Glomerular hyperfiltration in insulin-dependent diabetes mellitus is correlated with enhanced growth hormone secretion.
Enhanced GH secretion and hyperglycemia are suggested to play a role in the pathogenesis of glomerular hyperfiltration in insulin dependent diabetes mellitus. In this study we measured the GH response to GHRH (1 microgram/kg body weight), metabolic control, and renal function in 44 patients in order to explore a possible association between these parameters. Hyperfiltration [glomerular filtration rate (GFR) > 130 ml/min/1.73 m2] was present in 21 patients and normofiltration in 23. The duration of diabetes, plasma concentrations of renin, catecholamines, insulin-like growth factor-1 and blood glucose during renal function measurements were not different. GH response was significantly higher in patients with hyperfiltration. There was a positive relation between GH response and GFR (r = 0.51, P < 0.001) and effective renal plasma flow (r = 0.39, P < 0.01). GFR was correlated with insulin dose (r = 0.48, P < 0.001). There was no difference in glycosylated hemoglobin between the two groups. Patients with hyperfiltration used more insulin, had more frequent blood glucose values below the threshold level for activation of GH secretion, and had greater glycemic excursions than patients with normofiltration. The results suggest that GH hypersecretion and glomerular hyperfiltration are related and they support the possibility of a linkage between GH hypersecretion and glucose variability.
Blankestijn
P J
PJ
Department of Internal Medicine I, University Hospital Dijkzigt, Erasmus University, Rotterdam, The Netherlands.
Derkx
F H
FH
Birkenhäger
J C
JC
Lamberts
S W
SW
Mulder
P
P
Verschoor
L
L
Schalekamp
M A
MA
Weber
R F
RF
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D016009:Chi-Square Distribution; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate; D013006:Growth Hormone / Q000378:metabolism*; D013007:Growth Hormone-Releasing Hormone / Q000494:pharmacology; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D007678:Kidney Glomerulus / Q000098:blood supply / Q000503:physiopathology*; D008297:Male; D010902:Pituitary Gland / Q000187:drug effects / Q000378:metabolism*; D012044:Regression Analysis; D012079:Renal Circulation
D001786:Blood Glucose; D007328:Insulin; D013006:Growth Hormone; D013007:Growth Hormone-Releasing Hormone