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Biomedical subjects

M J Wiseman

Publications and source records attributed to M J Wiseman.

25 records · Page 2Linked to original sources
PubMed1984

Plasma renin activity in insulin-dependent diabetics with raised glomerular filtration rate.

Basal and ambulant plasma renin activity (PRA) were measured in 12 insulin-dependent diabetics (IDDS) with elevated glomerular filtration rate (GFR), 12 IDDs with normal GFR matched for age, sex and duration of diabetes and 12 age and sex matched non-diabetic control subjects. The two diabetic groups did not differ with respect to extracellular fluid volume, urinary sodium excretion, arterial blood pressure, mean plasma glucose concentration or urinary glucose excretion. Basal PRA did not differ significantly between the three groups. Ambulant PRA was significantly higher (P less than 0.02) in the group of IDDs with elevated GFR than in the control group. Our data suggest that, in IDDs with high GFR, haemodynamic alterations may stimulate a rise in PRA and thus angiotensin, a potent vasoconstrictor. Whether this represents an attempt of the renin-angiotensin system to normalise GFR or is the result of insensitivity of the renal vasculature to circulating angiotensin remains to be established.

Adolescent↗
PubMed1984

Threshold effect of plasma glucose in the glomerular hyperfiltration of diabetes.

Glomerular filtration rate (GFR) is abnormally high in some, but not all, insulin-dependent diabetic patients. The potential importance of this hyperfiltration lies in its possible link with later severe diabetic kidney disease. Inadequate glycaemic control is closely related to hyperfiltration but the mechanisms of the association are obscure. GFR and prevailing plasma glucose concentration were examined in a group of insulin-dependent diabetics without clinical proteinuria and in a group of non-diabetics, and their relationships observed using linear and multiple regression analysis. A positive correlation (r = 0.30, p less than 0.05) is found between mean plasma glucose concentration and GFR up to a mean plasma glucose level of approximately 13.5 mmol/l. Glycaemia in excess of this degree tends to be associated with a lower GFR. Multiple regression analysis confirmed the independence of plasma glucose as a determinant of GFR (p less than 0.05) at concentrations below 13.5 mmol/l. GFR declined significantly with age, but independently of diabetes duration, in the diabetic group (r = -0.48, p less than 0.001). GFR in the control group showed a statistically non-significant decline with age.

Adolescent↗
PubMed1981

Dislocation of the manubriosternal joint in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a disease characterised by joint deformity and subluxation. Although many joints may be involved, dislocation of the manubriosternal joint is extremely rare. A case of dislocation of this in a woman with RA is presented.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Genesis and evolution of proteinuria in diabetes mellitus.

Approximately 40-45% of insulin-dependent diabetic (IDD) patients will develop, with time, clinical proteinuria, a forerunner of certain renal failure. Before this, however, up to 45% of IDD patients excrete supranormal amounts of protein in the urine, though still undetectable by dipstix test. This microproteinuria appears to be glomerular in origin, consists mainly of albumin and IgG, and is associated with poor glycemic control and marginal elevation of arterial pressure. Glomerular hemodynamic disturbances, and loss of charge selectivity of the glomerular membrane, are probably responsible for this microproteinuria, which appears reversible by correction of hyperglycemia and raised blood pressure. Once the dipstix test becomes positive (i.e. total urinary protein excretion exceeds 0.5 g/24h) and blood pressure rises into the hypertensive range, glomerular filtration rate (GFR) falls relentlessly. By the time GFR is as low as 20 ml/min/1.73 m2, more IgG relative to albumin is being filtered, giving rise to a low selectivity proteinuria, a condition consistent with changes in the size selectivity properties of the glomerular filtre. Glycemic control does not affect the decline in GFR, although blood pressure control and low protein diet can slow it, presumably by altering the self-perpetuating hemodynamic disturbances that occur in surviving glomeruli. The recent demonstration that IDD patients with microalbuminuria in excess of 30 micrograms/min have approximately a 20-fold increase in risk of developing persistent detectable proteinuria has provided a link between these two phases of diabetic nephropathy. The reversibility of the early microalbuminuria heralds a real chance of preventing the later irreversible phase of end-stage renal failure.

Blood Glucose↗