Nephrology Dialysis Transplantation, Vol 13, Issue 3 623-629, Copyright © 1998 by Oxford University Press
J Herrera and B Rodriguez-Iturbe
Background: The increment in glomerular filtration
rate (GFR) after a protein load has been taken to reflect the renal reserve
capacity; however, this response is preserved in end-stage kidney disease.
Tubular secretion of creatinine is increased in relation to the GFR in
renal failure, but little is known about the tubular functional response to
stimulation despite the fact that tubulointerstitial lesions are always
pre-eminent in chronic renal damage. Therefore we decided to compare the
urinary creatinine excretion (UcrV) and tubular secretion of creatinine
(TScr) induced by a test meat meal in normal individuals and in individuals
with reduced nephron mass. Methods: We studied 12
normal subjects, seven healthy uninephrectomized (kidney donors) and eight
patients with chronic renal disease (serum creatinine ranging from 121.2 to
486 &mgr;mol/l). They had been on a standard diet for 5 days before the
studies. The test meal provided 80 g of animal protein. Three baseline and
four stimulated (post-meal) 30-min simultaneous inulin and creatinine
clearances were carried out. Results: We found that
normals increased more than twice the UCrV (post-meal=329.5±SEM
13.1 nmol/min/kg) and 3.4 times the TSCr (114,4±12.7
nmol/min/kg) after the test meal. In contrast, patients were unable to
raise their baseline values (P<0.001), despite a normal increment in
GFR. The data in kidney donors fell between normals and patients. Strong
correlation existed between the stimulated (but not the baseline) TScr
(P=0.003) and GFR and between UcrV post-meal/pre-meal ratio and GFR
(P<0.0001). Conclusion: The increment in TScr
resulting from a protein meal is related to the functioning nephron mass.
Evaluation of this increment could have potential clinical relevance.
Key words: creatinine; nephron mass; protein meal;
tubular secretion; uninephrectomy
ORIGINAL ARTICLES
Stimulation of tubular secretion of creatinine in health and in conditions associated with reduced nephron mass. Evidence for a tubular functional reserve
Renal Service and Laboratory, Hospital Universitario and Instituto de Investigaciones Biomedicas (INBIOMED), Fundacion para la Ciencia y Tecnologia (FUNDACITE-Zulia), Maracaibo, Venezuela; Corresponding author at: Renal Service, Hospital Universitario, Apartado Postal 1430, Maracaibo 4001-A, Venezuela
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