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L-Arginine-Induced Vasodilation of the Renal Vasculature Is Preserved in Uremic Type 1 Diabetic Patients After Kidney and Pancreas but not After Kidney-Alone Transplantation

¹ Department of Radiology, Università Vita e Salute-San Raffaele, San Raffaele Scientific Institute, Milan, Italy
² Department of Internal Medicine, Section of Organ Transplantation, Università Vita e Salute-San Raffaele, San Raffaele Scientific Institute, Milan, Italy
³ Department of Internal Medicine, Section of Nutrition and Metabolism, Università Vita e Salute-San Raffaele, San Raffaele Scientific Institute, Milan, Italy
⁴ Department of General Surgery, Università Vita e Salute-San Raffaele, San Raffaele Scientific Institute, Milan, Italy

Address correspondence and reprint requests to Francesco De Cobelli, MD, Department of Radiology, or Paolo Fiorina, MD, PhD, Department of Medicine, Università Vita e Salute-San Raffaele, San Raffaele Scientific Institute Via Olgettina, 60, 20132 Milan, Italy. E-mail: francesco.decobelli{at}hsr.it or paolo.fiorina{at}hsr.it

OBJECTIVE—In uremic type 1 diabetic patients, kidney and pancreas transplantation (KP) and kidney-alone transplantation (KD) provide full restoration of normal renal function; however, only KP, i.e., curing diabetes, is expected to prevent endothelial damages. Our aim was to study L-arginine-induced vasodilation of the renal vasculature in uremic type 1 diabetic patients after KP or KD using magnetic resonance (MR).

RESEARCH DESIGN AND METHODS—MR quantitative flow measurements were performed in 15 KP patients (mean age 39.0 ± 1.7 years, 10 men and 5 women), in 11 KD patients (mean age 47.3 ± 1.9 years, 7 men and 4 women), and in 8 nondiabetic kidney transplant patients (mean age 44.0 ± 4.8 years, 7 men and 1 woman), who were used as control subjects, to measure renal blood flow and velocity and renal vascular resistance before and immediately after infusion of L-arginine.

RESULTS—Renal blood flow and velocity were not different at baseline in KP, KD, and control subjects. In contrast, during L-arginine administration renal blood flow increased significantly in KP subjects (basal 8.4 ± 0.6 vs. post 9.6 ± 0.8 ml/s, 14.3 ± 4.4%, P < 0.05) and in control subjects (basal 9.3 ± 0.8 vs. post 9.1 ± 0.8 ml/s, 17.3 ± 6.2%, P < 0.01), while it remained unchanged in KD subjects (basal 10.0 ± 0.8 vs. post 11.6 ± 0.9 ml/s, -1.36 ± 6.9%, NS). Parallel results have been achieved for renal blood velocity (KP subjects: 20.1 ± 4.9%, P < 0.01; control subjects: 23.0 ± 7.99%, P < 0.01; and KD subjects: -0.3 ± 6.5%; NS). A reduction in renal vascular resistance in response to L-arginine was evident in KP and control subjects but not in KD patients.

CONCLUSIONS—L-Arginine vasodilatory response was successfully assessed with MR quantitative flow measurements. KP patients and control subjects, but not those with KD, showed a preserved L-arginine-induced vasodilation of the renal vasculature.

Abbreviations: ECG, electrocardiogram • eNOS, endothelial nitric oxide synthase • KD, kidney-alone transplantation • KP, kidney and pancreas transplantation • MR, magnetic resonance • RBF, renal blood flow • RBV, renal blood velocity • RVR, renal vascular resistance

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