Manto A, Cotroneo P, Porcelli G, D'Errico G, Marra G, Magnani P, Tilli P, Greco A V, Ghirlanda G
Istituto Clinica Medica, Rome, Italy.
Diabetologia. 1993 May;36(5):423-7. doi: 10.1007/BF00402278.
Kidney haemodynamics appear to change after the early phases of diabetic nephropathy: increases in glomerular filtration rate and in renal plasma flow have been widely reported, while kidney size is increased. As the renal kallikrein-kinin system has been demonstrated to regulate kidney blood circulation, we have evaluated the excretion of urinary kallikrein in 87 Type 1 (insulin-dependent) diabetic patients with and without hyperfiltration. Urinary kallikrein excretion was measured in 24-h urine collections. The esterolytic activity was determined by fluorimetric assay. The excretion of urinary kallikreins was significantly higher in hyperfiltering patients (472 +/- 125 esterase units/24 h) than in normofiltering (168 +/- 77 esterase units/24 h) and control subjects (151 +/- 39 esterase units/24 h), p < 0.001. Furthermore, we observed a positive correlation between urinary kallikrein excretion and glomerular filtration rate (r = 0.785). These data suggest that variations of kallikrein and kinin concentrations may play a role in the alteration of renal haemodynamics in Type 1 diabetes. It is possible that the kinin-kallikrein system, the renin-angiotensin system and the prostaglandins may interact to determine the haemodynamic alterations which are present in the diabetic disease.
糖尿病肾病早期阶段后，肾脏血流动力学似乎会发生变化：肾小球滤过率和肾血浆流量增加已被广泛报道，同时肾脏体积增大。由于已证明肾激肽释放酶-激肽系统可调节肾脏血液循环，我们评估了87例1型（胰岛素依赖型）糖尿病患者（有或无超滤）的尿激肽释放酶排泄情况。通过收集24小时尿液来测量尿激肽释放酶排泄量。通过荧光测定法测定酯酶活性。超滤患者的尿激肽释放酶排泄量（472±125酯酶单位/24小时）显著高于正常滤过患者（168±77酯酶单位/24小时）和对照组（151±39酯酶单位/24小时），p<0.001。此外，我们观察到尿激肽释放酶排泄量与肾小球滤过率之间呈正相关（r = 0.785）。这些数据表明，激肽释放酶和激肽浓度的变化可能在1型糖尿病患者肾脏血流动力学改变中起作用。激肽-激肽释放酶系统、肾素-血管紧张素系统和前列腺素可能相互作用，从而决定糖尿病疾病中存在的血流动力学改变。
