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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 mumol/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 less than 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 mumol/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 less than 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.
J S Lieberman, and
L Parra, and
L Newton, and
J D Scandling, and
N Loon, and
B D Myers
September 1997,
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J S Lieberman, and
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B D Myers
November 1987,
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J S Lieberman, and
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B D Myers
April 1986,
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J S Lieberman, and
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J S Lieberman, and
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B D Myers
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J S Lieberman, and
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Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association,
J S Lieberman, and
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August 2021,
Acta anaesthesiologica Scandinavica,
J S Lieberman, and
L Parra, and
L Newton, and
J D Scandling, and
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B D Myers
August 2021,
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J S Lieberman, and
L Parra, and
L Newton, and
J D Scandling, and
N Loon, and
B D Myers
August 1992,
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J S Lieberman, and
L Parra, and
L Newton, and
J D Scandling, and
N Loon, and
B D Myers
January 1991,
Nephron,
