[Role of the renin-angiotensin system in the pathogenesis, clinical picture and treatment of diabetic nephropathy].
Prevalence of diabetic nephropathy is increasing. Understanding of pathogenesis and clinical picture helps to manage this disease. Recent data of the research of this disease support that the renin-angiotensin system plays a pivotal role in the pathogenesis. Hyperglycaemia activates the renin-angiotensin system and induces transforming growth factor-beta expression. These both lead to glomerulosclerosis and tubulointerstitial fibrosis. Diabetic nephropathy develops earlier and progress faster in patients with DD or ID genotypes of angiotensin-I-converting-enzyme gene. Angiotensinogen and type 1 angiotensin-II-receptor gene mutations may be also predisposing factors for diabetic nephropathy. All these factors can be responsible for the hyperfiltration, albuminuria, salt sensitivity, and hypertension, which are characteristic features of diabetic nephropathy. According to these, one can suppose that inhibitors of the renin-angiotensin system are effective in the prevention and treatment of this disease. Evidence of clinical studies suggests that angiotensin-I-converting-enzyme inhibitors in type 1 diabetes can prevent overt nephropathy, decrease proteinuria, inhibit the loss of the glomerular filtration and decelerate progression. Angiotensin-II-receptor blockers exert the same effect in type 2 diabetic patients, and presumably angiotensin-I-converting-enzyme inhibitors have similar activity in this group of patients. That is why, in the case of intolerance of one class of drugs, the other should be substituted. Combination therapy of angiotensin-I-converting-enzyme inhibitors with angiotensin-II-receptor blockers can be the choice of treatment in the future.
Pécsi Tudományegyetem, Altalános Orvostudományi Kar, II. Sz. Belgyógyászati Klinika és Nephrologiai Centrum. wittmann@bel2.pote.hu
István
I
Wittmann
Péter
P
Degrell
Anette
A
Komáromy
Gergó Attila
GA
Molnár
Zoltán
Z
Wagner
László
L
Wagner
István
I
Mazák
Judit
J
Nagy
D000419:Albuminuria / Q000378:metabolism; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism*; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D011110:Polymorphism, Genetic; D012084:Renin-Angiotensin System
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors