Studies on acute glucose-induced aldosterone suppression: role of renin-angiotensin system

Carbohydrate exerts a mild influence on fluid retention following exercise-induced dehydration

Rapid and complete rehydration, or restoration of fluid spaces, is important when acute illness or excessive sweating has compromised hydration status. Many studies have investigated the effects of graded concentrations of sodium and other electrolytes in rehydration solutions; however, no study to date has determined the effect of carbohydrate on fluid retention when electrolyte concentrations are held constant. The purpose of this study was to determine the effect of graded levels of carbohydrate on fluid retention following exercise-induced dehydration. Fifteen heat-acclimatized men exercised in the heat for 90 min with no fluid to induce 2–3% dehydration. After a 30-min equilibration period, they received, over the course of 60 min, one of five test beverages equal to 100% of the acute change in body mass. The experimental beverages consisted of a flavored placebo with no electrolytes (P), placebo with electrolytes (P + E), 3%, 6%, and 12% carbohydrate solutions with electrolytes. All beverages contained the same type and concentration of electrolytes (18 meq/l Na+, 3 meq/l K+, 11 meq/l Cl−). Subjects voided their bladders at 60, 90, 120, 180, and 240 min, and urine specific gravity and urine volume were measured. Blood samples were taken before exercise and 30, 90, 180, and 240 min following exercise and were analyzed for glucose, sodium, hemoglobin, hematocrit, renin, aldosterone, and osmolality. Body mass was measured before and after exercise and a final body mass was taken at 240 min. There were no differences in percent dehydration, sweat loss, or fluid intake between trials. Fluid retention was significantly greater for all carbohydrate beverages compared with P (66.3 ± 14.4%). P + E (71.8 ± 9.9%) was not different from water, 3% (75.4 ± 7.8%) or 6% (75.4 ± 16.4%) but was significantly less than 12% (82.4 ± 9.2%) retention of the ingested fluid. No difference was found between the carbohydrate beverages. Carbohydrate at the levels measured exerts a mild influence on fluid retention in postexercise recovery.

Impact of hyperglycemia on the renin angiotensin system in early human type 1 diabetes mellitus

It has been demonstrated previously that moderate hyperglycemia without glucosuria can increase plasma renin activity and mean arterial pressure in young healthy males with early uncomplicated type 1 diabetes mellitus. This study was conducted to extend these observations by testing the hypothesis that mild to moderate hyperglycemia can affect renal function by increasing renin angiotensin system (RAS) activity in diabetic humans. The study included 10 men and women with early, uncomplicated type 1 diabetes (duration <5 yr), all ingesting a controlled sodium and protein diet. They were studied on four separate occasions, during a subdepressor dose of the angiotensin II (AngII) receptor blocker losartan, and during graded AngII infusion, 1.5 and 2.5 ng/kg per min, while euglycemic (blood glucose 4 to 6 mmol/L) and again while hyperglycemic without glucosuria (blood glucose 9 to 11 mmol/L), according to a randomized crossover design. Outcome measures included mean arterial pressure (MAP), GFR, effective renal plasma flow (ERPF), renal vascular resistance (RVR), filtration fraction (FF), and urine sodium excretion (UNaV) at baseline and in response to the above maneuvers. During hyperglycemic conditions, MAP was significantly higher compared with euglycemia, as were RVR and FF. After the administration of losartan, a significant renal and peripheral depressor effect was noted, with decreases in MAP, RVR, and FF, whereas during euglycemia the responses to losartan were minimal. AngII infusion resulted in elevations in MAP, RVR, and FF and a decline in UNaV during both glycemic phases, but the responses during hyperglycemia, most significantly at the 1.5 ng/kg per min infusion rate, were blunted. These data support the hypothesis that hyperglycemia affects renal function by activating the RAS. The mechanism remains obscure, but these contrasting responses may provide a link between the observations that maintenance of euglycemia and blockade of the RAS prevent or delay diabetic kidney disease, and furthermore, may clarify the mechanism whereby high glucose promotes renal disease progression in diabetes.

Glucose stimulates renin secretion via adrenergic mechanisms in the rat

To elucidate whether and why glucose directly influences renin secretion, the effect of glucose on renin secretion was investigated in the rat. In an in vivo study, renin activity significantly (p<0.01) increased from the basal value of 7.6 +/- 1.4 to 14.2 +/- 3.2 ng Ang I/ml/hr (mean +/- SD) after intravenous glucose (1.0 g/kg, in 50% glucose solution ) injection. Propranolol (10.5 mg/kg) pretreatment partly abolished the increase in renin activity induced by glucose injection. In an in vitro study, the isolated kidneys of male Wistar rats (200-250 g) were perfused with a basal perfusing medium containing 5.5 mM glucose for 20 min, and then perfused with the medium containing 16.5 mM glucose, 27.5 mM glucose, 5.5 mM glucose + 22 mM mannitol, 27.5 mM glucose + 1 microM phentolamine, or 27.5 mM glucose + 1 microM propranolol for 10 min, respectively. Renin activity was significantly increased from a basal value of 8.1 +/- 4.5 to peak value of 17.9 +/- 3.0 ng Ang I/ml/hr (p<0.01) by 16.5 mM glucose, to 59.0 +/- 10.5 ng Ang I/ml/hr (p<0.005) by 27.5 mM glucose, and to 24.7 +/- 5.8 ng Ang I/ml/hr (p<0.01) by 5.5 mM glucose + 22 mM mannitol. The increase in renin activity in the kidney perfused with 27.5 mM glucose was significantly (p<0.005) higher than that with 16.5 mM glucose or that with 5.5 mM glucose + 22 mM mannitol. The 27.5 mM glucose-stimulated increase in renin activity was not changed by the addition of 1 microM phentolamine, while it was completely abolished by the addition of 1 microM propranolol. These results suggest that glucose has a direct stimulating effect on renin secretion probably through beta-adrenergic mechanisms in the rat.