Fioretto P, Trevisan R, Valerio A, Avogaro A, Borsato M, Doria A, Semplicini A, Sacerdoti D, Jones S, Bognetti E
Istituto di Medicina Interna, Policlinico Universitario, Padua, Italy.
Am J Physiol. 1990 Mar;258(3 Pt 2):F675-83. doi: 10.1152/ajprenal.1990.258.3.F675.
The renal response to 100 g/1.73 m2 protein load in the form of a meat meal was studied in 19 normal subjects and 35 normoalbuminuric insulin-dependent diabetic patients (IDDs) under conditions of sustained euglycemia. The area under the glomerular filtration rate (GFR) curve rose above base line by 1,904 +/- 292 in normals and 502 +/- 237 ml/1.73 m2 in IDDs (P less than 0.01). The meat meal induced a greater increment in the area under the glucagon curve in normals (14,930 +/- 186 pg.ml-1.min-1) than in IDDs (7,227 +/- 67, P less than 0.01); similarly urinary excretion of prostaglandin E2 and 6-ketoprostaglandin F1 alpha rose by 119 and 98%, respectively, in normals but only by 2% (P less than 0.01 vs. normals) and 10% (P less than 0.01 vs. normals) in IDDs. The fractional albumin clearance rose by 102 and 251% in normals and IDDs, respectively. In five normal subjects indomethacin administration abolished the GFR, glucagon, prostaglandin, and albuminuric response to meat ingestion. Glucagon replacement under indomethacin treatment failed to restore these responses. In five diabetic patients, selected for having a flat glucagon and GFR response to a meat meal, replacement of glucagon to postprandial levels increased urinary vasodilatory prostaglandins and restored a normal GFR response. Thus in normal subjects renal vasodilatory prostaglandins appear to be the final effector of the renal hemodynamic and albuminuric response to a meat meal. The prostaglandin increase is likely to be mediated under physiological conditions by a glucagon rise, which, however, has no effect per se on renal hemodynamics.(ABSTRACT TRUNCATED AT 250 WORDS)
在持续正常血糖的条件下，对19名正常受试者和35名正常白蛋白尿的胰岛素依赖型糖尿病患者（IDDs）研究了以肉餐形式给予100 g/1.73 m²蛋白质负荷后肾脏的反应。正常受试者肾小球滤过率（GFR）曲线下面积比基线升高了1,904±292，IDDs患者升高了502±237 ml/1.73 m²（P<0.01）。肉餐引起正常受试者胰高血糖素曲线下面积的增加（14,930±186 pg.ml⁻¹.min⁻¹）大于IDDs患者（7,227±67，P<0.01）；同样，正常受试者前列腺素E2和6-酮前列腺素F1α的尿排泄分别增加了119%和98%，而IDDs患者仅分别增加了2%（与正常受试者相比P<0.01）和10%（与正常受试者相比P<0.01）。正常受试者和IDDs患者的白蛋白清除分数分别升高了102%和251%。在5名正常受试者中，给予吲哚美辛消除了肉摄入引起的GFR、胰高血糖素、前列腺素和白蛋白尿反应。在吲哚美辛治疗下补充胰高血糖素未能恢复这些反应。在5名对肉餐的胰高血糖素和GFR反应呈平坦的糖尿病患者中，将胰高血糖素补充至餐后水平可增加尿血管舒张性前列腺素并恢复正常的GFR反应。因此，在正常受试者中，肾血管舒张性前列腺素似乎是肾脏对肉餐的血流动力学和白蛋白尿反应的最终效应器。前列腺素的增加在生理条件下可能由胰高血糖素升高介导，然而，胰高血糖素本身对肾脏血流动力学没有影响。（摘要截短至250字）
