Tubular transport in kidneys of the patients with essential hypertension in combination with diabetes mellitus type II

Author(s):  V.V. Kolomiyets, Dr., Prof., M. Gorky Donetsk national medical university, Donetsk, Donetsk People's Republic, vvkolomiyets@i.ua

N.Y.Kryvonos , M. Gorky Donetsk national medical university, Donetsk, Donetsk People's Republic, voloskova81@mail.ru

Issue:  Volume 41, №2

Rubric:  Clinical Medicine

Annotation:  It has been studied the segmental tubular sodium reabsorbtion in 32 patients with essential hypertension combined with diabetes mellitus type II (main group), in 30 patients with essential hypertension, in 30 patients with diabetes mellitus type II (I и II comparative groups) with microalbuminuria and in 30 healthy persons on the background of oral salt loading with 172.4 mmol of sodium and of supported water diuresis with taking of 20 ml of distilled water on kg of body weight. After salt loading in patients of main group with essential hypertension combined with diabetes mellitus type II sodium excretion in-creased more than by 2 times (p<0.05) in the first 3 hours, then in consenquent 3 hours significantly falled and was lower than in healthy persons and in patients of both comparative groups. In patients with essen-tial hypertension combined with diabetes mellitus type II a functional reserve of sodium tubular transport significantly decreased and fast depleted during excretion of salt loading. In healthy persons and in patients of both comparative groups kidneys excreted more than 65% of loading sodium, in patients of main group – only 52.2±2.3% (p<0.05). In patients with essential hypertension combined with diabetes mellitus type II excreted renal function was disturbed in greater degree than in patients with essential hypertension and than in patients with diabetes mellitus type II. Renal inability to excrete of sodium loading effectively was caused by insufficient suppression of proximal and distal sodi-um reabsorbtion. Results of determining of urine osmolarities after salt loading demonstrated an ability of kidneys in patients with essential hypertension combined with diabetes mellitus type II to concentrate of urine in greater degree than in patients with essential hypertension or in patients with diabetes mellitus type II but this ability was short-term too. The excretion of surplus sodium in patients with essential hy-pertension in greater degree was determined by hydrostatic factor, in patients with diabetes mellitus type II it was determined in greater degree by volumetric factor, in patients with essential hypertension com-bined with diabetes mellitus type II it was mainly determined by volumetric factor. Thus, excretion of surplus sodium in patients with essential hypertension combined with diabetes mellitus type II was main-ly determined by mechanisms which were caused by diabetes mellitus type II and in less degree by essen-tial hypertension. Tubular-glomerular balans index in healthy persons was 160 mmol/mm Hg, in patients with diabetes mellitus type II – 233 mmol/mm Hg, in patients with essential hypertension (30 mmol/mm Hg) and especially in patients with essential hypertension combined with diabetes mellitus type II (9 mmol/mm Hg) it was significantly disturbed. Proximal sodium reabsorbtion in patients of main group decreased by 1.0±0.4% (р>0.05) in other groups – by 2.7-4.3%. Distal sodium reabsorbtion in patients of main group decreased – by 7.6±0.5% (р<0.05) and by 5.7-6.1% in other groups. There were decreased sodium-excreting and water-excreting renal function in patients with essential hy-pertension combined with diabetes mellitus type II due to tubular-glomerular dysbalance becaus of inade-quate supressing of proximal and distal sodium reabsorbtion.

Keywords:  essеntial hypertension, diabetes mellitus type II, sodium-excreting and water-excreting renal function, tubular-glomerular dysbalans, tubular sodium transport, proximal and distal sodium reab-sorbtion.

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