Reduction in albuminuria predicts a beneficial effect on diminishing the progression of human diabetic nephropathy during antihypertensive treatment

Rossing, Peter; Hommel, Eva; Smidt, Ulla M; Parving, Hans‐Henrik

doi:10.1007/s001250050140

Cited by 183 publications

(106 citation statements)

References 39 publications

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“…Ninomiya et al (2009) reported that high albuminuria and low eGFR are independent risk factors for renal events among patients with type 2 diabetes. A reduction in proteinuria shortly after onset of antihypertensive therapy by the blockade of the RAS is the best predictor of long-term preservation of renal function (Rossing et al 1994;Breyer et al 1996). It seems to be worthwhile that a significant reduction in proteinuria was observed shortly after the administration of liraglutide such as within one month (Table 1).…”

Section: Discussionmentioning

confidence: 99%

The Glucagon-Like Peptide-1 Receptor Agonist, Liraglutide, Attenuates the Progression of Overt Diabetic Nephropathy in Type 2 Diabetic Patients

Imamura

Hirai

2013

Tohoku J. Exp. Med.

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Diabetic nephropathy (DN) is the leading cause of end-stage renal disease. Glucagon-like peptide-1 (GLP-1) is one of the incretins, gut hormones released from the intestine in response to food intake. GLP-1 receptor (GLP-1R) agonists have been used to treat type 2 diabetes. Here, we studied the effect of the administration of a GLP-1R agonist, liraglutide, on proteinuria and the progression of overt DN in type 2 diabetic patients. Twenty-three type 2 diabetic patients with overt DN, who had already been treated with blockade of renin-angiotensin system under dietary sodium restriction, were given liraglutide for a period of 12 months. Treatment with liraglutide caused a significant decrease in HbA1c from 7.4 ± 0.2% to 6.9 ± 0.3% (p = 0.04), and in body mass index (BMI) from 27.6 ± 0.9 kg/m 2 to 26.5 ± 0.8 kg/m 2 after 12 months (p < 0.001), while systolic blood pressure did not change. The progression of DN was determined as the rate of decline in estimated glomerular filtration rate (eGFR). The 12-month administration of liraglutide caused a significant decrease in proteinuria from 2.53 ± 0.48 g/g creatinine to 1.47 ± 0.28 g/g creatinine (p = 0.002). The administration of liraglutide also substantially diminished the rate of decline in eGFR from 6.6 ± 1.5 mL/min/1.73 m 2 /year to 0.3 ± 1.9 mL/min/1.73 m 2 /year (p = 0.003). Liraglutide can be used not only for reducing HbA1c and BMI, but also for attenuating the progression of nephropathy in type 2 diabetic patients.

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Section: Discussionmentioning

confidence: 99%

The Glucagon-Like Peptide-1 Receptor Agonist, Liraglutide, Attenuates the Progression of Overt Diabetic Nephropathy in Type 2 Diabetic Patients

Imamura

Hirai

2013

Tohoku J. Exp. Med.

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“…Mesmo na presença da TFG normal, o paciente proteinúrico tem elevada chance de demonstrar perda progressiva da TFG (BRANTSMA et al, 2008). A proteinúria acelera a progressão da doença renal (ABBATE; ZOJA; REMUZZI, 2006) e a sua mensuração auxilia na monitoração da função renal: quanto maior a sua redução, menores as chances de perda da função renal (ROSSING et al, 1994;APPERLOO;DE ZEEW;DE JONG, 1994).…”

