Improvement of Renal Function in Type 2 Diabetic Nephropathy
Autor: | Punnee Butthep, Narisa Futrakul, Visith Sitprija, Prasit Futrakul |
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Rok vydání: | 2007 |
Předmět: |
Adult
Vascular Endothelial Growth Factor A Efferent arteriole medicine.medical_specialty Circulating endothelial cell Vasodilator Agents Hemodynamics Renal function Blood Pressure Kidney Kidney Function Tests Critical Care and Intensive Care Medicine Diabetic nephropathy Internal medicine medicine Humans Diabetic Nephropathies Endothelial dysfunction Glycated Hemoglobin business.industry General Medicine Middle Aged medicine.disease Endocrinology medicine.anatomical_structure Diabetes Mellitus Type 2 Nephrology Creatinine Microalbuminuria business Kidney disease |
Zdroj: | Renal Failure. 29:155-158 |
ISSN: | 1525-6049 0886-022X |
Popis: | Therapeutic failure in preventing renal disease progression in type 2 diabetic nephropathy (DN) is due to a failure in the early detection of DN by microalbuminuria and the inappropriate correction of renal hemodynamic maladjustment secondary to glomerular endothelial dysfunction.Thirty patients associated with normoalbuminuric type 2 DN were subject to the following studies: tubular function by means of fractional excretion of magnesium (FE Mg), vascular function by means of determining the circulating endothelial cell, VEGF, VEGF/TGF B ratio, and intrarenal hemodynamic studies.FE Mg, circulating endothelial cells, and TGF B were abnormally elevated, and VEGF/TGF B ratio was decreased in these normoalbuminuric patients. The intrarenal hemodynamic study revealed a hemodynamic maladjustment characterized by a preferential constriction at the efferent arteriole and a reduction in peritubular capillary flow. Following treatment with vasodilators, a decrease in efferent arteriolar resistance and increase in peritubular capillary flow as well as glomerular clearance were observed.FE Mg appears to be a more sensitive marker than microalbuminuria for the early detection of DN. Increased endothelial cell injury is reflected by enhanced circulating endothelial cell loss in conjunction with the increased TGF B and the decreased ratio between VEGF and TGF B. This is further supported by the dysfunctioning glomerular endothelium, which is characterized by hemodynamic maladjustment and a reduction in the peritubular capillary flow. A correction of such hemodynamic maladjustment by multidrug vasodilators effectively improves renal perfusion and restores renal function in type 2 DN. |
Databáze: | OpenAIRE |
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