Skip to main content
British Medical Journal (Clinical Research Ed.) logoLink to British Medical Journal (Clinical Research Ed.)
. 1987 Jun 6;294(6585):1443–1447. doi: 10.1136/bmj.294.6585.1443

Effect of antihypertensive treatment on kidney function in diabetic nephropathy.

H H Parving, A R Andersen, U M Smidt, E Hommel, E R Mathiesen, P A Svendsen
PMCID: PMC1246607  PMID: 3111583

Abstract

The effect of long term, aggressive antihypertensive treatment on kidney function in diabetic nephropathy was studied prospectively in 11 insulin dependent diabetics (mean age 30). During the mean pretreatment period of 32 (range 23-66) months the glomerular filtration rate decreased significantly and albuminuria and the arterial blood pressure increased significantly. During the 72 (range 32-91) month period of antihypertensive treatment the average arterial blood pressure fell from 143/96 mm Hg to 129/84 mm Hg and albuminuria decreased from 1038 micrograms/min to 504 micrograms/min. The rate of decline in the glomerular filtration rate decreased from 0.89 (range 0.44-1.46) ml/min/month before treatment to 0.22 (range 0.01-0.40) ml/min/month during treatment. The rate of decline in the glomerular filtration rate was significantly smaller during the second three years compared with the first three years in patients who received long term antihypertensive treatment (greater than or equal to 6 years). One patient died from acute myocardial infarction (glomerular filtration rate 46 ml/min/1.74 m2). Effective antihypertensive treatment postpones renal insufficiency in diabetic nephropathy.

