The relationship between the renal reabsorption of cysteine and the lowered urinary pH in diabetics.
OBJECTIVE
In diabetic patients, reduced urinary pH (UpH) is a predictive factor for cardiorenal-vascular disorders. Synthesis of glutathione, an anti-oxidative stress substance, is induced to counteract renal oxidative stress. UpH declines as glutamate is consumed, as does the synthesis of ammonia from glutamate. Glutathione is synthesized from glutamate and cysteine; however, in diabetes, the relationship between lowered UpH and the roles of renal amino acids is unknown. We, therefore, examined the relationship between amino-acid kinetics, UpH, and renal function.


METHODS
This cross-sectional study targeted 100 non-diabetic obese individuals (OG: obese group) and 100 diabetics (DG: diabetic group). We investigated their blood amino acids, urinary amino-acid excretion, the reabsorption rates of various amino acids, and their relationship with the UpH and estimated glomerular filtration rate (eGFR).


RESULTS
The DG subjects showed higher blood cysteine concentration, urinary glutamate, and cysteine excretions than the OG subjects. Although the glutamate reabsorption rate declined in the DG subjects, that of cysteine increased due to the lowered eGFR. The DG subjects' urinary cysteine excretion correlated positively with UpH, making this urinary cysteine excretion the sole independent risk factor for lower UpH.


CONCLUSIONS
In patients with diabetes, the reabsorbed amount of cysteine, not glutamate, regulates the amount of glutathione synthesis in the kidneys. The more an amount of cysteine reabsorption increases concurrently with a decline in eGFR, the more its urinary excretion decreases. Under these conditions, concurrently, the glutamate consumption then increases, resulting in decreased ammonia synthesis and UpH.
Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan. ogawa-s@hosp.tohoku.ac.jp.|Section of Clinical Medicine, Division of Research in Student Support, Institute for Excellence in Higher Education, Tohoku University, Tohoku, Japan. ogawa-s@hosp.tohoku.ac.jp.
Susumu
S
Ogawa
Section of Clinical Medicine, Division of Research in Student Support, Institute for Excellence in Higher Education, Tohoku University, Tohoku, Japan.
Junko
J
Takiguchi
Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Manami
M
Shimizu
Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Kazuhiro
K
Nako
Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Masashi
M
Okamura
Section of Clinical Medicine, Division of Research in Student Support, Institute for Excellence in Higher Education, Tohoku University, Tohoku, Japan.
Yoshitaka
Y
Kinouchi
Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Sadayoshi
S
Ito
D000368:Aged; D003430:Cross-Sectional Studies; D003545:Cysteine / Q000097:blood / Q000652:urine*; D003920:Diabetes Mellitus / Q000652:urine*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000652:urine; D065608:Renal Reabsorption; D014556:Urine / Q000737:chemistry; D055815:Young Adult
D003545:Cysteine
Cysteine; Glutamate; Oxidative stress; Urinary pH