Glomerular size-selective dysfunction in NIDDM is not ameliorated by ACE inhibition or by calcium channel blockade

Piero Ruggenenti, Lidia Mosconi, Fabio Sangalli, Federica Casiraghi, Vincenzo Gambara, Giuseppe Remuzzi, Andrea Remuzzi

Research output: Contribution to journalArticlepeer-review

Abstract

Background. In patients with insulin-dependent diabetes mellitus (IDDM) and overt nephropathy glomerular barrier size-selectivity progressively deteriorates with time and is effectively improved by angiotensin converting enzyme (ACE) inhibition. Whether similar glomerular functional changes develop in proteinuric patients with non-insulin-dependent diabetes mellitus (NIDDM), and whether antihypertensive agents can favorably affect glomerular filtration of macromolecules in these patients, has not been documented yet. Methods. We investigated renal hemodynamics and fractional clearance of neutral dextrans of graded sizes, in nine proteinuric patients with NIDDM and renal biopsy findings of typical diabetic glomerulopathy. Six healthy volunteers served as controls. We also investigated the effects of an ACE inhibitor and of a calcium channel blocker, both given in doses targeted to achieve a comparable level of systemic blood pressure control, on glomerular hemodynamics and sieving function. Theoretical analysis of glomerular macromolecule transport was adopted to evaluate intrinsic glomerular membrane permeability properties. Results. Fractional clearance of large macromolecules (42 to 66 Å in radius) was significantly higher in diabetic patients than in controls, and the distribution of membrane pore radii was calculated to be shifted towards larger pore sizes in diabetics (mean radius increased from 55 to 60 Å). Despite effective blood pressure control, neither antihypertensive affected glomerular hemodynamics to any significant extent. Fractional clearance of dextrans, as well as of albumin and IgG, and total urinary proteins were not modified by either treatments. Conclusions. These data indicate that patients with NIDDM and overt nephropathy develop abnormalities in size-selective function of the glomerular barrier and, at variance to IDDM, such changes were not ameliorated either by ACE inhibition or calcium channel blockade.

Original languageEnglish
Pages (from-to)984-994
Number of pages11
JournalKidney International
Volume55
Issue number3
DOIs
Publication statusPublished - 1999

Keywords

  • Angiotensin converting enzyme
  • Blood pressure
  • Dextran
  • Glomerular sieving
  • Non-insulindependent diabetes mellitus
  • Proteinuria

ASJC Scopus subject areas

  • Nephrology

Fingerprint Dive into the research topics of 'Glomerular size-selective dysfunction in NIDDM is not ameliorated by ACE inhibition or by calcium channel blockade'. Together they form a unique fingerprint.

Cite this