Microvascular disease and endothelial dysfunction in chronic kidney diseases: therapeutic implication.
This paper was aimed to study biomarkers of endothelial injury in chronic kidney diseases. Fifty chronic kidney disease patients were subject to the following determinations: (i) circulating endothelial cells, (ii) soluble VCAM-1, (iii) transforming growth factor beta (TGFB), and (iv) intrarenal hemodynamics. Increased number of circulating endothelial cells was significantly observed. A significant depletion of vascular endothelial growth factor (VEGF) or a depleted VEGF/TGFB ratio was also documented. Results showed that sVCAM was not significantly different from normal control. Intrarenal hemodynamic alteration demonstrated a characteristic of hemodynamic maladjustment. Since increased number of circulating endothelial cells is a sensitive biomarker for endothelial cell injury in chronic kidney diseases, such injury is supported by the depletion of VEGF. The endothelial cell loss correlates with the glomerular endothelial dysfunction characterized by hemodynamic maladjustment at the efferent arteriole and reduction in peritubular capillary flow. In conclusion, correction of such hemodynamic maladjustment with multidrug vasodilators can effectively restore renal function in chronic kidney diseases.
King Chulalongkorn Memorial Hospital and Ramathibody Hospital, Bangkok, Thailand. fmednft@md.chula.ac.th
Narisa
N
Futrakul
Punnee
P
Butthep
Suthiluk
S
Patumraj
Prasong
P
Siriviriyakul
Prasit
P
Futrakul
D015415:Biomarkers / Q000032:analysis; D016022:Case-Control Studies; D002908:Chronic Disease; D042783:Endothelial Cells / Q000473:pathology*; D006439:Hemodynamics; D006801:Humans; D007674:Kidney Diseases / Q000473:pathology / Q000503:physiopathology*; D008833:Microcirculation / Q000473:pathology / Q000503:physiopathology; D012079:Renal Circulation; D016212:Transforming Growth Factor beta / Q000097:blood; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood; D014652:Vascular Diseases / Q000473:pathology* / Q000503:physiopathology
D015415:Biomarkers; D016212:Transforming Growth Factor beta; D019010:Vascular Cell Adhesion Molecule-1