INCREASE IN GLOMERULAR-FILTRATION RATE IN PATIENTS WITH INSULIN-DEPENDENT DIABETES AND ELEVATED ERYTHROCYTE SODIUM LITHIUM COUNTERTRANSPORT

Increased sodium–lithium countertransport in erythrocytes is found in patients with insulin-dependent diabetes mellitus (IDDM) and nephropathy. To determine whether such an increase precedes the onset of nephropathy and, if so, whether it is associated with changes in renal function, we measured erythrocyte sodium–lithium countertransport in 52 patients with IDDM but not nephropathy or hypertension and in 32 control subjects. Seventeen of the 52 patients with IDDM (33 percent) had sodium–lithium countertransport activity that exceeded the maximal activity in the control subjects (0.39 mmol of lithium per hour per liter of cells). Eighteen of the 52 patients with IDDM were studied in more detail. The 7 patients with raised sodium–lithium countertransport values had glomerular filtration rates (median, 159 ml per minute per 1.73 m2 of body-surface area; range, 134 to 197) that were significantly higher (P<0.01) than those in the remaining 11 patients with IDDM and normal sodium–lithium countertransport (median, 126 ml per minute per 1.73 m2; range, 110 to 176) or in the 10 control subjects (median, 128 ml per minute per 1.73 m2; range, 93 to 151 ). In the seven patients with elevated sodium–lithium countertransport, the filtration fraction (median, 0.27; range, 0.22 to 0.37) was also greater (P<0.01) than that in control subjects (median, 0.22; range, 0.18 to 0.28). There were no differences in renal function between the patients with IDDM and normal sodium–lithium countertransport and the control subjects. We conclude that sodium–lithium countertransport is increased in patients with IDDM before the onset of nephropathy and is associated with hyperfiltration. Thus, elevated sodium–lithium countertransport activity may be an early marker of diabetic nephropathy. (N Engl J Med 1990; 322:500–5.). © 1990, Massachusetts Medical Society. All rights reserved.