Clinical Investigation

Kidney International (1981) 20, 259–266; doi:10.1038/ki.1981.129

Responsiveness of plasma renin and aldosterone in diabetes mellitus

Carlo Beretta-Piccoli1, Peter Weidmann1 and Gerald Keusch1

1Medizinische Poliklinik, University of Berne, Switzerland

Correspondence: Dr P Weidmann, Medizinische Universitätspoiklinik, Freiburgstrasse 3, 3010 Berne, Switzerland

Received 25 June 1980; Revised 11 November 1980.

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Abstract

Responsiveness of plasma renin and aldosterone in diabetes mellitus. The responses of plasma renin activity (PRA) and aldosterone (PAldo) to the assumption of upright posture, i.v. furosemide, or angiotensin ill (AII) infusion were assessed in 25 patients with stable nonazotemic diabetes mellitus and in 25 sex-matched normal subjects of comparable age. The responsiveness of PRA to isoprenaline infusion and of plasma Cortisol and aldosterone to corticotropin were also investigated in 13 and 18 subjects of these groups, respectively. There was no significant difference between the two groups in mean body weight, plasma and urinary sodium or potassium, exchangeable sodium, blood volume, and supine PRA or PAldo. But upright PRA and PAldo were on average lower in diabetic than in normal subjects (P < 0.05), particularly in diabetics with associated mild hypertension (P < 0.05). Following furosemide injection, PRA at any given level of basal activity was significantly lower in diabetic than in normal subjects (P < 0.05), whereas mean Pauo was only minimally lower. A pressor dose of AII (diastolic blood pressure, +23 mm Hg) induced comparable increases in PAldo (+284 and +276%) and decreases in PRA (-45 and -34%) in the two groups. Isoprenaline infusion, which increased heart rate by 37%, caused marked renin stimulation (+134%) in the diabetic patients. Plasma Cortisol and PAldo responses 30 to 60 min after corticotropin injection averaged +179% and +500%, respectively. These results confirm that the postural responses of PRA and PAldo are blunted in some patients with uncomplicated diabetes, and they reveal distinct impairment of the renin responsiveness to furosemide in this disease. Four other functions of the renin-angiotensin-aldosterone system, namely the AII-renin inhibitory feedback loop, beta adrenergic-mediated renin activation, adrenal AII receptors, and ACTH-dependent adrenal biosynthetic pathways appear to be generally intact in patients with stable nonazotemic diabetes mellitus.

Capacité de réponse de l'activité rénine plasmatique et de l'aldostérone au cours du diabète sucré. La réponse de l'activité rénine plasmatique (PRA) et de l'aldostérone (PAldo) au passage à la position debout, au furosémide intraveineux ou à la perfusion d'angiotensine II (AII) a été évaluée chez 25 malades atteints de diabète sucré stable, sans insuffisance rénale, et chez 25 sujets normaux appariés pour l'âge et le sexe. La réponse de PRA à la perfusion d'isoprénaline et celle du Cortisol plasmatique et de PAldo à la corticotropine ont aussi été étudiées chez 13 et 18 sujets des groupes précédents, respectivement. Il n'y avait pas de différence entre les deux groupes en ce qui concerne le poids corporel moyen, le sodium ou le potassium plasmatique et urinaire, le sodium échangeable, le volume sanguin et PRA ou PAldo en position couchée. Les valeurs de PRA et de PAldo en position debout, cependant, étaient en moyenne inférieures chez les diabétiques (P < 0,05) et plus particulièrement chez les diabétiques atteints d'hypertension artérielle modérée (P < 0,05). Après injection de furosémide, PRA était significativement inférieure chez les diabétiques (P < 0,05) pour chaque niveau d'activité basale, alors que PAldo était à peine inférieure. Une dose pressive d'AII (pression diastolique augmentée de 23 mm Hg) a déterminé des augmentations comparables de PAldo (+284 et +276%) et des diminutions comparables de PRA (-45 et -34%) dans les deux groupes. La perfusion d'isoprénaline, qui a augmenté le rythme cardiaque de 37%, a déterminé une stimulation importante de la rénine (+134%) chez les diabétiques. Les réponses de PAldo et du Cortisol plasmatique 30 et 60 min après l'injection de corticotropine étaient en moyenne de +179 et +500%, respectivement. Ces résultats confirment que la réponse posturale de PRA et PAldo est atténuée chez certains malades atteints de diabète non compliqué et établissent que la réponse de la rénine au furosémide est nettement altérée dans cette maladie. Quatre autres fonctions du système rénine-angiotensine-aldostérone, le rétro contrôle inhibiteur AII-rénine, l'activation de la rénine à médiation béta adrénergique, les récepteurs surrénaliens de l'AII, et la voie de biosynthèse dépendant de l'ACTH, paraissent être intacts chez les malades atteints de diabète sucré stable sans insuffisance rénale.

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