4.2±1.7 to 15.2±2.3 mmol/1 was accompanied by an enhancement of GFR from 128±15 to 132±14 ml/minxl.73 m² (2p=0.030) and of RPF from 534±116 to 562±105 ml/minxl.73 m² (2p=0.023). By contrast oral glucose load to the nine patients with hyperglycaemia (<8 mmol/1) during baseline conditions raising blood glucose from 11.9±2.0 to 19.6±1.5 mmol/1 was accompanied by a reduction in GFR from 149±15 to 139±9 ml/min × l.73 m² (2p>0.001) while RPF was unchanged. No changes in blood pressure or urinary albumin excretion rates took place in either group. The reduction in plasma protein and in plasma growth hormone concentration were similar in the two groups. No change was seen in plasma arginine vasopressin concentration. There was no difference in the qualitative GFR response in patients with high initial GFR values (<130 ml/min × l.73 m²) as compared to patients with initial values below 130 ml/min × l.73 m². It is concluded that the induction of moderate hyperglycaemia in IDDM patients is followed by an enhancement of GFR and RPF provided near-normoglycaemia before the glucose challenge.

Key Words:

• arginine vasopressin
• glomerular filtration rate
• hyperglycaemia
• insulin-dependent diabetes mellitus
• renal plasma flow