Pathophysiological aspects of edema formation in diabetic nephropathy

Hommel, Eva; Mathiesen, Elisabeth R.; Aukland, Knut; Parving, Hans-Henrik
December 1990
Kidney International;Dec1990, Vol. 38 Issue 6, p1187
Academic Journal
The present study was undertaken to evaluate some pathophysiological mechanisms of edema formation in diabetic nephropathy. Sixty-three subjects were investigated: 9 normal subjects (I). 9 normoalbuminuric Type 1 (insulin-dependent) diabetic patients (II), 15 microalbuminuric Type 1 diabetic patients (III), 16 Type 1 diabetic patients with nephropathy without edema (IV), and 14 Type 1 diabetic patients with nephropathy and edema (V). Plasma volume (125l-albumin), glomerular filtration rate and extracellular fluid volume (51Cr-EDTA) were measured. Colloid osmotic pressure and albumin concentration were measured in plasma and in subcutaneous interstitial fluid (suction blister technique). The ratio between plasma volume and interstitial fluid volume was reduced in patients with edema compared with group 1 (P < 0.05). The interstitial colloid osmotic pressure (mm Hg) was significantly reduced (P < 0.05) in group V compared with the other groups (V: 4.3 ± 1.1, I: 7.9 ± 1.7, II: 7.5 ± 1.8, III: 6.6 ± 1.5, IV: 6.6 ± 1.1), but the transcapillary colloid osmotic gradient in patients with edema was comparable with the remaining subjects. The ratio between interstitial and plasma albumin concentration was significantly reduced in group V compared with groups I and II (V: 0.31 ± 0.1, I: 0.43 ± 0.06, II: 0.44 ± 0.06; P < 0.01; III: 0.41 ± 0.07, IV: 0.41 ± 0.08). This reduction was mainly due to enhanced lymph flow. The wash-down of subcutaneous interstitial protein indicated increased capillary filtration, but at the same time limited the increase in net filtration pressure and thereby prevented progressive edema formation in diabetic nephropathy. The failure of this mechanism to prevent edema is presumably due to an additional filtering force of capillary hypertension and/or increased surface area.


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