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Improvement of renal function in type 2 diabetic nephropathy
Narisa Futrakul1, Punnee Butthep, Prasit Futrakul
1Department of Physiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. fmednft@med.chula.ac.th
Renal Failure
|March 17, 2007
Summary
Fractional excretion of magnesium (FE Mg) is a more sensitive marker than microalbuminuria for early type 2 diabetic nephropathy detection. Correcting hemodynamic maladjustment with vasodilators improves renal perfusion and function.
Area of Science:
- Nephrology
- Endocrinology
- Vascular Biology
Background:
- Therapeutic failure in type 2 diabetic nephropathy (DN) stems from delayed detection via microalbuminuria and unaddressed renal hemodynamic issues.
- Glomerular endothelial dysfunction contributes to progressive renal disease in type 2 diabetes.
Purpose of the Study:
- To investigate early markers and hemodynamic changes in normoalbuminuric type 2 DN.
- To assess tubular and vascular function, including endothelial cell markers and intrarenal hemodynamics.
Main Methods:
- Studied 30 normoalbuminuric type 2 DN patients.
- Assessed fractional excretion of magnesium (FE Mg), circulating endothelial cells, VEGF, VEGF/TGF-B ratio, and intrarenal hemodynamics.
Main Results:
- Normoalbuminuric patients showed elevated FE Mg, circulating endothelial cells, and TGF-B, with a decreased VEGF/TGF-B ratio.
- Intrarenal hemodynamics revealed efferent arteriole constriction and reduced peritubular capillary flow.
- Vasodilator treatment improved efferent arteriolar resistance, peritubular capillary flow, and glomerular clearance.
Conclusions:
- FE Mg is a more sensitive early marker for DN than microalbuminuria.
- Elevated circulating endothelial cells, TGF-B, and reduced VEGF/TGF-B ratio indicate endothelial injury.
- Hemodynamic maladjustment and reduced peritubular capillary flow characterize glomerular endothelial dysfunction; vasodilators can improve renal function.
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