[Increase glomerular filtration rate and urinary excretion of nitric oxide metabolites in diabetes. Modification with low captopril doses treatment].
OBJECTIVE
to measure the baseline urinary excretion of nitric oxide metabolites and their changes after an oral acute protein load (APL) and after a short-course with a low-dose captopril treatment in children with I-II stages of diabetic nephropathy.


METHODS
eleven children with early diagnosis of insulin dependent diabetes mellitus and with poor metabolic control were studied. Urinary excretion of nitric oxide metabolites (UENOm) and renal functional reserve with iothalamate clearance were measured, before and after an APL both in baseline form and after 15 days with captopril treatment.


RESULTS
In pre-treatment period the UENOm was 1113 +/- 797 and after APL was 1800.10 +/- 1329.07 nmol\mL\minute (ns). Glomerular filtration rate (GFR) was 159.5 +/- 42.1 and post-APL was 149.3 +/- 41.2 mL/minute 1.73 m2 (ns). Post-captopril treatment, UENOm 2316.30 +/- 1392 and after APL was 1514.49 +/- 685 nmol\mL\minute (ns). GFR pre-APL was 119.6 +/- 28.8 mL/minute 1.73 m2, p<0.03 versus GFR baseline precaptopril) and post-APL was 135.0 +/- 15.0 ml/minute 1.73 m2, p<0.05 versus GFR baseline post-captopril). The renal plasmatic flow and the filtration fraction did not have significative changes.


CONCLUSIONS
the renal functional reserve was restored with captopril despite the poor metabolic control. It is difficult to identify if the basal UENOm were elevated because, the normal values were unknown in association with the poor metabolic control. And it's interesting that the captopril decreases the GRF and the UENOm rises without correlation with or without renal functional reserve and changes in UENOm.
Osorio-Bretón
María del Pilar
Mdel P
Departamento de Nefrología, Hospital de Especialidades, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Distrito Federal, México. pilarob13@hotmail.com
D000293:Adolescent; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000494:pharmacology; D002216:Captopril / Q000008:administration & dosage* / Q000494:pharmacology; D002648:Child; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000378:metabolism / Q000652:urine*
D000806:Angiotensin-Converting Enzyme Inhibitors; D009569:Nitric Oxide; D002216:Captopril