Natochin Iu V, Shestakova M V, Kuznetsova A A, Klefortova I I, Trubitsyna N P, Dedov I I
Ter Arkh. 2010;82(6):9-14.
To evaluate the kidney status from osmotic urine concentration in different stages of diabetes mellitus (DM) to define whether not only glomeruli and proximal tubules, but also renal medullary substance structures are involved into the pathological process, as well as their reaction to endogenous vasopressin production.
Forty patients with a 1-to-28-year history of DM, including 18 with diabetic nephropathy, 10 with chronic renal failure, and 22 without diabetic nephropathy, were examined. Urine and blood osmolality were determined and renal osmoregulating function was estimated.
Decreased glomerular filtration rate was found in relation to the duration of DM. The osmolality of nocturnal urine samples tended to diminish during short-term deprivation depending on the duration of DM. Increased diuresis in DM was shown to correlate with the higher reabsorption of osmotically free water.
Diminished renal concentrating capacity in DM appears to depend on evolving renal failure rather than vasopressin resistance. The application of a new approach, by calculating the clearance of sodium-free water, suggests that its increased reabsorption favors normalization of serum osmolality in hyperglycemia.
通过评估糖尿病（DM）不同阶段的尿液渗透浓缩功能来了解肾脏状况，以确定不仅肾小球和近端小管，而且肾髓质结构是否参与病理过程，以及它们对内源性血管升压素产生的反应。
对40例DM病程1至28年的患者进行检查，其中包括18例糖尿病肾病患者、10例慢性肾衰竭患者和22例无糖尿病肾病患者。测定尿液和血液渗透压，并评估肾脏渗透调节功能。
发现肾小球滤过率随DM病程延长而降低。根据DM病程，短期禁水期间夜间尿液样本的渗透压趋于降低。DM患者尿量增加与渗透自由水重吸收增加相关。
DM患者肾脏浓缩能力下降似乎取决于进展性肾衰竭而非血管升压素抵抗。通过计算无钠水清除率应用新方法表明，其重吸收增加有助于高血糖时血清渗透压正常化。
