Pdf glomerular hyperfiltration in prediabetes and prehypertension. Mechanisms of diabetic hyperfiltration kidney international. Elevated glomerular filtration rate gfr is a common observation in early diabetes mellitus and closely correlates to the progression of diabetic nephropathy. Glomerular hyperfiltration can be caused by afferent arteriolar vasodilation as seen in patients with diabetes or after a highprotein meal, andor by efferent arteriolar vasoconstriction owing to. In diabetes, glomerular hyperfiltration is mediated by the hyper glycaemic period over time 10. In youthonset type 2 diabetes, the most important risk factor for glomerular hyperfiltration is insulin resistance 11. When diabetes is poorly controlled, the kidney has increased sensitivity to amino acids with an augmented glomerular hyper. The full text of this article is available in pdf format. This phenomenon, known as glomerular hyperfiltration, classically has been hypothesized to predispose to irreversible nephron damage, thereby. High intraglomerular pressure is associated with renal hyperfiltration, leading to the initiation and progression of kidney disease in experimental models of diabetes mellitus dm. Whether amelioration of hyperfiltration is renopro tective is worth investigating.
According to a recent metaanalysis of studies performed in type 1 diabetic subjects, individuals with glomerular hyperfiltration are at increased risk for albuminuria and the progression of diabetic nephropathy 6. Treatable glomerular hyperfiltration in patients with. Pdf glomerular hyperfiltration in experimental diabetes mellitus. The mediators driving glomerular hyperfiltration in diabetes have not been clearly elucidated despite detailed. The prevalence of hyperfiltration may be lower in the era of more aggressive glucose control. Article pdf available in nephrology dialysis transplantation 275. In healthy volunteers, administration of exogenous gh induces glomerular hyperfiltration 6. The glomerular filtration rate gfr starts to decline with increasing rates of albuminuria and when the. The impact of hyperfiltration on the diabetic kidney emconsulte. In humans, hyperfiltration is observed in patients with type 1 and type 2 dm, and is also seen in patients with prediabetic conditions, such as the metabolic syndrome. Hyperfiltration also occurs early in the course of type 1 and type 2 diabetes. Renal hyperfiltration related to diabetes mellitus and. The hyperfiltration has been explained to be the result of a reduced load of sodium and chloride. Gh affects renal function both directly and indirectly through serum or local igf1 3, 4, 5.
No single definition of glomerular hyperfiltration has. In both type 1 and type 2 diabetes, these aberrant renal hemodynamics are corrected by intensive glycemic control. Hyperglycemia interacts with amino acids to trigger glomerular hyperfiltration. Moreover, at the singlenephron level, diabetesrelated renal hemo dynamic alterationsas an adaptation to reduction in functional nephron mass and or in. Glomerular hyperfiltration is a phenomenon that can occur in various clinical conditions including kidney disease. Prediabetes and risk of glomerular hyperfiltration and albuminuria. Hyperfiltrationdiabetesintraglomerular pressurediabetic nephropathy. Pdf glomerular hyperfiltration in experimental diabetes.
Glomerular hyperfiltration in prediabetes and prehypertension. Glomerular hyperfiltration is a characteristic functional abnormality in insulindependent diabetes mellitus and occurs in the large majority of young type 1 diabetic patients 5. In an original report of 110 newly diagnosed patients with type 2 diabetes mellitus, for example, the gfr was above 140 mlmin in 16 percent and more than two standard deviations above the mean of a control population in 45 percent. Tubular reabsorption and diabetesinduced glomerular.
American diabetes association predmada and the international expert. The patient developed insulindependent diabetes mclii tus iddm at the age of. Driven by the ever increasing prevalence of diabetes, diabetic kidney disease dkd has become. An increased glomerular filtration rate gfr is a typical feature of type 1 diabetic patients of short duration and it is. Early glomerular hyperfiltration and the development of late nephropathy in type 1 insulindependent diabetes mellitus h. Driven by the everincreasing prevalence of diabetes, diabetic kidney disease dkd has become.