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The kidney in diabetes mellitus : urinary transfer in excretion, hypertension, the Renin-Angiotensin-Aldosterone system, and the role of angiotensin converting enzyme inhibitors in therapy

O'Donnell, Mark John (1993)
M.D. thesis, University of Birmingham.

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Abstract

Patients with diabetic renal disease develop elevated urinary albumin excretion rates [AER] and hypertension. Preliminary data from several groups suggest that diabetic patients handle transferrin, a protein similar in size and weight, in a different fashion from albumin. In the first part of this thesis I report the results of clinical studies of urinary transferrin excretion [TER] in diabetes mellitus. More than 80% type 1 [insulin dependent] diabetic patients have increased TER but less than 40% have increased AER. TER may be provoked by exercise in uncomplicated type 1 diabetes and the rise is proportionally far greater than that for AER. Newly diagnosed type 2 [non-insulin dependent] diabetic subjects have increased TER which falls with improved glycaemic control. Interventional studies with lisinopril, an angiotensin converting enzyme [ACE] inhibitor, in microalbuminuric and macroalbuminuric diabetic subjects show a reduction in TER independent of reduction in blood pressure. Data are presented suggesting a role for altered renal tubular function in TER in diabetes. The second part of the thesis examines the role of the system in the hypertension of diabetic renal disease. Patients with elevated AER have increased resting plasma renin activity. Those with uncomplicated diabetes show an exaggerated blood pressure reponse to exercise. ACE inhibition reduces blood pressure in hypertensive patients and AER in both hypertensive and normotensive patients.

Type of Work:M.D. thesis.
School/Faculty:Faculties (to 1997) > Faculty of Medicine and Dentistry
Department:Medicine
Subjects:RC Internal medicine
QP Physiology
Institution:University of Birmingham
Library Catalogue:Check for printed version of this thesis
ID Code:37
This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder.
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