Microalbuminuria and proximal tubule remodeling in the cardiometabolic syndrome.
Microalbuminuria is a simple screening test that is not only associated with an increased risk of progressive renal insufficiency, but also an increased risk of cardiovascular disease and stroke in the cardiometabolic syndrome. The role of oxidative stress, inflammation, and cellular-extracellular matrix remodeling fibrosis is very important, and the authors have previously observed that albuminuria is related, in part, to loss of the integrity of the glomerular filtration apparatus. The proximal tubule may play a more important role than previously thought, as it is estimated that in health this portion of the nephron reabsorbs 5-8 g of albumin that normally leaks through the glomerulus on a daily basis. Recently, the authors have made important preliminary observational findings regarding proximal tubule microvilli remodeling and oxidative stress, which may help to explain microalbuminuria. These observations suggest that albuminuria is associated with proximal tubule injury, as well as loss of integrity of the glomerular filtration barrier in association with obesity and insulin resistance.
Department of Internal Medicine, Division of Endocrinology Diabetes and Metabolism, University of Missouri School of Medicine, Columbia, MO, USA. mrh29@usmo.com
Melvin R
MR
Hayden
Nazif A
NA
Chowdhury
Lauren
L
Witte
James R
JR
Sowers
D000419:Albuminuria / Q000150:complications* / Q000175:diagnosis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D000818:Animals; D050533:Glomerular Basement Membrane / Q000473:pathology; D005919:Glomerular Filtration Rate; D006801:Humans; D007333:Insulin Resistance; D007687:Kidney Tubules, Proximal / Q000473:pathology* / Q000503:physiopathology; D024821:Metabolic Syndrome / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D008871:Microvilli / Q000473:pathology; D009765:Obesity / Q000150:complications / Q000473:pathology; D018384:Oxidative Stress; D051381:Rats; D017207:Rats, Sprague-Dawley; D011924:Rats, Zucker; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology