Vascular inflammation, atherosclerosis, and lipid metabolism and the occurrence of non-high albuminuria diabetic kidney disease: A cross-sectional study

Abstract

Aim: Atherosclerosis involves vascular endothelial damage and lipid metabolism disorder, which is closely related to the occurrence and development of diabetic kidney disease (DKD). However, studies on non-high albuminuria DKD (NHADKD) with an albumin to creatinine ratio (ACR) <30 mg/g are rare. This study is to investigate the relationship between atherogenic factors and the occurrence of NHADKD. Methods: Serum lipid indicators, lipoprotein-associated phospholipase A2 (Lip-PLA2) and homocysteine levels were measured in 1116 subjects to analyze their relationship with NHADKD. Results: Among all subjects, Lip-PLA2 had the closest but relatively weak correlation with ACR ( r = 0.297, p < 0.001) and only homocysteine was moderately correlated with eGFR ( r = −0.465, p < 0.001). However, in patients with NHADKD, these atherosclerotic factors were weakly correlated or uncorrelated with eGFR (max. | r| = 0.247). Stratified risk analysis showed that when ACR was <10 mg/g, homocysteine [OR = 6.97(4.07–11.95)], total cholesterol (total-Chol) [OR = 6.04(3.03–12.04)], and high-density lipoprotein cholesterol (HDL-Chol) [OR = 5.09(2.99–8.64)] were risk factors for NHADKD. There was no significant difference of OR between these three factors ( Z = 0.430–1.044, all p > 0.05). When ACR was ⩾10mg/g, homocysteine [OR = 17.26(9.67–30.82)] and total-Chol [OR = 5.63(2.95–10.76)] were risk factors for NHADKD, and ORhomocysteine was significantly higher than ORtotal-Chol ( Z = 3.023, p < 0.05). Conclusions: The occurrence of NHADKD may be related to the levels of homocysteine, total-Chol, HDL-Chol, and Lip-PLA2 in blood. Among them, homocysteine may be most closely related to NHADKD.

Identification of histopathological and clinical spectrum of diabetic kidney disease based on an unsupervised hierarchical clustering analysis of elderly autopsy specimens

“…On the other hand, cluster 3 was associated with other commodities, such as hypertension and dyslipidemia, which is consistent with previous studies that hypertension and excess fatty acids are associated with DKD 1,6 . The occurrence of less‐proteinuric DKD has been reported to be associated with vascular inflammation, atherosclerosis, and lipid metabolism 28 . Furthermore, low HDLC and high TG levels are independent risk factors for the development of DKD 29 .…”

“…1,6 The occurrence of less-proteinuric DKD has been reported to be associated with vascular inflammation, atherosclerosis, and lipid metabolism. 28 Furthermore, low HDLC and high TG levels are independent risk factors for the development of DKD. 29 In our study, we showed the clinical spectrum of more-proteinuric In conclusion, we found that polar vasculosis indicates the presence of DM and hypertension.…”

Comparisons of the Relationships Between Multiple Lipid Indices and Diabetic Kidney Disease in Patients With Type 2 Diabetes: A Cross-Sectional Study

“…In addition, macrophages can be attracted by oxidized LDL, chemotaxis and phagocytosis oxidized LDL to form foam cells. Subsequently, the accumulation of foam cells in renal arterioles aggravates local renal hemodynamic disorders ( 35 ). Sodium-glucose co-transporter-2 inhibitors are a novel class of hypoglycemic agents recommended for type 2 diabetic patients with DKD by a group of guidelines, and a clinical study showed that the use of SGLT2 inhibitors could significantly reduce the level of sd-LDL-C in patients with T2D ( 36 ).…”

Update on pathogenesis and diagnosis flow of normoalbuminuric diabetes with renal insufficiency

“…Hyperlipidemia (high triglycerides, high total cholesterol, or low high-density lipoprotein cholesterol) is the independently factor related to renal impairment [ 28 , 75 , 82 ]. A recent study has reported that increased lipid abnormalities play a certain role in the occurrence and development of NADRI [ 71 ]. Further studies indicate that insulin resistance syndrome may underlie or mediate the relationship between lipids and renal function loss [ 82 ] and hypercholesterolemia may cause kidney damage by atherosclerosis and glomerulosclerosis [ 83 ].…”

“…Currently, the pathogenesis of NADRI remains to be fully elucidated. The proposed pathogenic mechanisms that underlie NADRI are multifactorial, complex and may involve age-associated renal senescence, hypertension, dyslipidemia, obesity, renal hypertensive and interstitial fibrosis, vascular disease, arteriosclerosis, cholesterol microemboli, lipid toxicity, inflammation, and masking of albuminuria by RAAS inhibitors [4,5,22,28,58,[70][71][72]. Based on the clinical research of identified clinical and pathological characteristics, we attempt to propose a hypothetical model for the development of NADRI (Fig.…”