Early Alteration in Glomerular Reserve in Humans at Genetic Risk of Essential Hypertension

Abstract

Essential hypertension has a familial predisposition, but the phenotype of elevated blood pressure has delayed penetrance. Because the kidney is a crucial determinant of blood pressure homeostasis, we studied early glomerular alterations in still-normotensive young subjects at genetic risk of hypertension. Thirty-nine normotensive adults (mean age 29 to 31 years), stratified by genetic risk (parental family history [FH]) of hypertension (26 with positive FH [FH+], 13 with negative FH [FH−]), underwent intravenous infusion of mixed amino acids. Before and during amino acid administration, we measured glomerular filtration rate (GFR), putative second messengers of amino acids (nitric oxide [NO·] metabolites and cGMP), serum insulin and amino acid concentrations, and the FE Li + as an index of renal proximal tubular reabsorption. The FH+ group had a blunted GFR rise in response to amino acids (2.43±8.16% versus 31.0±13.4% rise, P =0.0126). The amino acid–induced change in GFR correlated ( r =0.786, P <0.01) with the change in urinary NO· metabolite excretion; a diminished rise in urinary NO· metabolite excretion in the FH+ group ( P =0.0105) suggested a biochemical mechanism for the different GFR responses between FH groups: a relative inability to convert arginine to NO·. The FH+ group had a far lower initial cGMP excretion at baseline (261±21.1 versus 579±84.9 nmol · h −1 /1.73 m 2 , P =0.001), although cGMP did not change during the amino acid infusion ( P =0.703). FH status, baseline GFR, and baseline serum insulin jointly predicted GFR response to amino acids ( P =0.0013), accounting for ≈45% of the variance in GFR response. Decline in FE Li +, an inverse index of proximal tubular reabsorption, paralleled increase in GFR ( r =−0.506, P =0.01), suggesting differences in proximal tubular reabsorption during amino acids between the FH groups. GFR response to amino acid infusion was blunted in the FH+ group despite significantly higher serum concentrations of 6 amino acids (arginine, isoleucine, leucine, methionine, phenylalanine, and valine) in the FH+ group, suggesting a novel form of insulin resistance (to the amino acid–translocating action of insulin) in FH+ subjects. We conclude that blunted glomerular filtration reserve in response to amino acids is an early-penetrance phenotype seen even in still-normotensive subjects at genetic risk of hypertension and is linked to impaired formation of NO· in the kidney. Corresponding changes in GFR and fractional excretion of Li + suggest that altered proximal tubular reabsorption after amino acids is an early pathophysiologic mechanism. Resistance to the amino acid–translocating actions of insulin may play a role in the biological response to amino acids in this setting. This glomerular reserve phenotype may be useful in genetic studies of renal traits preceding or predisposing to hypertension.