Section: Proteinúriaunclassified

Testes de avaliação de injúria renal precoce em cães e gatos

2014

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ResumoA identificação de injúrias renais é uma medida importante que tem como objetivo evitar a instalação de alterações irreversíveis, tal como a doença renal crônica, problema de incidência elevada em cães e gatos. As concentrações séricas de ureia e de creatinina são os parâmetros rotineiramente avaliados, quando se busca a identificação de insuficiência renal. Porém, estes valores só se encontram alterados quando 66 a 75% dos néfrons apresentam incapacidade de função excretora. Em muitas situações, uma agressão desta magnitude pode ser suficiente para causar a morte do animal. Avaliações que identifiquem a agressão, antes mesmo que as funções encontrem-se alteradas vêm sendo estudadas, mostrando serem importantes avaliadores precoces de possíveis danos irreversíveis. A quantificação das enzimas urinárias, proteína urinária, fração de excreção de eletrólitos, taxa de filtração glomerular e a observação do sedimento urinário têm grande valor como exames sensíveis de injúria renal precoce. Há a necessidade do emprego de testes que auxiliem, não somente na identificação precoce, mas também na determinação da progressão da doença e da eficácia do tratamento. A presente revisão objetiva descrever os testes laboratoriais que podem ser realizados para a avaliação precoce de injúria renal de cães e gatos. Palavras-chave: Injúria renal, diagnóstico precoce, taxa de filtração glomerular, proteinúria AbstractThe identification of kidney injury is an important measure that aims to prevent the installation of irreversible changes, such as chronic kidney disease, seen most frequently in dogs and cats. Serum urea and creatinine parameters are routinely assessed, when searching renal failure. However, these values are only changed when 66 to 75% of glomerular filtration rate has been lost. In many situations, an attack of this magnitude may be enough to cause the animal's death. Evaluations that identify the aggression, even before the functions themselves are altered, have been studied and shown to be important early evaluators, signaling prior to possible irreversible damage. The quantification of urinary enzymes, urinary protein, fractional excretion of electrolytes, glomerular filtration rate and urinary sediment, have shown great value as sensitive tests of renal injury. There is the need of the use of tests that assists in early diagnosis and also determines the progression of disease and efficacy of the treatment. The present review aims to describe the laboratory tests that may be performed to evaluate early kidney injury in dogs and cats.

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“…6,7 Consistently, studies in both diabetic and nondiabetic chronic renal disease showed that renoprotective treatments effectively limit the progressive decline in GFR to the extent they lower proteinuria. 6,10,11 Moreover, the rate of renal function loss largely depended on the level of proteinuria achieved by therapy, and the slowest progression was observed in patients with the lowest residual proteinuria. 12 These findings confirm that proteinuria should be considered as a novel target of renoprotective therapy and suggest that urinary proteins should be reduced as far as possible to halt or prevent renal disease progression.…”

mentioning

confidence: 99%

Role of Remission Clinics in the Longitudinal Treatment of CKD

Ruggenenti¹,

Perticucci²,

Cravedi³

et al. 2008

Journal of the American Society of Nephrology

184

144

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Heavy proteinuria is a major determinant of progression to ESRD for patients with chronic nephropathies and reducing proteinuria should be a key target for renoprotective therapy. In the Remission Clinic, we applied a multimodal intervention to target urinary proteins in 56 consecutive patients who had Ͼ3 g proteinuria/d despite angiotensin-converting enzyme inhibitor therapy. We compared the rate of GFR decline and incidence of ESRD in this cohort with 56 matched historical reference subjects who had received conventional therapy titrated to a target BP. During a median follow-up of 4 yr, the monthly rate of GFR decline was significantly lower in the Remission Clinic cohort (median Ϫ0.17 versus Ϫ0.56 ml/min per 1.73 m 2 ; P Ͻ 0.0001), and ESRD events were significantly reduced (3.6 versus 30.4% reached ESRD). Follow-up BP, cholesterol, and proteinuria were lower in Remission Clinic patients than in reference subjects, such that disease remission or regression was achieved in up to 50% of patients who would have been otherwise expected to progress rapidly to ESRD on conventional therapy. Proteinuria reduction independently predicted a slower rate of GFR decline and ESRD incidence, but response to treatment differed depending on the underlying disease. Regarding safety, no patient was withdrawn because of hyperkalemia. In summary, multidrug treatment titrated to urinary protein level can be safely and effectively applied to normalize proteinuria and to slow the loss of renal function significantly, especially among patients without type 2 diabetes and with otherwise rapidly progressing chronic nephropathies.

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Reduction in albuminuria predicts a beneficial effect on diminishing the progression of human diabetic nephropathy during antihypertensive treatment

Cited by 183 publications

References 39 publications

The Glucagon-Like Peptide-1 Receptor Agonist, Liraglutide, Attenuates the Progression of Overt Diabetic Nephropathy in Type 2 Diabetic Patients

The Glucagon-Like Peptide-1 Receptor Agonist, Liraglutide, Attenuates the Progression of Overt Diabetic Nephropathy in Type 2 Diabetic Patients

Testes de avaliação de injúria renal precoce em cães e gatos

Role of Remission Clinics in the Longitudinal Treatment of CKD

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