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The renin-angiotensin-aldosterone system is suppressed in adults with Type 1 diabetes
Mats Bojestig
Department of Medicine and Care, University Hospital of Linkoping
Fredrik H Nystrom
Department of Medicine and Care, University Hospital of Linkoping, fredrik.nytrom@ lio.se
Hans J Arnqvist
Department of Medicine and Care, University Hospital of Linkoping
Johnny Ludvigsson
Department of Pediatrics, University Hospital of Linköping, Sweden
Bengt E Karlberg
Department of Medicine and Care, University Hospital of Linkoping
Poor glycaemic control and high blood pressure are two important risk factors for the development of retinopathy and nephropathy in Type 1 diabetes. The renin-angiotensin-aldosterone system (RAAS) may be involved in this process, since treatment with angiotensin-converting enzyme (ACE) inhibitors postpones the development of these complications. We investigated whether plasma renin activity (PRA), plasma angiotensin II (Ang II) and atrial natriuretic peptide (ANP) differed in Type 1 diabetic patients compared with healthy controls. We recruited 80 patients with Type 1 diabetes of more than 10 years' duration and 75 age-matched controls. We found that PRA and Ang II concentrations were significantly lower in patients than in the controls. The levels of ANP, on the other hand, were higher in patients than in controls. PRA correlated negatively to the mean value of HbA1c during the previous five years. PRA and Ang II were significantly lower in patients with mean HbA1c >8.4% compared with those with mean HbA1c <7.2%. In summary, we found patients with Type 1 diabetes to have RAAS suppression and increased ANP levels, suggesting a state of fluid retention.
Key Words: renin • angiotensin II • atrial natriuretic peptide • albuminuria • glycaemic control • type 1 diabetes
References
- Marre M., Chatellier G., Leblanc H., Guyene TT, Menard J., Passa P. Prevention of diabetic nephropathy with enalapril in normotensive diabetics with microalbuminuria. BMJ 1988;297:1092-5.[Abstract/Free Full Text]
- Mathiesen ER, Hommel E., Giese J., Parving HH Efficacy of captopril in postponing nephropathy in normotensive insulin dependent diabetic patients with microalbuminuria. BMJ 1991;303:81-7.[Abstract/Free Full Text]
- Mogensen CE Microalbuminuria, blood pressure and diabetic renal disease: origin and development of ideas. Diabetologia 1999;42:263-85.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- de Chatel R., Weidmann P., Flammer J. et al. Sodium, renin, aldosterone, catecholamines, and blood pressure in diabetes mellitus. Kidney Int 1977;12:412-21.[Web of Science][Medline]
[Order article via Infotrieve]
- O'Hare JP, Anderson JV, Millar ND, Bloom SR, Corrall RJThe relationship of the renin-angiotensin-aldosterone system to atrial natriuretic peptide and the natriuresis of volume expansion in diabetics with and without proteinuria. Postgrad Med J 1988;64 (Suppl 3):35-8; discussion 48-9.[Abstract/Free Full Text]
- Feldt-Rasmussen B., Mathiesen ER, Deckert T. et al. Central role for sodium in the pathogenesis of blood pressure changes independent of angiotensin, aldosterone and catecholamines in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1987;30:610-7.[Web of Science][Medline]
[Order article via Infotrieve]
- Tuck ML, Sambhi MP, Levin L. Hyporeninemic hypoaldosteronism in diabetes mellitus. Studies of the autonomic nervous system's control of renin release. Diabetes 1979;28:237-41.[Medline]
[Order article via Infotrieve]
- Christlieb AR, Kaldany A., D'Elia JA Plasma renin activity and hypertension in diabetes mellitus. Diabetes 1976;25:969-74.[Abstract]
- Bell GM, Bernstein RK, Laragh JH et al. Increased plasma atrial natriuretic factor and reduced plasma renin in patients with poorly controlled diabetes mellitus. Clin Sci 1989;77:177-82.[Web of Science][Medline]
[Order article via Infotrieve]
- Predel HG, Schulte-Vels O., Sorger M., Glanzer K., Geller C., Kramer HJ Atrial natriuretic peptide in patients with diabetes mellitus type I. Effects on systemic and renal hemodynamics and renal excretory function. Am J Hypertens 1990;3:674-81.[Web of Science][Medline]
[Order article via Infotrieve]
- Nystrom F., Karlberg BE, Ohman KP Serum angiotensin-converting enzyme activity correlates positively with plasma angiotensin II: a population-based study of ambulatory blood pressure and the renin-angiotensin system. J Hum Hypertens 1997;11:301-6.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Bojestig M., Arnqvist HJ, Karlberg BE, Ludvigsson J. Unchanged incidence of severe retinopathy in a population of Type 1 diabetic patients with marked reduction of nephropathy. Diabet Med 1998;15:863-9.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Fyhrquist F., Soveri P., Puutula L., Stenman UH Radioimmunoassay of plasma renin activity. Clin Chem 1976;22:250-6.[Abstract/Free Full Text]
- Kappelgaard AM, Nielsen MD, Giese J. Measurement of angiotensin II in human plasma: technical modifications and practical experience. Clin Chim Acta 1976;67:299-306.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Juppner H., Brabant G., Kapteina U., Kirschner M., Klein H., Hesch RD Direct radioimmunoassay for human atrial natriuretic peptide (hANP) and its clinical evaluation. Biochem Biophys Res Commun 1986;139:1215-23.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Strojek K., Grzeszczak W., Lacka B., Gorska J., Keller CK, Ritz E. Increased prevalence of salt sensitivity of blood pressure in IDDM with and without microalbuminuria. Diabetologia 1995;38:1443-8.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Miller JA, Floras JS, Zinman B., Skorecki KL, LoganAG Effect of hyperglycaemia on arterial pressure, plasma renin activity and renal function in early diabetes. Clin Sci( Colch) 1996;90:189-95.[Web of Science][Medline]
[Order article via Infotrieve]
- Stenvinkel P., Saggar-Malik AK, Alvestrand A. Renal haemodynamics and tubular sodium handling following volume expansion with sodium chloride (NaCl) and glucose in healthy humans. Scand J Clin Lab Invest 1992;52:837-46.[Web of Science][Medline]
[Order article via Infotrieve]
- Brochner-Mortensen J. Glomerular filtration rate and extracellular fluid volumes during normoglycemia and moderate hyperglycemia in diabetics. Scand J Clin Lab Invest 1973;32:311-6.[Web of Science][Medline]
[Order article via Infotrieve]
- Correa-Rotter R., Hostetter TH, Rosenberg ME Renin and angiotensinogen gene expression in experimental diabetes mellitus. Kidney Int 1992;41:796-804.[Web of Science][Medline]
[Order article via Infotrieve]
Journal of Renin-Angiotensin-Aldosterone System, Vol. 1, No. 4,
353-356 (2000)
DOI: 10.3317/jraas.2000.065
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