Renal functional changes in relation to hemodynamic parameters during exercise test in normoalbuminuric insulin-dependent children

Aim: To examine the relationship between filtration fraction and systemic vasculopathy, in normoalbuminuric insulin-dependent diabetic adolescents. Methods: We calculated filtration fraction from measured glomerular filtration rate and renal plasma flow during a hypotonic saline perfusion test in 30 normotensive adolescent diabetic patients (9-19 years), with a mean duration of diabetes of 7.4 years. Blood pressure and heart rate were measured in basal conditions, during a 24-h ambulatory monitoring and during a dynamic exercise test on a cycle ergometer and peripheral vascular resistance was calculated. Results: Filtration fraction was increased in the diabetic children compared with controls (30 +/- 6% vs. 22 +/- 4%, p < 0.001), while renal plasma flow was significantly lower (453 +/- 133 mL/min/1.73 m(2) vs. 593 +/- 155 mL/min/1.73 m(2), p < 0.001). Peripheral vascular resistance was significantly higher at peak exercise in diabetic children compared to controls (16.3 +/- 1.3 mmHg/L min m(2) vs. 11.4 +/- 0.5 mmHg/L min m(2), p < 0.01). Conclusion: These results indicate that in young patients with IDDM, without apparent nephropathy or apparent systemic vasculopathy, filtration fraction is increased, suggesting an increased intraglomerular pressure. The associated reduced decrease of peripheral vascular resistance (increased diastolic blood pressure during exercise) suggests that renal functional abnormalities may be partly explained by a systemic vasculopathy, also present in the kidney.