title: Effects of insulin and lipid emulsion on renal haemodynamics and renal sodium handling in IDDM patients.
abstract: To evaluate the role of insulin and hypertriglyceridaemia in the regulation of renal haemodynamics and sodium handling in insulin-dependent diabetes mellitus (IDDM), 11 IDDM patients without microalbuminuria and 13 weight-, age-, protein intake- and sex-matched healthy control subjects were studied. Clearances of inulin (Cin), para-amino-hippuric acid (CPAH), sodium (CNa), and lithium (CLi) were measured in four 60-min clearance periods (periods I, II, III and IV) during isoinsulinaemia with lipid emulsion infusion (study 1), a hyperinsulinaemic isoglycaemic clamp with Intralipid infusion (study 2), and during time-controlled isoinsulinaemia (study 3). We found that Cin, CPAH and filtration fraction were comparable in IDDM and control subjects, whereas CNa was decreased in diabetic subjects (2.01 +/- 1.11 vs 3.03 +/- 1.32 ml/min; p < 0.05) due to elevations of proximal tubular fractional and absolute reabsorptions of sodium (p < 0.05). Insulin infusion did not affect Cin, increased CPAH (p < 0.05) and, consequently, lowered the filtration fraction (p < 0.01) in both groups. While acute hyperinsulinaemia resulted in increases in distal tubular fractional and absolute reabsorptions of sodium (p < 0.01) contributing to a fall in CNa (p < 0.01) in control subjects, in diabetic subjects the sodium-retaining effect of insulin was not significant. The lipid emulsion did not alter any of the estimated parameters. We conclude that IDDM without microalbuminuria is associated with a tendency to sodium retention which is not aggravated by insulin when compared to control subjects. Acutely induced hypertriglyceridaemia does not alter renal haemodynamics or renal sodium handling.
authors.affiliation: Department of Diabetes, Postgraduate Medical School, Prague, Czech Republic.
authors.forename: T
authors.initials: T
authors.lastname: Pelikánová
authors.forename: I
authors.initials: I
authors.lastname: Smrcková
authors.forename: J
authors.initials: J
authors.lastname: Krízová
authors.forename: J
authors.initials: J
authors.lastname: Stríbrná
authors.forename: V
authors.initials: V
authors.lastname: Lánská
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000503:physiopathology* / Q000652:urine; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage / Q000494:pharmacology*; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D015309:Glucose Clamp Technique; D006442:Glycated Hemoglobin / Q000032:analysis; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D007444:Inulin / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics / Q000494:pharmacology*; D007668:Kidney / Q000098:blood supply / Q000187:drug effects / Q000503:physiopathology*; D007684:Kidney Tubules / Q000187:drug effects / Q000502:physiology / Q000503:physiopathology; D008094:Lithium / Q000493:pharmacokinetics; D008297:Male; D008657:Metabolic Clearance Rate / Q000187:drug effects; D012016:Reference Values; D012079:Renal Circulation / Q000187:drug effects*; D012964:Sodium / Q000652:urine*; D014280:Triglycerides / Q000097:blood; D010130:p-Aminohippuric Acid / Q000493:pharmacokinetics
chemical_list: D001786:Blood Glucose; D005217:Fat Emulsions, Intravenous; D005230:Fatty Acids, Nonesterified; D006442:Glycated Hemoglobin; D007444:Inulin; D008094:Lithium; D012964:Sodium; D014280:Triglycerides; D010130:p-Aminohippuric Acid