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This Article Full Text Full Text (PDF) All Versions of this Article: ASN.2006080859v1 17/12/3293    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stankovic, A. R. Articles by Hollenberg, N. K. Search for Related Content PubMed PubMed Citation Articles by Stankovic, A. R. Articles by Hollenberg, N. K. Related Collections Related Article

Prorenin and Angiotensin-Dependent Renal Vasoconstriction in Type 1 and Type 2 Diabetes

Departments of Medicine and Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts

Address correspondence to: Dr. Norman K. Hollenberg, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115. Phone: 617-732-6682; Fax: 617-232-2869; E-mail: djpagecapo{at}rics.bwh.harvard.edu

Prorenin is a powerful marker for risk of nephropathy and retinopathy in diabetes, but the responsible mechanism remains unclear. Studied were 35 patients with diabetes (18 with type 1 and 17 with type 2) and 69 age-matched healthy subjects with para-aminohippurate and inulin clearances and their response to captopril. All patients with diabetes had normal renal function and no microalbuminuria. Prorenin was calculated as the difference between total renin and active renin. Active renin level in patients with diabetes (11.6 ± 0.9 µU/ml) was significantly lower than in normal subjects (14.5 ± 1.3 µU/ml; P < 0.05); despite this, the renal vascular response to captopril was much larger (82.9 ± 11.5 versus 13.6 ± 5.8 ml/min per 1.73 m²; P < 0.01). Prorenin in both patients with type 1 and type 2 diabetes (175.7 ± 15.1 µU/ml) also was significantly higher than in normal subjects (128 ± 5.8 µU/ml; P < 0.01). Active renin correlated with prorenin in normal subjects (r = 0.44, P = 0.0002), and this correlation was much more striking in patients with diabetes (r = 0.72, P = 0.0001). The active renin and prorenin correlation was identical in type 1 and type 2 diabetes. There was a clear correlation between plasma prorenin and the renovascular response to captopril in patients with diabetes (P < 0.01) but not in normal subjects (P > 0.13). The strong correlation between plasma prorenin concentration and the renovascular response to captopril in diabetes supports the hypothesis of a direct effect of prorenin, but the unanticipated high degree of correlation between plasma prorenin and active renin limits the conclusions that can be drawn.

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