Microalbuminuria—A Biomarker of Renal Microvascular Disease

Futrakul, Narisa; Sridama, Vitaya; Futrakul, Prasit

doi:10.1080/08860220802595948

Cited by 50 publications

(42 citation statements)

References 34 publications

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“…Microalbuminuria is recognised as a clinical marker of the first stages of nephropathy in type 1 and 2 diabetes [5,6], whereas in essential hypertension it is mainly considered an indicator of cardiovascular risk [1,5]. However, microalbuminuria identifies an already established glomerular damage, which is likely to be preceded by earlier structural and functional alterations undetectable to date, unless by kidney biopsy [7][8][9]. Moreover, a variable percentage of type 2 diabetic patients show an impairment of GFR even in the presence of normal albumin excretion [10].…”

mentioning

confidence: 99%

Dynamic evaluation of renal resistive index in normoalbuminuric patients with newly diagnosed hypertension or type 2 diabetes

et al. 2011

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Aim/hypothesis Renal resistive index is a useful measure for quantifying alterations in renal blood flow. In the present study we evaluated resistive index at baseline and after vasodilation induced by nitroglycerine in normoalbuminuric patients with type 2 diabetes or essential hypertension, relating the values to indices of systemic vascular dysfunction. Methods Newly diagnosed treatment-naïve type 2 diabetic (n=32) and hypertensive patients (n=49) were compared with 27 age-and sex-matched healthy controls. Renal resistive index was obtained by duplex ultrasound at baseline and after 25 μg sublingual nitroglycerine. Endothelium-dependent (flow-mediated dilation) and -independent (response to nitroglycerine) vasodilation in the brachial artery was assessed by computerised edge detection system. Carotid-femoral pulse-wave velocity and augmentation index were assessed by applanation tonometry. Nitrotyrosine levels, an index of oxidative stress, were also measured. Results Resistive index was higher in diabetic than in hypertensive patients and controls (p < 0.001), while changes in resistive index induced by nitroglycerine were lower in hypertensive patients compared with controls (p< 0.01), and were further reduced in type 2 diabetic patients. Hypertensive and diabetic patients showed significantly increased arterial stiffness, nitrotyrosine levels and reduced endothelial function than controls (p<0.05). Changes in resistive index induced by nitroglycerine were independently related to serum glucose, reactive hyperaemia and aortic pulse-wave velocity in the overall population. Conclusions/interpretation These results support the dynamic evaluation of renal resistive index as an early detector of renal vascular alterations in the presence of type 2 diabetes and hypertension, even before the onset of microalbuminuria.

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confidence: 99%

Dynamic evaluation of renal resistive index in normoalbuminuric patients with newly diagnosed hypertension or type 2 diabetes

et al. 2011

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“…We hypothesize that the ensuing development of albuminuria in this model may be as a result of a number of mechanisms. It is possible that glomerular endothelial dysfunction developed, therefore increasing glomerular filtration pressure, leading to protein leakage (17). Reactive oxygen species may have also caused a loss of negatively charged surface of the capillary wall, therefore allowing negatively charged albumin to freely pass through the filtration barrier.…”

Section: Ajp-renal Physiolmentioning

confidence: 99%

Simvastatin and tempol protect against endothelial dysfunction and renal injury in a model of obesity and hypertension

Knight

Yuan

Roy

et al. 2010

American Journal of Physiology-Renal Physiology

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Knight SF, Yuan J, Roy S, Imig JD. Simvastatin and tempol protect against endothelial dysfunction and renal injury in a model of obesity and hypertension. Am J Physiol Renal Physiol 298: F86 -F94, 2010. First published November 11, 2009 doi:10.1152/ajprenal.00351.2009.-Obesity and hypertension are risk factors for the development of chronic kidney disease. The mechanisms by which elevated blood pressure and fatty acids lead to the development of renal injury are incompletely understood. Here, we investigated the contributions of cholesterol and oxidative stress to renal endothelial dysfunction and glomerular injury in a model of obesity and hypertension. Male Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHR) were fed a normal diet, a high-fat diet, a high-fat diet with tempol, or a high-fat diet with simvastatin for up to 10 wk. Blood pressure was not altered by a high-fat diet or treatments. After 3 wk, renal afferent dilatory responses to acetylcholine were impaired in WKY rats and SHR fed a high-fat diet. Tempol treatment prevented this vascular dysfunction in both strains; however, simvastatin treatment demonstrated greater beneficial effects in the SHR. Albuminuria was observed in the SHR and was exacerbated by a high-fat diet. Tempol and simvastatin treatment significantly ameliorated albuminuria in the SHR fed a high-fat diet. Ten weeks on a high-fat resulted in an increase in urinary 8-isoprostane in WKY rats and SHR, and tempol and simvastatin treatment prevented this increase, indicating a reduction in renal oxidative stress. Monocyte chemoattractant protein-1 (MCP-1) excretion was significantly elevated by a high-fat diet in both strains, and tempol prevented this increase. Interestingly, simvastatin treatment had no effect on MCP-1 levels. These data indicate that tempol and simvastatin treatment via a reduction in oxidative stress improve renal endothelial function and decrease glomerular injury in a model of obesity and hypertension. kidney; oxidative stress; metabolic syndrome; inflammation OBESITY HAS REACHED EPIDEMIC proportions in the developed world, with 50% of the US population now classified as overweight or obese, and the numbers are rising (National Health and Nutrition Examination Survey, available at http:// www.cdc.gov/nchs/nhanes.htm). Obesity is associated with increased risk of developing diabetes, hypercholesterolemia, and hypertension, which together are described as the metabolic syndrome (18, 29). Independently, obesity and hypertension increase the risk of renal dysfunction; obese patients are four times more likely to develop renal disease than nonobese patients, and hypertension accounts for 25% of renal dysfunction cases (27). Obese patients are at a higher risk of developing hypertension, therefore combining risk factors and compounding the negative effect on cardiovascular health. In particular, renal injury associated with obesity and hypertension has been shown to be more severe than renal disease observed as a result of each risk factor alone. This addi...

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“…17 All these markers, in fact, reflect macrovascular disease. However, a combination of any of these markers with renal markers such as microalbuminuria, 18,19 renal functional impairment, and renal pathology may as well indirectly reflect renal microvascular disease.…”

Section: Renal Microvascular Disease Is Underestimated In Renal Diseamentioning

confidence: 99%

“…In this regard, another noninvasive diagnostic tool includes Duplex Doppler sonography to detect renal vascular resistance 31 and microalbuminuria. 18,19 It has recently been demonstrated that the magnitude of renal microvascular disease predicts the therapeutic responsiveness to vasodilator treatment in chronic kidney disease (CKD). A mild degree of renal microvascular disease is associated with a normal or mildly altered vascular homeostasis with an adequate response to vasodilator treatment.…”

Section: Renal Microvascular Disease Is Underestimated In Renal Diseamentioning

confidence: 99%

Renal Microvascular Disease Predicts Renal Function in Diabetes

Futrakul

2011

Renal Failure

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Microalbuminuria—A Biomarker of Renal Microvascular Disease

Cited by 50 publications

References 34 publications

Dynamic evaluation of renal resistive index in normoalbuminuric patients with newly diagnosed hypertension or type 2 diabetes

Dynamic evaluation of renal resistive index in normoalbuminuric patients with newly diagnosed hypertension or type 2 diabetes

Simvastatin and tempol protect against endothelial dysfunction and renal injury in a model of obesity and hypertension

Renal Microvascular Disease Predicts Renal Function in Diabetes

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