Juxtamedullary microvascular dysfunction during the hyperfiltration stage of diabetes mellitus

This study was designed to identify and localize defects in renal microvascular function during the hyperfiltration stage of diabetes mellitus. Male Sprague-Dawley rats were injected intravenously with 65 mg/kg streptozotocin (IDDM rats) or vehicle (sham rats). IDDM rats received insulin (3 U · kg^-1 · day^-1) via an osmotic minipump; sham rats received diluent. During the ensuing 2-wk period, blood glucose levels averaged 89 ± 2 mg/dl in 33 sham rats and 290 ± 13 mg/dl in 37 IDDM rats. At the end of this period, inulin clearance was elevated in eight IDDM rats (1.43 ± 0.17 ml · min^-1 · g kidney wt^-1) compared with six sham rats (0.78 ± 0.05 ml · min^-1 · g kidney wt^-1). The remaining animals served as tissue donors for study of the renal microvasculature using the in vitro blood- perfused juxtamedullary nephron technique. Kidneys from sham and IDDM rats were perfused with homologous blood at a renal arterial pressure of 110 mmHg. Juxtamedullary single-nephron glomerular filtration rate was higher in IDDM rats (41.5 ± 5.4 nl/min) than in sham rats (25.4 ± 2.4 nl/min). Afferent arteriolar inside diameter was greater in IDDM rats (34 ± 2 μm) than in sham rats (22 ± 1 μm); however, efferent arteriolar diameter did not differ between groups. The afferent arteriolar vasoconstrictor response to norepinephrine (NE) was attenuated in IDDM rats, relative to sham rats, over a wide range of NE concentrations. In contrast, NE evoked similar degrees of efferent vasoconstriction in IDDM and sham rats. Sodium nitroprusside (SNP; 100 μM) caused a greater afferent vasodilation in sham than in IDDM rats, while the efferent response to SNP was comparable in both groups. These observations indicate that afferent, but not efferent, arterioles are nearly maximally dilated and exhibit diminished NE responsiveness during the hyperfiltration stage of diabetes. These selective changes in preglomerular function could underlie the hyperfiltration characteristic of early diabetes mellitus.