Intrarenal arteriosclerosis and impairment of kidney function in NIDDM subjects

Boeri, D; Derchi, Lorenzo E.; Martinoli, Carlo; Simoni, G; Sampietro, Llibertat Real; Storace, Daniela; Ponte, L.; Calvi, C.; Repetto, Maria Pia; Robaudo, Cristina; Maiello, M

doi:10.1007/s001250050877

Cited by 40 publications

(34 citation statements)

References 9 publications

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“…Consistent with previous studies, we found that the resistance index of the intrarenal arteries correlated with age, eGFR, and BMI in subjects with type 2 diabetes (21,22). Unlike a previous study, duration of diabetes was not found to correlate with resistance index values (22).…”

Section: The Effect Of Ras Inhibition On Intrarenal Resistance Indexsupporting

confidence: 89%

“…Our results also support the finding that increases in intrarenal arterial resistance index are not related to albuminuria (21,23). Decreases in GFR in subjects with type 2 diabetes have been associated with increases in carotid intimal-medial thickness, carotid stiffness, and increases in the intrarenal arterial resistance index (23).…”

Section: The Effect Of Ras Inhibition On Intrarenal Resistance Indexsupporting

confidence: 88%

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Is Nonalbuminuric Renal Insufficiency in Type 2 Diabetes Related to an Increase in Intrarenal Vascular Disease?

et al. 2006

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OBJECTIVE -To investigate the role of intrarenal vascular disease in the pathogenesis of nonalbuminuric renal insufficiency in type 2 diabetes.RESEARCH DESIGN AND METHODS -We studied 325 unselected clinic patients who had sufficient clinical and biochemical information to calculate an estimated glomerular filtration rate (eGFR) using the Modified Diet in Renal Disease six-variable formula, at least two estimations of urinary albumin excretion rates (AER), and a renal duplex scan to estimate the resistance index of the interlobar renal arteries. The resistance index, measured as part of a complications surveillance program, was compared in patients with an eGFR Ͻ or Ն60 ml/min per 1.73 m 2 who were further stratified into normo-(AER Ͻ20), micro-(20 -200), or macroalbuminuria (Ͼ 200 g/min) categories.RESULTS -Patients with an eGFR Ͻ60 ml/min per 1.73 m 2 had a higher resistance index of the renal interlobar arteries compared with patients with an eGFR Ն60 ml/min per 1.73 m 2 . However, the resistance index was elevated to a similar extent in patients with an eGFR Ͻ60 ml/min per 1.73 m 2 regardless of albuminuric status (normo-0.74 Ϯ 0.01, micro-0.73 Ϯ 0.01, and macroalbuminuria resistance index 0.75 Ϯ 0.11). Multiple regression analysis revealed that increased age (P Ͻ 0.0001), elevated BMI (P ϭ 0.0001), decreased eGFR (P Ͻ 0.01), and decreased diastolic blood pressure (P Ͻ 0.01), but not an increased AER, were independently associated with an elevated resistance index in patients with impaired renal function.CONCLUSIONS -Subjects with type 2 diabetes and reduced glomerular filtration rate had similar degrees of intrarenal vascular disease, as measured by the intrarenal arterial resistance index, regardless of their AER status. The pathological mechanisms that determine the relationship between impaired renal function and AER status in subjects with type 2 diabetes remain to be elucidated. Diabetes Care 29:1560 -1566, 2006T raditionally, microvascular disease resulting in a glomerulopathy and an increase in albumin excretion rate (AER) is believed to be the only significant mechanism by which diabetic renal disease develops. However, recent results have challenged the concept that a decline in renal function in patients with diabetes is always accompanied by an increased AER. Results from our group (1,2) and from the Third National Health and Nutrition Survey (NHANES III) (3,4) have suggested that the finding of nonalbuminuric renal insufficiency is not an uncommon discovery for subjects with diabetes, especially those with type 2 diabetes.The structural basis of nonalbuminuric renal insufficiency in type 2 diabetes remains to be elucidated. However, the use of techniques such as duplex Doppler ultrasound allows for the rapid, noninvasive evaluation of the intrarenal vasculature (5). In particular, the presence of intrarenal vascular disease can be documented by the use of established methods such as the calculation of the resistance index (5,6). Intrarenal arteriosclerosis, as opposed to other forms of renal dama...

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Section: The Effect Of Ras Inhibition On Intrarenal Resistance Indexsupporting

confidence: 89%

Section: The Effect Of Ras Inhibition On Intrarenal Resistance Indexsupporting

confidence: 88%

Is Nonalbuminuric Renal Insufficiency in Type 2 Diabetes Related to an Increase in Intrarenal Vascular Disease?

et al. 2006

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“…Because biopsy studies are lacking, it is not clear whether a high renal RI in patients with diabetes is merely the result of structural changes of renal vessels (i.e., arteriosclerosis) or whether structural and/or functional changes of larger vessels (e.g., aortic stiffness) also play a role. The observation of a significant influence of lower body macroangiopathy on RI in patients with diabetes points to the latter possibility (35). This is further corroborated by the finding that a high RI was accompanied by signs of atherosclerosis in other vascular beds such as carotid arteries (36).…”

