Some cardiopulmonary functions in type I diabetes mellitus with incipient nephropathy

We studied some cardiopulmonary functions in relation to metabolic control and procollagen III in 35 patients with type I diabetes mellitus; 15 normoalbuminuric [Gl] and 20 microalbuminuric [GIl]. Fifteen subjects of comparable age and sex were studied as controls [GIII]. Patients suffering from cardiac, pulmonary or renal diseases other than diabetic nephropathy were excluded. Non of our patients had hypertension, hyperuricaemia or autonomic neuropathy. Echodoppler study showed that E/A ratio, PFR, NPFR and TPF were significantly lower in GIl than GIll [P<0.05 in all parameters except Ei/Ai ratio where P<0,01]. The IRT was significantly prolonged in GIl than Gill [P< 0.01]. There were insignificant difference of all LV diastolic parameters between Gl and GIII [P>0.05] and there were weak-ve correlation between E/A and HbA[1c] [P=0.07] and significant -ve correlation between E/A and procollagen III [P< 0.01]. Although the anthropometric variables did not differ significantly among diabetics and controls, yet the lung functions did between GIl and GIII. The mean values of DLCO and its percent predicted were significantly reduced in GIl than GIll [P<0.01]. Significant -ve correlations were observed between DLCO and both HbA[1c] [p< 0.01] and procollagen III [P<0.05]. Except a significantly lower MVV [P<0.05], there were no significant differences between Gl and GIII in all pulmonary functions [P>0.05]. It could be concluded that type I diabetic patients with microalbuminuria may have LV diastolic dysfunction as well as combined restrictive and obstructive pulmonary defects with significant reduction in the diffusing capacity. These cardiopulmonary changes increase with poor glycaemic control and could be attributed to deposition of collagen in the myocardium and lung paranchyma

linkage of anp level to NA+,K+ -atpase, osmotic fragility under the effect of mannitol in crf patients

The present study was designed to determine the plasma level of ANP in chronic renal failure CRF patients before and after mannitol infusion in order to find whether the protective effect of mannitol is a primary action or is due to release of ANP, also, to elucidate the possible effects of mannitol on red cell membrane changes and enzyme activities in these CRF patients. To achieve this goal, 20 patients with CRF and 10 healthy controls were investigated for the following parameters: Plasma ANP level, blood urea and creatinine concentration, blood picture, blood indices, the activity of erythrocyte Na-K-ATPase and hemolysis of red cell to different concentrations of NaCl. 500 ml 20% mannitol were given to uremic patients by i.v. infusion for 5 consecutive days. All the previous parameters were reestimated on the 5th day half an hour after mannitol infusion [MI] and then 24 hours after the last mannitol infusion [6th day]. From this study, it can be concluded that the volume loading by MI can be regarded as an important physiological stimulus of ANP release. This beneficial effect obtained by MI were transient and it is suggested that it is more advantageously replaced by an infusion of doses of synthetic h-ANP to obtain more durable results. Activation of sodium-potassium ATPase of the erythrocyte ghosts accompanying the elevated level of ANP in this study was supported by the positive correlation between Na-K-ATPase and ANP after MI