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Am J Physiol Renal Physiol 278: F817-F822, 2000;
0363-6127/00 $5.00
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Vol. 278, Issue 5, F817-F822, May 2000

Glomerular hemodynamics in severe obesity

Avry Chagnac1, Talia Weinstein1, Asher Korzets1, Edward Ramadan2, Judith Hirsch1, and Uzi Gafter1

1 Department of Nephrology and 2 Department of Surgery A, Rabin Medical Center-Golda (Hasharon) Campus, Petah Tikva 49372, Israel; and 3 Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel

Differential solute clearances were used to characterize glomerular function in 12 nondiabetic subjects with severe obesity (body mass index >38). Nine healthy subjects served as the control group. In the obese group, glomerular filtration rate (GFR) and renal plasma flow (RPF) exceeded the control value by 51 and 31%, respectively. Consequently, filtration fraction increased. The augmented RPF suggested a state of renal vasodilatation involving, mainly or solely, the afferent arteriole. Albumin excretion rate and fractional albumin clearance increased by 89 and 78%, respectively. Oral glucose tolerance tests were suggestive of insulin resistance. Insulin resistance was positively correlated with GFR (r = 0.88, P < 0.001) and RPF (r = 0.72, P < 0.001). Mean arterial pressure was higher than in the control group. Fractional clearances of dextrans of broad size distribution tended to be lowered. The determinants of the GFR were estimated qualitatively by using a theoretical model of dextran transport through a heteroporous membrane. This analysis suggests that the high GFR in very obese subjects may be the result of an increase in transcapillary hydraulic pressure difference (Delta P). An abnormal transmission of increased arterial pressure to the glomerular capillaries through a dilated afferent arteriole could account for the augmentation in Delta P.

dextran; glomerular barrier; hyperfiltration; insulin resistance; transcapillary hydraulic pressure difference


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