Main Risk Factors for Nephropathy in Type 2 Diabetes Mellitus Are Plasma Cholesterol Levels, Mean Blood Pressure, and Hyperglycemia

Ravid, Mordchai; Brosh, David; Ravid-Safran, Dorit; Levy, Zohar; Rachmani, Rita

doi:10.1001/archinte.158.9.998

Cited by 399 publications

(262 citation statements)

References 37 publications

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“…The detrimental effect of protein intake observed in studies of patients with renal disease may also be related to the fact that many sources of animal protein are high in cholesterol and saturated fat. High cholesterol levels have also been shown to be a risk factor for progression of renal disease and may adversely affect renal function and renal hemodynamics (37)(38)(39). Therefore, since dietary intake of animal fat influences serum cholesterol level, we adjusted for animal fat intake as well as hypercholesterolemia.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Protein Intake on Renal Function Decline in Women with Normal Renal Function or Mild Renal Insufficiency

Knight

Stampfer²,

Hankinson³

et al. 2003

Ann Intern Med

362

243

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Section: Discussionmentioning

confidence: 99%

The Impact of Protein Intake on Renal Function Decline in Women with Normal Renal Function or Mild Renal Insufficiency

Knight

Stampfer²,

Hankinson³

et al. 2003

Ann Intern Med

362

243

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“…During recent decades, the pathophysiology of diabetic nephropathy has become complex and serious because of coexisting lifestylerelated disorders, such as hyperlipidaemia, hypertension and obesity [3]. In fact, hyperlipidaemia is an independent risk factor for the progression of diabetic nephropathy in both type 1 and type 2 diabetes [4,5], but the underlying molecular mechanism remains elusive [6]. Toll-like receptors (TLRs) are a family of receptors that play a critical role in the innate immune system by activating proinflammatory signalling pathways in response to molecular patterns synthesised by microorganisms [7].…”

Section: Introductionmentioning

confidence: 99%

Exacerbation of diabetic nephropathy by hyperlipidaemia is mediated by Toll-like receptor 4 in mice

et al. 2012

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Aims/hypothesis Hyperlipidaemia is an independent risk factor for the progression of diabetic nephropathy, but its molecular mechanism remains elusive. We investigated in mice how diabetes and hyperlipidaemia cause renal lesions separately and in combination, and the involvement of Toll-like receptor 4 (TLR4) in the process. Methods Diabetes was induced in wild-type (WT) and Tlr4 knockout (KO) mice by intraperitoneal injection of streptozotocin (STZ). At 2 weeks after STZ injection, normal diet was substituted with a high-fat diet (HFD). Functional and histological analyses were carried out 6 weeks later. Results Compared with treatment with STZ or HFD alone, treatment of WT mice with both STZ and HFD markedly aggravated nephropathy, as indicated by an increase in albuminuria, mesangial expansion, infiltration of macrophages and upregulation of pro-inflammatory and extracellularmatrix-associated gene expression in glomeruli. In Tlr4 KO mice, the addition of an HFD to STZ had almost no effects on the variables measured. Production of protein S100 calcium binding protein A8 (calgranulin A; S100A8), a potent ligand for TLR4, was observed in abundance in macrophages infiltrating STZ-HFD WT glomeruli and in glomeruli of diabetic nephropathy patients. High-glucose and fatty acid treatment synergistically upregulated S100a8 gene expression in macrophages from WT mice, but not from KO mice. As putative downstream targets of TLR4, phosphorylation of interferon regulatory factor 3 (IRF3) was enhanced in kidneys of WT mice co-treated with STZ and HFD. Conclusions/interpretation Activation of S100A8/TLR4 signalling was elucidated in an animal model of diabetic glomerular injury accompanied with hyperlipidaemia, which may provide novel therapeutic targets in progressive diabetic nephropathy.

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“…O teste foi logo introduzido na prática clínica para auxiliar no manejo dos pacientes com DM (8). No entanto, foi apenas na década de 90 que o verdadeiro valor clínico desta dosagem laboratorial ficou definitivamente estabelecido, a partir de dois grandes ensaios clínicos (3,4) Esta mesma relação entre níveis de HbA 1c e o desenvolvimento das complicações crônicas do DM também foi observada em outros ensaios clínicos publicados nas últimas décadas (9)(10)(11)(12)(13)(14)(15)(16).…”

Section: Introductionunclassified

Glico-hemoglobina (HbA1c): aspectos clínicos e analíticos

Camargo

Gross

2004

Arq Bras Endocrinol Metab

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RESUMOA glico-hemoglobina (GHb) é um parâmetro importante no controle glicêmico de pacientes com DM. Vários estudos clínicos mostraram claramente que a melhora no controle glicêmico está fortemente associada com a diminuição no desenvolvimento e/ou progressão das complicações em diabetes melito tipos 1 e 2. A medida exata e precisa da GHb é uma questão importante para os laboratórios clínicos. Vários fatores afetam os resultados e podem levar a resultados errôneos. Nesta revisão, discutimos os problemas da padronização da determinação da GHb para monitorar a terapia diabética e também os principais fatores interferentes. Os métodos para GHb podem ser diferentemente afetados pelas interferências. O efeito da interferência pode ser clinicamente mais relevante com o pior controle glicêmico. O laboratório deve estar atento para estes fatores para evitar confusão na interpretação clínica dos resultados, e os clínicos devem contatar o laboratório sempre que houver discrepância entre a impressão clínica e o resultado laboratorial. Glycohemoglobin (GHb) has a key role in the assessment of glycemic control in diabetic patients. Several studies have clearly shown that improved glycemic control is strongly associated with decreased development and/or progression of diabetic complications in both type 1 and 2 diabetes mellitus. Therefore, accurate determination of GHb concentration is an important issue for clinical laboratories. Several factors may affect and lead to erroneous results. We discuss the problems of standardization of GHb measurements for monitoring glycemic control and also consider the potential interfering factors on GHb measurements. Moreover, GHb assays may be affected by interference in different ways. The effect of interference may be more clinically relevant with poor metabolic control. Laboratory staff must be aware of all pitfalls to avoid adding more confusion to the clinical interpretation of HbA 1c values and physicians should contact laboratories if discrepancies between clinical impressions and laboratory data are observed.

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Main Risk Factors for Nephropathy in Type 2 Diabetes Mellitus Are Plasma Cholesterol Levels, Mean Blood Pressure, and Hyperglycemia

Cited by 399 publications

References 37 publications

The Impact of Protein Intake on Renal Function Decline in Women with Normal Renal Function or Mild Renal Insufficiency

The Impact of Protein Intake on Renal Function Decline in Women with Normal Renal Function or Mild Renal Insufficiency

Exacerbation of diabetic nephropathy by hyperlipidaemia is mediated by Toll-like receptor 4 in mice

Glico-hemoglobina (HbA1c): aspectos clínicos e analíticos

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