ATRIAL NATRIURETIC FACTOR IN NORMOTENSI1TE AND HYPERTENSIVE NON NEPHROPATHIC INSULIN DEPENDENT DIABETES MELLITUS
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This study was carried on 60 subjects classtfied into 4 groups. Group 1 consisted of 10 healthy control subjects. Group 11 consisted of 20 normotensive non-nephropathic well controlled 1DDM patients Group 1.11 consisted of 20 hypertensive non-nephropathic well-controlled 1DDM patients and Group IV consisted of 10 hypertensive non-nephropathic non-diabetic patients. All members of the study were subjected to the following investigations: assay of microalbuminuria, serum creatinine. biochemical liver functions. plasma glucose (fasting & 2 hours postprandial). serum Na+ level. 24 hours urinary Na+and base line plasma ANP level. All subjects received saline infusion (2 mato( / Kg / 90 min) & diabetic patients received l.V. insulin infusion (15 rn.uglh). then 24 hours urinary Na+ & plasma ANP level were remeasured. Tests of autonomic nervous system were performed to diabetic patients. Base line plasma ANP level was significantly higher in both diabetic and hypertensive patients when compared to controL Elevated ANP level in diabetic patients was explained by hyperinsulinemia. which causes Na+ & H20 retention whereas ANP elevation in hypertensive patients was attributed to positive Na+ balance, increased cardiac filling pressure as well as elevated renin & aldosterone. We found that ANP was signficandy elevated after saline challenge in control & hypertensive patients whereas it was unchanged in diabetic patients. This could be explained by exhaustion of cardiac stores of ANP & impaired responsiveness, of atrial stretch receptors in diabetes. Our work showed that the kidneys had impaired responsiveness to ANP in diabetes. This was inferred from the following: non significant change in urinary No.+ in IDDM either the base line or after saline challenge & significant negative correlation between plasma ANP & urinary Na+ . Our study showed that autonomic neuropathy had no significant impact on ANP in IDDM whereas disease duration, age ez, blood pressure significantly altered ANP level.