Clinical impact of albuminuria in diabetic nephropathy

Abstract

Patients suffering from diabetic nephropathy, resulting in end-stage renal failure, are increasing in number. Pathophysiology of diabetic nephropathy remains to be fully investigated. In clinical settings, the presence of albuminuria/overt proteinuria and low glomerular filtration rate may predict poor renal prognosis, however, the prognosis of normoalbuminuric renal insufficient diabetic patients remains contravertial. In addition to the measurement of urinary albumin excretion, biomarker studies to detect diabetic nephropathy in the earlier stage more specifically have been investigated worldwide.A growing body of evidence reveals that remission and/or regression of diabetic nephropathy has been noted, which may be an indicator for cardiovascular and renal risk reduction. Deeper insights into pathological characteristics as well as clinical impacts of albuminuria on renal and cardiovascular outcome would be required.3

Clinical impact of albuminuria and glomerular filtration rate on renal and cardiovascular events, and all-cause mortality in Japanese patients with type 2 diabetes

“…In addition, cardiovascular diseases and deaths increase in patients with diabetic nephropathy before and after dialysis [2][3][4]. Therefore, to determine and manage risk factors for progression of renal and cardiovascular outcomes and mortality is of importance to prolong the life expectancy of diabetic patients.…”

Hyperoside pre-treatment prevents glomerular basement membrane damage in diabetic nephropathy by inhibiting podocyte heparanase expression

“…The early stage of DN is clinically characterized with persistent micro-albuminuria and multiple renal pathological injuries 3 . Early morphological alterations in DN include glomerular hypertrophy, mesangial matrix expansion and GBM thickening 4, 5 .…”

Helicobacter pylori infection associated with type 2 diabetic nephropathy in patients with dyspeptic symptoms

“…The stages in pathogenesis involve diabetic microalbuminuria, macroalbuminuria, and renal failure. Multiple factors are involved including blood glucose, blood lipid, and insulin resistance (4,5). Additionally, inflammatory reactions were also recognized to play an essential role in each stage of the diabetic nephropathy (6).…”

“…In addition, a few studies reported H. pylori infection in different stages of diabetic nephropathy (19). We hypothesize that H. pylori infection in the pathogenesis of systemic inflammation and vascular endothelial damages suggests a significant association Page 5 of 27 A c c e p t e d M a n u s c r i p t 4 between H. pylori infection and urinary protein, which is a hallmark of progression of diabetic nephropathy. We therefore investigated the prevalence of H. pylori infection in patients with type 2 diabetes mellitus and diabetic nephropathy and investigated if different stages of diabetic nephropathy showed higher level of urine protein and inflammatory mediators in infected than in non-infected patients.…”