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Nephrol Dial Transplant (1996) 11: 2421-2425
© 1996 European Renal Association-European Dialysis and Transplant Association

research-article

Correlation between glomerular morphology and renal haemodynamic response to amino-acid administration in patients with IgA nephropathy

C. Pluvio1, E. de Pascale1, M. Giordano1, D. Cirillo1, M. Carone1, M. Pluvio1, P. Castellino2, and C. Giordano1

1Instituto di Medicina Interna e Nefrologia, Seconda Universitá di Napoli Italy 2Universita' degli Studi di Catania Italy

Correspondence and offprint requests to: Correspondence and offprint requests to: Pietro Castellino MD, Via R. De Cesare 31, 80131 Napoli, Italy

RATIONALE.: To establish relationship, if any, between renal morphology and renal haemodynamic response to amino acids.

DESIGN AND METHODS.: We investigated the correlation between renal haemodynamic regulation and morphology in a group of 15 patients with primary IgA nephropathy (IgAN) (age 26±2 years, BMI 24.4±1, GFR 64±5 ml/min, RPF 377±34 mI/mm, FF 0.17±0.02). Twelve normal subjects (age 30±3 years, BMI 24±1, GFR 82±6 ml/min, RPF421±42 ml/min, FF 0.19±0.02) were studied as controls. IgA patients were divided into two groups according to the histological staging of glomerular lesions: group I (n=7) stage II, and group II (n=8) stage III–IV.

RESULTS.: In the basal state GFR was similar in the two groups and averaged 64±9 and 64±6 ml/mm respectively. In contrast, FF was significantly lower in group II(0.14±0.01) (P<0.05) in comparison to group I (0.21±0.03) and controls (0.19±0.02). In order to evaluate the renal functional reserve, all study groups underwent to an intravenous amino-acid infusion designed to increase plasma amino acid levels twofold (total from 2096±145 to 4301±221 µmol/l in IgA nephropathy patients and from 2272±83 to 3844±238 µmol/l in controls). In response to amino-acid infusion, GFR rose significantly in group I (GFR 20±2% and RPF 37±4% versus basal) and controls (GFR 20±2% and RPF 20±3% versus basal) (both P<0.01 vs basal). In contrast, in patients with more severe glomerular lesions (group II) neither GFR nor RPF rose significantly (GFR –1±4% and RPF –8±6% versus basal) (P NS versus basal, P<0.01 versus group I and controls).

CONCLUSIONS.: The data show that in IgA nephropathy: severe forms of glomerular lesions are associated with a complex alteration of glomerular haemodynamic regulation, characterized by lower basal FF and loss of haemodynamic response to hyperaminoacidaemia.

Keywords: GFR; RPF; amino acid; IgA nephropathy; renal biopsy


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