Early detection of endothelial injury and dysfunction in conjunction with correction of hemodynamic maladjustment can effectively restore renal function in type 2 diabetic nephropathy.
This paper was aimed to investigate (1) the early marker of endothelial injury in type 2 diabetes, (2) the intrarenal hemodynamics and renal function, and (3) the therapeutic strategy aiming to restore renal function. Fifty patients (35 normoalbuminuric and 15 albuminuric type 2 diabetes) were examined. Blood was collected for determination of circulating vascular endothelial cells (CEC) and the serum was prepared for determination of transforming growth factor beta (TGFbeta), ratio of CEC/TGFbeta, and soluble vascular cell adhesion molecule. Intrarenal hemodynamics and renal function were also assessed. The results showed that increased number of circulating EC, elevated TGFbeta and depleted ratio of CEC/TGFbeta were significantly observed. Intrarenal hemodynamic study revealed a hemodynamic maladjustment characterized by preferential constriction of the efferent arteriole, intraglomerular hypertension and reduction in peritubular capillary flow. It was concluded that early marker of endothelial injury is reflected by increasing number of CEC. Such markers correlate with the glomerular endothelial dysfunction associated with hemodynamic maladjustment. Early detection of endothelial injury and appropriate correction of hemodynamic maladjustment by multidrug vasodilators can effectively restore renal function in type 2 diabetic nephropathy.
Futrakul
Narisa
N
Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. fmednft@md.chula.ac.th
Butthep
Punnee
P
Vongthavarawat
Varaphon
V
Futrakul
Prasit
P
Sirisalipoch
Sasitorn
S
Chaivatanarat
Tawatchai
T
Suwanwalaikorn
Sompongse
S
D000328:Adult; D015415:Biomarkers / Q000097:blood / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D042783:Endothelial Cells / Q000166:cytology; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008274:Magnesium / Q000652:urine; D008875:Middle Aged; D012044:Regression Analysis; D012079:Renal Circulation / Q000502:physiology; D018709:Statistics, Nonparametric; D016212:Transforming Growth Factor beta / Q000097:blood; D042461:Vascular Endothelial Growth Factor A / Q000097:blood; D014665:Vasodilator Agents / Q000627:therapeutic use
D015415:Biomarkers; D016212:Transforming Growth Factor beta; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D014665:Vasodilator Agents; D008274:Magnesium