Section: Discussionmentioning

confidence: 71%

“…Previous studies in patients with type 2 diabetes have indicated that an increased RI is associated with the presence of established diabetic nephropathy, i.e., higher grade albumin excretion rate accompanied by reduced creatinine clearance (35,36). It therefore has been speculated that RI in patients with type 2 diabetes could serve as an easy-to-assess indicator of progression, similarly as has been suggested for other renal diseases (37).…”

Section: Discussionmentioning

confidence: 93%

Chronic Angiotensin II Receptor Blockade Reduces (Intra)Renal Vascular Resistance in Patients with Type 2 Diabetes

Fliser¹,

Wagner²,

Loos³

et al. 2005

Journal of the American Society of Nephrology

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Increased (intra)renal activity of the renin-angiotensin system may cause a persistent increase in renovascular resistance and intraglomerular pressure in patients with diabetes, thus contributing to the development of diabetic renal damage. The effect of chronic angiotensin II subtype 1 receptor blockade on (intra)renal hemodynamics in patients with type 2 diabetes was examined in a double-blind parallel group study. Patients were treated with 40 mg of olmesartan (n ‫؍‬ 19) or placebo (n ‫؍‬ 16), and renal hemodynamics were assessed before and after 12 wk of treatment using inulin and para-aminohippurate clearance techniques. Olmesartan significantly reduced 24-h ambulatory systolic and diastolic BP (both P < 0.05). In parallel, effective renal plasma flow increased significantly from 602 ؎ 76 to 628 ؎ 87 ml/min per 1.73 m 2 , whereas filtration fraction and renovascular resistance decreased significantly (all P < 0.05). With placebo treatment, effective renal plasma flow decreased and filtration fraction increased significantly (both P < 0.05). GFR was not affected by both treatments. Active plasma renin concentration increased considerably (P < 0.05) with olmesartan therapy but remained unchanged with placebo treatment. Nitric oxide metabolism (plasma nitrate and nitrite) and asymmetric dimethylarginine blood levels were not affected by olmesartan and placebo therapy. In contrast, plasma 8-isoprostane 15(S)-8-iso-prostaglandin F 2a concentration, a biochemical marker of oxidative stress, decreased significantly (P < 0.05) with olmesartan treatment. Chronic angiotensin II subtype 1 receptor blockade decreases (intra)renal vascular resistance and increases renal perfusion despite significant BP reduction. In addition, it significantly reduces oxidative stress. These effects of angiotensin II receptor antagonists may contribute to their beneficial long-term renal effects in patients with type 2 diabetes.

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“…Interstitial accumulation of advanced-glycated end products, which include collagen, elastin, and other connective tissue proteins, may be responsible for alterations of the diastolic properties of the heart in persons with hyperglycemia (30,31). On the other hand, glomerular dysfunction, intrarenal arteriosclerosis, interstitial fibrosis, and interstitial edema are related to the alteration in intrarenal hemodynamics in diabetic patients (32)(33)(34)(35)(36). Furthermore, many studies have reported that hyperinsulinemia and insulin resistance may contribute to both LV diastolic dysfunction (37)(38)(39) and glomerular hyperten- , diastolic-to-systolic ratio; RI, resistance index; A/E, peak velocity ratio of the atrial filling wave-to-early diastolic filling wave; DcT, deceleration time of the E wave; GT, glucose tolerance.…”

Section: Fig 1 Correlation Between Renal Doppler Parameters (D/s Anmentioning

confidence: 99%

Association between Left Ventricular Diastolic Dysfunction and Renal Hemodynamic Change in Patients with Treated Essential Hypertension

et al. 2003

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The heart and kidneys are important target organs in hypertension. Early signs of hypertensive target organ Abnormalities in left ventricular (LV) diastolic filling have been described in patients with hypertension, even in the absence of left ventricular hypertrophy (7-9). Moreover, impaired LV diastolic relaxation is a prognostic indicator of cardiovascular risk (10). An increased intrarenal resistance index (RI) evaluated by renal Doppler ultrasonography has also been reported in patients with essential hypertension (11,12). Assessment of intrarenal vascular resistance is useful in determining the degree of intrarenal damage. High levels of RI are associated with subclinical end-organ damage-namely microalbuminuria, LV hypertrophy, and carotid atherosclerosis-in hypertensive patients (13,14). In addition, an RI value of ≥ 0.8 is a strong and independent

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Intrarenal arteriosclerosis and impairment of kidney function in NIDDM subjects

Cited by 40 publications

References 9 publications

Is Nonalbuminuric Renal Insufficiency in Type 2 Diabetes Related to an Increase in Intrarenal Vascular Disease?

Is Nonalbuminuric Renal Insufficiency in Type 2 Diabetes Related to an Increase in Intrarenal Vascular Disease?

Chronic Angiotensin II Receptor Blockade Reduces (Intra)Renal Vascular Resistance in Patients with Type 2 Diabetes

Association between Left Ventricular Diastolic Dysfunction and Renal Hemodynamic Change in Patients with Treated Essential Hypertension

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