Plasma prorenin activity and complications in children with insulin-dependent diabetes mellitus

Article Abstract:

The active kidney enzyme renin is produced from an inactive form, prorenin, that transforms the liver protein angiotensinogen to angiotensin I, which is then converted by angiotensin-converting enzyme to angiotensin II. This factor, angiotensin II, constricts blood vessels and activates the production and release of the adrenal hormone aldosterone, which regulates sodium, potassium, and chloride metabolism. Prorenin is also secreted into the blood, and has been shown to be elevated in patients who have insulin-dependent diabetes mellitus (IDDM, sugar diabetes requiring insulin injections). Microvessel disease normally begins in patients with IDDM approximately five years after the onset of their disease. Changes in the vessels of the eye frequently lead to retinal disease or retinopathy, which can lead to blindness. Similar changes in the kidney make diabetic patients liable for severe kidney disease which can become end-stage, i.e. resulting in nonfunctional kidneys. Blood levels of the hormone precursor (as indicated by angiotensin activity) were measured in a group of 135 children and adolescent IDDM patients, and 54 similarly aged nondiabetic control subjects. Increased levels of blood prorenin activity were detected in children with diabetic complications. In this experiment the blood levels of 14 adolescent IDDM patients, who did not have measurable levels of urinary albumin, had blood levels of prorenin approximately twice those seen in normal children. Adolescent IDDM patients who demonstrated diabetic complications (urinary albumin or retinopathy) had significantly higher prorenin than those patients who did not exhibit such diabetic changes. When plasmal prorenin levels were elevated, kidney or retinal pathology developed more rapidly. The study shows that high blood levels of prorenin indicate a high risk of impending diabetic complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Diabetic retinopathy

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Renin - from beginning to end

Article Abstract:

Two articles in the October 18, 1990 issue of The New England Journal of Medicine are concerned with the measurement of various elements of the renin-angiotensin-aldosterone system. This system is important in the maintenance of blood pressure, and involves the secretion of preprorenin and conversion of this compound to prorenin by a group of endocrine cells, the juxtaglomerular cells, located in the cortex of the kidney. The active kidney enzyme renin is produced from an inactive form, prorenin, that transforms the liver protein angiotensinogen to angiotensin I, which is then converted by angiotensin-converting enzyme to angiotensin II. This factor, angiotensin II, constricts blood vessels and activates the production and release of the adrenal hormone aldosterone, which regulates sodium, potassium, and chloride metabolism. One of these articles deals with the identification of diabetic children and adolescents who are at increased risk of retinal and kidney pathologies when their levels of prorenin are found to be elevated. While the results of this work do not show a causal relationship between blood prorenin and complications of diabetes, the data do establish the value of prorenin as a marker of incipient pathologic difficulties. The second study investigates the risk of microcirculatory abnormalities (small vessel disease) in the kidney as a result of a congenital form of polycystic disease, suggesting that the renin-angiotensin-aldosterone system is an important underlying causative factor in the condition. This study establishes that measurements of plasmal prorenin may be useful in the identification of patients at risk, thus allowing more intensive clinical intervention. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Measurement, Polycystic kidney disease, Renin, editorial

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Relation of skin capillary pressure in patients with insulin-dependent diabetes mellitus to complications and metabolic control

Article Abstract:

Patients with insulin-dependent diabetes mellitus may develop nail-fold capillary hypertension before the onset of microvascular disease. Nail-fold capillaries are the small blood vessels that are located underneath the fingernail cuticle. Average blood pressure of nail-fold capillaries was higher in 29 patients with insulin-dependent diabetes mellitus than in 29 healthy individuals. Blood pressure in nail-fold capillaries also was measured in seven additional diabetes patients without complications affecting the central nervous system before and after three months of improved diabetic control. Average blood pressure of nail-fold capillaries was lower after the three months of improved diabetic control, compared to before. Insulin-dependent diabetes mellitus that is not well controlled can impair blood flow and cause microvascular disease.

Hypertension, Cutaneous manifestations of general diseases, Skin manifestations

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