The renin-angiotensin system and its blockade in diabetic renal and cardiovascular disease

Kalantarinia, Kambiz; Okusa, Mark D.

doi:10.1007/s11892-006-0045-4

Cited by 13 publications

(9 citation statements)

References 70 publications

(47 reference statements)

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“…Conversely, Christiansen et al showed that increased heart rate and cardiac contractility preexisted microalbuminuria, suggesting that the above factors may contribute to renal hyperperfusion and glomerular hyperfiltration, findings which are observed in T1DM patients, before the development of microalbuminuria [49]. Recently, it was suggested that the renin-angiotensin-aldosterone system might play a central role in the development and the progression of renal as well as cardiovascular impairment in patients with T1DM, while randomized, controlled trials demonstrated beneficial effects on renal and cardiovascular function of the use of angiotensin-converting enzyme inhibitors [50].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular impairment in children, adolescents, and young adults with type 1 diabetes mellitus (T1DM)

et al. 2007

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Left ventricular (LV) function was assessed in 42 patients (mean age +/- SD, 18.45 +/- 3.76 years; 17 males) with type I diabetes mellitus (T1DM; mean duration 9.89 years) and in 43 healthy controls (mean age +/- SD, 18.27 +/- 3.36 years; 18 males). Systolic, diastolic cardiac function and LV dimensions were assessed using M-mode and Doppler echocardiography. Neural autonomic function was assessed by measuring RR variation during deep breathing, Valsava maneuver, 30/15 ratio, and blood pressure response to standing. Fractional shortening, peak velocity of early ventricular filling (E wave), peak velocity of LV filling (A wave), E/A ratio, deceleration time, isovolumic relaxation time, LV dimensions (interventricular septum, posterior wall thickness, end diastolic diameter [EDD] and systolic diameter [ESD]) were all comparable between patients with T1DM and controls. However, in 11 T1DM patients with microalbuminuria and/or retinopathy, EDD, ESD, E/A ratio, and E wave were all lower (p = 0.0011, p = 0.019, p = 0.0011, and p = 0.030, respectively) while, A wave, heart rate, and diastolic blood pressure were all higher (p = 0.008, p = 0.0024 and p = 0.004, respectively) compared to matched for age and sex controls. Furthermore, in six of the 11 T1DM patients with microangiopathy who had E/A <1.12 (<2 SD of the control mean), significant and marginally significant correlations were found between E/A ratio and the duration of the disease as well as the mean HbA1c of the last year (r = -0.38, p = 0.011 and r = -0.287, p = 0.064, respectively). In conclusion, it has been found that impairment of diastolic, but not systolic, LV function can be detected early in young patients with T1DM and microangiopathy.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular impairment in children, adolescents, and young adults with type 1 diabetes mellitus (T1DM)

et al. 2007

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“…Type I diabetes has been associated with natriuresis and diuresis, as well as activation of vasopressin and the reninangiotensin-aldosterone system (7,84). Several groups have examined the regulation of sodium transporters in type I diabetic rodents (47,57,91,92,97,109,124).…”

Section: Altered Expression Of Sodium Transporter and Channels In Diamentioning

confidence: 99%

Insulin's impact on renal sodium transport and blood pressure in health, obesity, and diabetes

Tiwari

Riazi²,

Ecelbarger³

2007

American Journal of Physiology-Renal Physiology

111

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Insulin has been shown to have antinatriuretic actions in humans and animal models. Moreover, endogenous hyperinsulinemia and insulin infusion have been correlated to increased blood pressure in some models. In this review, we present the current state of understanding with regard to the regulation of the major renal sodium transporters by insulin in the kidney. Several groups, using primarily cell culture, have demonstrated that insulin can directly increase activity of the epithelial sodium channel, the sodium-phosphate cotransporter, the sodium-hydrogen exchanger type III, and Na-K-ATPase. We and others have demonstrated alterations in the expression at the protein level of many of these same proteins with insulin infusion or in hyperinsulinemic models. We also discuss how this regulation is perturbed in type I and type II diabetes mellitus. Finally, we discuss a potential role for regulation of insulin receptor signaling in the kidney in contributing to sodium balance and blood pressure. insulin resistance; ENaC; Zucker rats; streptozotocin Overview INSULIN HAS BEEN DEMONSTRATED to increase sodium reabsorption in the proximal tubule (9), the thick ascending limb (78, 102), and the distal tubule including the collecting duct (54, 144), using micropuncture and perfused tubule approaches. Over 10 years ago, Sechi (127), Butlen (30), and colleagues using I 125 -labeled insulin demonstrated binding sites in multiple cell types along the renal tubular epithelium. However, because the kidney expresses other receptors similar to the classic insulin receptor (IR), including the insulin growth factor receptor (IGF) and the IR-related receptor (IRR), the precise nature of the "receptor" that labeled insulin was binding to was not absolutely certain. Nonetheless, more recent studies showed mRNA expression of the classic IR in whole homogenates of the kidney (31, 32,130,132), and our group (150) has recently found IR expression at the protein level using immunoblotting and immunohistochemistry in the proximal tubule, thick ascending limb, and collecting duct. In this review, we discuss studies that have investigated the regulation of the major renal sodium transporters in the kidney by insulin. In addition, we examine how this regulation is altered in insulin resistance, which is a hyperinsulinemic state, as well as in type I and type II diabetes. We also discuss what is known about the regulation of the IR in the kidney, how it is affected by insulin resistance and/or diabetes, and how this might ultimately affect sodium balance and blood pressure.

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“…Despite the renoprotective effects reported in recent years, antihypertensive agents such as angiotensinconverting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) cannot completely prevent the progression of diabetic nephropathy and merely delay the onset of ESRD (Kalantarinia and Okusa, 2006). Therefore, a new drug for treatment of diabetic nephropathy based on a different mechanism of action is awaited with anticipation.…”

mentioning

confidence: 99%

The amelioration of streptozotocin diabetes-induced renal damage by Wu-Ling-San (Hoelen Five Herb Formula), a traditional Chinese prescription

Liu

Tzeng

Liou

et al. 2009

Journal of Ethnopharmacology

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The renin-angiotensin system and its blockade in diabetic renal and cardiovascular disease

Cited by 13 publications

References 70 publications

Cardiovascular impairment in children, adolescents, and young adults with type 1 diabetes mellitus (T1DM)

Cardiovascular impairment in children, adolescents, and young adults with type 1 diabetes mellitus (T1DM)

Insulin's impact on renal sodium transport and blood pressure in health, obesity, and diabetes

The amelioration of streptozotocin diabetes-induced renal damage by Wu-Ling-San (Hoelen Five Herb Formula), a traditional Chinese prescription

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