[Molecular pathogenesis of chronic kidney disease].
High blood pressure, poor glycemic control, obesity, metabolic syndrome, dyslipidemia, smoking and older age are the risk factors for susceptibility to and initiation of CKD. In these conditions, systemic blood pressure can be transmitted to the glomerular capillary network because of impairment of autoregulationary mechanism existing on the afferent arteriole of glomerulus. Glomerular hypertension and endothelial dysfunction are regarded as the common mechanisms underlying in the development of CKD. Albuminuria reflects the dysregulation of glomerular hemodynamics and vascular damage. Low-grade albuminuria (below the current microalbuminuria threshold) is the independent risk factor for the development of CVD. The renin-angiotensin system(RAS), insulin resistance and increased sympathetic nerve activity are implicated in the development of glomerular hypertension and endothelial dysfunction. Endothelial dysfunction could be caused by decrease of BH4 resultant eNOS uncoupling. Endothelial dysfunction could be regarded as the common mechanisms which link CKD and cardiovascular diseases.
Kashihara
Naoki
N
Division of Nephrology, Department of Internal Medicine, Kawasaki Medical School.
Satoh
Minoru
M
D000419:Albuminuria; D002318:Cardiovascular Diseases / Q000209:etiology; D002908:Chronic Disease; D018450:Disease Progression; D004730:Endothelium, Vascular / Q000503:physiopathology; D019276:Glycocalyx; D006801:Humans; D006973:Hypertension; D007333:Insulin Resistance; D007674:Kidney Diseases / Q000209:etiology*; D052250:Nitric Oxide Synthase Type III; D011507:Proteinuria; D012307:Risk Factors
D052250:Nitric Oxide Synthase Type III