[Diabetic nephropathy: the role of blood pressure and extra-cellular volume in its pathogenesis and treatment].
Hypertension is an important risk factor for the development of cardiovascular disease and for the progression of renal insufficiency. In the pathophysiology of hypertension in diabetes mellitus, expansion of the extracellular fluid volume has a pivotal role. Coinciding derangements are probably responsible for this expansion: increased proximal tubular reabsorption, inadequate activation of the renin-angiotensin system and impaired renal autoregulation. Together, these lead to glomerular hypertension and resultant glomerular damage. Many clinical trials emphasise the importance of the renin-angiotensin system in the treatment of diabetics with hypertension. There are strong indications that correction of the excess volume is pivotal in the treatment of hypertension in patients with diabetic nephropathy. However, many recent studies have omitted consideration of the role of extracellular fluid-volume expansion. Many questions remain unanswered about the pathophysiology of hypertension in diabetes mellitus. More insight into the pathophysiology could well result in improved treatment of the hypertension and thus help to delay the progression of diabetic nephropathy.
Afd. Nierziekten en Hypertensie, Universitair Medisch Centrum, Utrecht.
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Braam
E J
EJ
de Koning
E J
EJ
Mees
D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume; D003920:Diabetes Mellitus / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D012084:Renin-Angiotensin System / Q000502:physiology