Influence of an extracellular volume expansion (ECVE) on renal amino acid- and sodium handling in patients with autosomal dominant polycystic kidney disease (ADPKD)

Abstract

Although ADPKD is one of the first kidney diseases to be understood from the gene to the pathogenesis of clinical abnormalities, there were no data concerning the renal handling of amino acids and possible disorders of amino acid (AA) pattern in these patients. Therefore, in 9 patients suffering from ADPKD and in 8 healthy normal persons (NP) renal amino acid excretion was measured before and after extracellular volume expansion (ECVE) (21 of physiological electrolyte solution). Renal function was stable in both groups (serum creatinine: ADPKD: 85.1 ± 18.4 vs. NP 84.4 ± 13.5 μmol/l; GFR: 93.8 ± 16.4 vs. 104.4 ± 9.4 ml/min/1.73 m2). Mean blood pressure was higher in ADPKD patients than in NP (99.4 ± 2.6 vs. 85.5 ± 2.4 mmHg), but did not change after ECVE. After ECVE in both groups, urine volume increased distinctly, whereas GFR was only slightly enhanced. The plasma concentrations of leucine, glycine, valine, threonine, glutamine, and alanine were significantly higher in controls than in ADPKD patients. The amino acid reabsorption capacity was reduced in ADPKD patients in 12 of 21 amino acids before ECVE. After ECVE, the fractional excretion of amino acids (FEAA) increased only in NP. In parallel with changes in amino acid handling, the FENa (%) after ECVE increased both in ADPKD patients and in NP (before ECVE - ADPKD: 1.22 ± 0.23 vs. NP: 1.53 ± 0.23; after ECVE: 3.17 ± 0.25 (ADPKD) vs. 2.74 ± 0.22/NP; (ADPKD p ≤ 0.01, NP p ≤ 0.02) whereas FELi (%) increased significantly only in ADPKD (p ≤ 0.045) range (before ECVE - ADPKD: 25.8 ± 8.9 vs. NP: 20.5 ± 4.0; after ECVE: 41.4 ±15.4 vs. 25.2 ± 3.9). Furthermore, concentrations of cGMP (pmol/ml) in plasma increased after ECVE (before ECVE - ADPKD: 5.31 ± 0.56 vs. NP: 6.65 ±0.79; after ECVE: 11.31 ± 1.66 vs. 11.30 ± 1.91; p ≤ 0.05). Na+-dependent and, perhaps, NO-mediated processes in the reabsorption of AA in the proximal tubule seem to be different in ADPKD and may be related to different distributions of receptors and ATP-dependent transport systems with pathogenetic impact on abnormal transtubular fluid transport in ADPKD.