Full text

PDF
1443

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersen A. R., Christiansen J. S., Andersen J. K., Kreiner S., Deckert T. Diabetic nephropathy in Type 1 (insulin-dependent) diabetes: an epidemiological study. Diabetologia. 1983 Dec;25(6):496–501. doi: 10.1007/BF00284458. [DOI] [PubMed] [Google Scholar]
  2. Berglund J., Lins L. E., Lins P. E. Predictability in diabetic nephropathy. Acta Med Scand. 1984;215(3):263–270. doi: 10.1111/j.0954-6820.1984.tb05004.x. [DOI] [PubMed] [Google Scholar]
  3. Berkman J., Rifkin H. Unilateral nodular diabetic glomerulosclerosis (Kimmelstiel-Wilson): report of a case. Metabolism. 1973 May;22(5):715–722. doi: 10.1016/0026-0495(73)90243-6. [DOI] [PubMed] [Google Scholar]
  4. Björck S., Nyberg G., Mulec H., Granerus G., Herlitz H., Aurell M. Beneficial effects of angiotensin converting enzyme inhibition on renal function in patients with diabetic nephropathy. Br Med J (Clin Res Ed) 1986 Aug 23;293(6545):471–474. doi: 10.1136/bmj.293.6545.471. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Borch-Johnsen K., Andersen P. K., Deckert T. The effect of proteinuria on relative mortality in type 1 (insulin-dependent) diabetes mellitus. Diabetologia. 1985 Aug;28(8):590–596. doi: 10.1007/BF00281993. [DOI] [PubMed] [Google Scholar]
  6. Brenner B. M. Hemodynamically mediated glomerular injury and the progressive nature of kidney disease. Kidney Int. 1983 Apr;23(4):647–655. doi: 10.1038/ki.1983.72. [DOI] [PubMed] [Google Scholar]
  7. Bröchner-Mortensen J. A simple method for the determination of glomerular filtration rate. Scand J Clin Lab Invest. 1972 Nov;30(3):271–274. doi: 10.3109/00365517209084290. [DOI] [PubMed] [Google Scholar]
  8. Bröchner-Mortensen J., Rödbro P. Selection of routine method for determination of glomerular filtration rate in adult patients. Scand J Clin Lab Invest. 1976 Jan;36(1):35–43. doi: 10.1080/00365517609068016. [DOI] [PubMed] [Google Scholar]
  9. Deckert T., Poulsen J. E., Larsen M. Prognosis of diabetics with diabetes onset before the age of thirty-one. I. Survival, causes of death, and complications. Diabetologia. 1978 Jun;14(6):363–370. doi: 10.1007/BF01228130. [DOI] [PubMed] [Google Scholar]
  10. Elder J. B., Ganguli P. C., Gillespie I. E. Cimetidine and gastric cancer. Lancet. 1979 May 12;1(8124):1005–1006. doi: 10.1016/s0140-6736(79)92757-0. [DOI] [PubMed] [Google Scholar]
  11. Gundersen H. J., Osterby R. Glomerular size and structure in diabetes mellitus. II. Late abnormalities. Diabetologia. 1977 Jan;13(1):43–48. doi: 10.1007/BF00996326. [DOI] [PubMed] [Google Scholar]
  12. Hasslacher C., Stech W., Wahl P., Ritz E. Blood pressure and metabolic control as risk factors for nephropathy in type 1 (insulin-dependent) diabetes. Diabetologia. 1985 Jan;28(1):6–11. doi: 10.1007/BF00276992. [DOI] [PubMed] [Google Scholar]
  13. Hommel E., Parving H. H., Mathiesen E., Edsberg B., Damkjaer Nielsen M., Giese J. Effect of captopril on kidney function in insulin-dependent diabetic patients with nephropathy. Br Med J (Clin Res Ed) 1986 Aug 23;293(6545):467–470. doi: 10.1136/bmj.293.6545.467. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hostetter T. H., Olson J. L., Rennke H. G., Venkatachalam M. A., Brenner B. M. Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation. Am J Physiol. 1981 Jul;241(1):F85–F93. doi: 10.1152/ajprenal.1981.241.1.F85. [DOI] [PubMed] [Google Scholar]
  15. Hostetter T. H., Rennke H. G., Brenner B. M. The case for intrarenal hypertension in the initiation and progression of diabetic and other glomerulopathies. Am J Med. 1982 Mar;72(3):375–380. doi: 10.1016/0002-9343(82)90490-9. [DOI] [PubMed] [Google Scholar]
  16. Hostetter T. H., Troy J. L., Brenner B. M. Glomerular hemodynamics in experimental diabetes mellitus. Kidney Int. 1981 Mar;19(3):410–415. doi: 10.1038/ki.1981.33. [DOI] [PubMed] [Google Scholar]
  17. Jensen P. K., Christiansen J. S., Steven K., Parving H. H. Renal function in streptozotocin-diabetic rats. Diabetologia. 1981 Oct;21(4):409–414. [PubMed] [Google Scholar]
  18. Jensen P. K., Steven K., Blaehr H., Christiansen J. S., Parving H. H. Effects of indomethacin on glomerular hemodynamics in experimental diabetes. Kidney Int. 1986 Feb;29(2):490–495. doi: 10.1038/ki.1986.26. [DOI] [PubMed] [Google Scholar]
  19. Krolewski A. S., Warram J. H., Christlieb A. R., Busick E. J., Kahn C. R. The changing natural history of nephropathy in type I diabetes. Am J Med. 1985 May;78(5):785–794. doi: 10.1016/0002-9343(85)90284-0. [DOI] [PubMed] [Google Scholar]
  20. Mancini G., Carbonara A. O., Heremans J. F. Immunochemical quantitation of antigens by single radial immunodiffusion. Immunochemistry. 1965 Sep;2(3):235–254. doi: 10.1016/0019-2791(65)90004-2. [DOI] [PubMed] [Google Scholar]
  21. Mauer S. M., Steffes M. W., Azar S., Sandberg S. K., Brown D. M. The effects of Goldblatt hypertension on development of the glomerular lesions of diabetes mellitus in the rat. Diabetes. 1978 Jul;27(7):738–744. doi: 10.2337/diab.27.7.738. [DOI] [PubMed] [Google Scholar]
  22. Mitch W. E., Walser M., Buffington G. A., Lemann J., Jr A simple method of estimating progression of chronic renal failure. Lancet. 1976 Dec 18;2(7999):1326–1328. doi: 10.1016/s0140-6736(76)91974-7. [DOI] [PubMed] [Google Scholar]
  23. Mogensen C. E. Long-term antihypertensive treatment inhibiting progression of diabetic nephropathy. Br Med J (Clin Res Ed) 1982 Sep 11;285(6343):685–688. doi: 10.1136/bmj.285.6343.685. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Parving H. H., Kastrup H., Smidt U. M., Andersen A. R., Feldt-Rasmussen B., Christiansen J. S. Impaired autoregulation of glomerular filtration rate in type 1 (insulin-dependent) diabetic patients with nephropathy. Diabetologia. 1984 Dec;27(6):547–552. doi: 10.1007/BF00276965. [DOI] [PubMed] [Google Scholar]
  25. Parving H. H., Smidt U. M., Friisberg B., Bonnevie-Nielsen V., Andersen A. R. A prospective study of glomerular filtration rate and arterial blood pressure in insulin-dependent diabetics with diabetic nephropathy. Diabetologia. 1981 Apr;20(4):457–461. doi: 10.1007/BF00253407. [DOI] [PubMed] [Google Scholar]
  26. Parving H. H., Viberti G. C., Keen H., Christiansen J. S., Lassen N. A. Hemodynamic factors in the genesis of diabetic microangiopathy. Metabolism. 1983 Sep;32(9):943–949. doi: 10.1016/0026-0495(83)90210-x. [DOI] [PubMed] [Google Scholar]
  27. Puska P., Iacono J. M., Nissinen A., Korhonen H. J., Vartianinen E., Pietinen P., Dougherty R., Leino U., Mutanen M., Moisio S. Controlled, randomised trial of the effect of dietary fat on blood pressure. Lancet. 1983 Jan 1;1(8314-5):1–5. doi: 10.1016/s0140-6736(83)91556-8. [DOI] [PubMed] [Google Scholar]
  28. Steffes M. W., Brown D. M., Mauer S. M. Diabetic glomerulopathy following unilateral nephrectomy in the rat. Diabetes. 1978 Jan;27(1):35–41. doi: 10.2337/diab.27.1.35. [DOI] [PubMed] [Google Scholar]
  29. Steffes M. W., Brown D. M., Mauer S. M. The development, enhancement, and reversal of the secondary complications of diabetes mellitus. Hum Pathol. 1979 May;10(3):293–299. doi: 10.1016/s0046-8177(79)80026-x. [DOI] [PubMed] [Google Scholar]
  30. Viberti G. C., Bilous R. W., Mackintosh D., Bending J. J., Keen H. Long term correction of hyperglycaemia and progression of renal failure in insulin dependent diabetes. Br Med J (Clin Res Ed) 1983 Feb 19;286(6365):598–602. doi: 10.1136/bmj.286.6365.598. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Viberti G. C., Bilous R. W., Mackintosh D., Keen H. Monitoring glomerular function in diabetic nephropathy. A prospective study. Am J Med. 1983 Feb;74(2):256–264. doi: 10.1016/0002-9343(83)90624-1. [DOI] [PubMed] [Google Scholar]
  32. Zatz R., Dunn B. R., Meyer T. W., Anderson S., Rennke H. G., Brenner B. M. Prevention of diabetic glomerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest. 1986 Jun;77(6):1925–1930. doi: 10.1172/JCI112521. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Medical Journal (Clinical research ed.) are provided here courtesy of BMJ Publishing Group

RESOURCES