We evaluated the renal and hormonal responses to volume expansion induced by water immersion in subjects with diabetic nephropathy (n = 12) and in healthy control subjects (n = 9). Immersion induced similar average increments in sodium excretion (±223 vs. 176 μmol/min) and comparable decrements in renovascular resistance (RVR; –15 vs. – 16 U). However, whereas the control subjects responded uniformly, the response among diabetic subjects was highly variable, with a subset of patients exhibiting paradoxical antinatriuresis and vasoconstriction. Immersion was associated with marked elevation of atrial natriuretic peptide (ANP) in plasma of diabetic versus control subjects (61 ± 9 vs. 19 ± 2 pM, respectively; P < 0.001). Yet for each picomolar increment in plasma ANP during immersion, the corresponding increases in urinary excretion of cyclic guanosine monophosphate (26 vs. 279 pmol/min) and sodium (9 vs. 47 μmol/min) and the reciprocal lowering of RVR (0.7 vs. 1.9 U) were blunted in the diabetic versus control group. Volume contraction in the postimmersion period was associated with disproportionate antinatriuresis and renal vasoconstriction in the diabetic group, despite a persistent elevation of ANP (29 ± 2 vs. 16 ± 2 pM, P < 0.01). We propose that renal insensitivity to ANP in diabetic nephropathy could contribute to altered vasoreactivity and abnormal excretory responsiveness to changing plasma volume. Blunted natriuresis in response to ANP release and enhanced sodium retention during volume contraction could account for the expanded extracellular fluid volume that has consistently been reported to accompany the development of diabetic nephropathy.
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Original Articles|
July 01 1991
Atrial Natriuretic Peptide and Response to Changing Plasma Volume in Diabetic Nephropathy
Jonathan S Lieberman;
Jonathan S Lieberman
Stanford University Medical Center, Department of Medicine, Division of Nephrology
Stanford, California
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Lilia Parra;
Lilia Parra
Stanford University Medical Center, Department of Medicine, Division of Nephrology
Stanford, California
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Lynne Newton;
Lynne Newton
Stanford University Medical Center, Department of Medicine, Division of Nephrology
Stanford, California
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John D Scandling;
John D Scandling
Stanford University Medical Center, Department of Medicine, Division of Nephrology
Stanford, California
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Nicholas Loon;
Nicholas Loon
Stanford University Medical Center, Department of Medicine, Division of Nephrology
Stanford, California
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Bryan D Myers
Bryan D Myers
Stanford University Medical Center, Department of Medicine, Division of Nephrology
Stanford, California
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Address correspondence and reprint requests to Bryan D. Myers, MD, Stanford University Medical Center, Department of Medicine, S-215, Division of Nephrology, Stanford, CA 94305.
Diabetes 1991;40(7):893–901
Article history
Received:
June 19 1990
Revision Received:
February 19 1991
Accepted:
February 19 1991
PubMed:
1647996
Citation
Jonathan S Lieberman, Lilia Parra, Lynne Newton, John D Scandling, Nicholas Loon, Bryan D Myers; Atrial Natriuretic Peptide and Response to Changing Plasma Volume in Diabetic Nephropathy. Diabetes 1 July 1991; 40 (7): 893–901. https://doi.org/10.2337/diab.40.7.893
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