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Early renal and vascular changes in ADPKD patients with low-grade albumin excretion and normal renal function

Pablo J Azurmendi1, Adriana R Fraga, Felicita M Galan

  • 1Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Argentina pazurmendi@lanari.fmed.uba.ar

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|April 1, 2009
PubMed
Abstract

Insights

In young Autosomal dominant polycystic kidney disease (ADPKD) patients, normal urine albumin/creatinine ratio (UACR) indicates no early renal or vascular changes. However, subtle changes may exist even below microalbuminuria levels.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Biomarkers

Background:

  • Autosomal dominant polycystic kidney disease (ADPKD) is characterized by increased urine monocyte chemoattractant protein-1 (MCP-1) and carotid intima-media thickness (CIMT) preceding serum creatinine changes.
  • Microalbuminuria is a known index of ADPKD progression, but early renal and vascular changes at normal or minimally elevated urine albumin excretion levels remain understudied.

Purpose of the Study:

  • To investigate whether early renal and vascular alterations are detectable in young ADPKD patients with normal or minimally increased urine albumin/creatinine ratio (UACR).
  • To assess the relationship between UACR, urine MCP-1, MCP-1 fractional excretion (FE(MCP-1)), and carotid intima-media thickness (CIMT) in early-stage ADPKD.

Main Methods:

  • A cross-sectional study involving 48 young ADPKD patients with normal renal function and 21 age-matched controls.
  • Measurement of urine albumin/creatinine ratio (UACR), urine MCP-1, FE(MCP-1), endothelial-dependent vascular relaxation (EDVR), aortic pulse-wave velocity (Ao-PWV), and CIMT.
  • UACR >6.8 mg/g was used as a threshold to identify potential renal and vascular alterations.

Main Results:

  • ADPKD patients with UACR ≤6.8 mg/g showed no significant differences in urine MCP-1, FE(MCP-1), or CIMT compared to controls.
  • ADPKD patients with UACR >6.8 mg/g exhibited significantly higher levels of urine MCP-1, FE(MCP-1), and CIMT compared to both controls and ADPKD patients with lower UACR.
  • These findings persisted in normotensive ADPKD patients, while EDVR and Ao-PWV showed no significant differences across groups.

Conclusions:

  • In young ADPKD patients, normal UACR levels suggest a renal interstitium comparable to healthy individuals and no subtle atherosclerotic changes in carotid arteries.
  • Early renal and vascular changes in ADPKD may be detectable at UACR levels below those traditionally defined as microalbuminuria.
  • UACR serves as a potential early indicator for renal and vascular remodeling in ADPKD, even at levels below microalbuminuria thresholds.

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