Mg. Koopman et L. Arisz, SPECTRUM OF DIURNAL RHYTHMS IN GLOMERULAR-PERMEABILITY IN PATIENTS WITH MEMBRANOUS NEPHROPATHY, Nephrology, dialysis, transplantation, 12, 1997, pp. 47-52
Background. Diurnal rhythms in proteinuria and selectivity index (SI)
of proteinuria can vary from patient to patient with respect to phase
and amplitude (A/M) and in some cases rhythms are absent. The aim of t
he present study was to relate this variability to a different pattern
of diurnal rhythms in permselectivity of the glomerular capillary wal
l (GCW). Methods. Ten patients with nephrotic syndrome due to membrano
us nephropathy were studied. Diurnal rhythmicity in size-dependent per
mselectivity of the GCW was determined by measuring 3-h fractional cle
arances of dextrans (30-90 Angstrom) over a period of 1 day. Results.
Four types of rhythmicity could be recognized. Type I and II only diff
ered in the magnitude of the diurnal variability in glomerular transpo
rt through large pores (r(2)) and shunt pathway (omega). Both had norm
al rhythms in clearance of proteins and SI, but all rhythms were more
pronounced in the patients with normal renal function and mild histolo
gical abnormalities (type II). Although type III also had a normal GFR
and minor histological lesions, only transport through omega (and not
through r(2)) showed a significant diurnal rhythm, which implied that
this type did not have a normal rhythm in SI. The patients with advan
ced renal failure and extensive interstitial lesions neither had a rhy
thm in permselectivity nor had normal rhythms for proteinuria and SI (
type IV). Conclusions. The type of rhythmicity in glomerular permeabil
ity corresponds well with the presence and phase of rhythms in clearan
ce of proteins and in SI of the proteinuria.