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In this study, plasma renin activity (PRA) and aldosterone levels were determined in 96 type II diabetic patients (50 females, 46 males) with a duration longer than 10 years and in 20 similarly aged-matched healthy subjects in order to investigate the frequency of HRHA in type II diabetes mellitus (DM). Patients with adrenal insufficiency and those using nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics or angiotensin converting enzyme (ACE) inhibitors during last one month were not included in this study. After at least a 3-day of diabetic diet containing normal salt amount, PRA and aldosterone levels were measured in venous samples obtained after a 2-hour standing. In diabetic group, mean PRA and aldosterone levels were found to be significantly decreased when compared to the control group. The cutt off points for hyporeninemia and hypoaldosteronism were calculated by mean value oj control group-2SD, and PRA values lower than 1.5 ng/ml/h and aldosterone values lower than 4 ng/dl were accepted as hyporeninemia and hypoaldosteronism, respectively. According to these criteria, HRHA was detected in 15 (156 %) patients.
Mean age, mean arterial pressure and potassium levels were higher and mean GFR values were lower in patients with than in ones without HRHA.
After 3-days of salt-free diet, renin-aldosterone stimulation was performed in 15 patients with HRHA by giving 20 mg iv furosemide. While 9 patients respond to stimulation (mild or secondary forms), PRA and aldosterone levels of remaining 6 patients were not increased (true HRHA). Six patients not responding to stimulation had lower GFR, hyperpotassemia and mild metabolic acidosis. Hyperpotassemia was partly controlled by insulin and sodium bicarbonate therpy in these 6 cases.
As a conclusion, we found that the frequency oj HRHA in type II DM was significantly high. Therefore, ACE inhibitors and NSAIDs should not be given to type II diabetic patients, particulary over 50 years oj age without determining serum potassium and creatinine levels.