Diabetic nephropathy in type 2 diabetes mellitus: risk factors and prevention

Murussi, Marcia; Coester, Ariane; Gross, Jorge Luiz; Silveiro, Sandra Pinho

doi:10.1590/s0004-27302003000300003

Cited by 17 publications

(6 citation statements)

References 121 publications

(127 reference statements)

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“…Similar to other countries, chronic kidney disease has been an important public health problem in Brazil. It is estimated that at least one third of Brazilians with type 2 diabetes are affected by DN [34,35]. …”

Section: Resultsmentioning

confidence: 99%

Epidemiology, management, complications and costs associated with type 2 diabetes in Brazil: a comprehensive literature review

et al. 2013

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BackgroundWith an estimated 74% of all deaths attributable to non-communicable diseases (NCDs) in 2010, NCDs have become a major health priority in Brazil. The objective of the study was to conduct a comprehensive literature review on diabetes in Brazil; specifically: the epidemiology of type 2 diabetes, the availability of national and regional sources of data (particularly in terms of direct and indirect costs) and health policies for the management of diabetes and its complications.MethodsA literature search was conducted using PubMed to identify articles containing information on diabetes in Brazil. Official documents from the Brazilian government and the World Health Organization, as well as other grey literature and official government websites were also reviewed.ResultsFrom 2006 to 2010, an approximate 20% increase in the prevalence of self-reported diabetes was observed. In 2010, it was estimated that 6.3% of Brazilians aged 18 years or over had diabetes. Diabetes was estimated to be responsible for 278,778 years of potential life lost for every 100,000 people. In 2013, it is estimated that about 7% of patients with diabetes has had one or more of the following complications: diabetic foot ulcers, amputation, kidney disease, and fundus changes. The estimated annual direct cost of diabetes was USD $3.952 billion in 2000; the estimated annual indirect cost was USD $18.6 billion. The two main sources of data on diabetes are the information systems of the Ministry of Health and surveys. In the last few years, the Brazilian Ministry of Health has invested considerably in improving surveillance systems for NCDs as well as implementing specific programmes to improve diagnosis and access to treatment.ConclusionsBrazil has the capacity to address and respond to NCDs due to the leadership of the Ministry of Health in NCD prevention activities, including an integrated programme currently in place for diabetes. Strengthening the surveillance of NCDs is a national priority along with recognising the urgent need to invest in improving the coverage and quality of mortality data. It is also essential to conduct regular surveys of risk factors on a national scale in order to design effective preventive strategies.

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Section: Resultsmentioning

confidence: 99%

Epidemiology, management, complications and costs associated with type 2 diabetes in Brazil: a comprehensive literature review

et al. 2013

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“…A combination of environmental and clinical factors in genetically predisposed individuals have been suggested to be involved in DKD, including persistent hyperglycaemia, arterial hypertension and/or dyslipidaemia 37. In addition, familial aggregation of nephropathy in T2DM has been reported in several populations 38.…”

Section: Discussionmentioning

confidence: 99%

Clinical and genetic associations of renal function and diabetic kidney disease in the United Arab Emirates: a cross-sectional study

et al. 2018

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ObjectivesWithin the Emirati population, risk factors and genetic predisposition to diabetic kidney disease (DKD) have not yet been investigated. The aim of this research was to determine potential clinical, laboratory and reported genetic loci as risk factors for DKD.Research design and methodsFour hundred and ninety unrelated Emirati nationals with type 2 diabetes mellitus (T2DM) were recruited with and without DKD, and clinical and laboratory data were obtained. Following adjustments for possible confounders, a logistic regression model was developed to test the associations of 63 single nucleotide polymorphisms (SNPs) in 43 genetic loci with DKD (145 patients with DKD and 265 without DKD). Linear regression models, adjusted for age and gender, were then used to study the genetic associations of five renal function traits, including 83 SNPs with albumin-to-creatinine ratio, 92 SNPs with vitamin D (25-OH cholecalciferol), 288 SNPs with estimated glomerular filtration rate (eGFR), 363 SNPs with serum creatinine and 73 SNPs with blood urea.ResultsPatients with DKD, as compared with those without the disease, were mostly men (52%vs38% for controls), older (67vs59 years) and had significant rates of hypertension and dyslipidaemia. Furthermore, patients with DKD had T2DM for a longer duration of time (16vs10 years), which in an additive manner was the single factor that significantly contributed to the development of DKD (p=0.02, OR=3.12, 95% CI 1.21 to 8.02). Among the replicated associations of the genetic loci with different renal function traits, the most notable included SHROOM3 with levels of serum creatinine, eGFR and DKD (Padjusted=0.04, OR=1.46); CASR, GC and CYP2R1 with vitamin D levels; as well as WDR72 with serum creatinine and eGFR levels.ConclusionsAssociations were found between several genetic loci and risk markers for DKD, which may influence kidney function traits and DKD in a population of Arab ancestry.

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“…DN is histologically defined by thickening of the glomerular basement membrane, increased fractional mesangial volume, and podocyte abnormalities [ 2 ]. Hyperglycemia, hypertension and proteinuria are the main insults that cause structural abnormalities in a diabetic kidney [ 1 , 4 - 6 ].…”

Section: Introductionmentioning

confidence: 99%

Nitric oxide system and diabetic nephropathy

Dellaméa

Leitão

Friedman

et al. 2014

Diabetol Metab Syndr

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About 30% of patients with type 2 diabetes mellitus develop clinically overt nephropathy. Hyperglycemia is necessary, but not sufficient, to cause the renal damage that leads to kidney failure. Diabetic nephropathy (DN) is a multifactorial disorder that results from interaction between environmental and genetic factors. In the present article we will review the role of the nitric oxide synthase (NOS) in the pathogenesis of DN.Nitric oxide (NO) is a short-lived gaseous lipophilic molecule produced in almost all tissues, and it has three distinct genes that encode three NOS isoforms: neuronal (nNOS), inducible (iNOS) and endothelial (eNOS).The correct function of the endothelium depends on NO, participating in hemostasis control, vascular tone regulation, proliferation of vascular smooth muscle cells and blood pressure homeostasis, among other features. In the kidney, NO plays many different roles, including control of renal and glomerular hemodynamics. The net effect of NO in the kidney is to promote natriuresis and diuresis, along with renal adaptation to dietary salt intake.The eNOS gene has been considered a potential candidate gene for DN susceptibility. Three polymorphisms have been extensively researched: G894T missense mutation (rs1799983), a 27-bp repeat in intron 4, and the T786C single nucleotide polymorphism (SNP) in the promoter (rs2070744). However, the potential link between eNOS gene variants and the induction and progression of DN yielded contradictory results in the literature.In conclusion, NOS seems to be involve in the development and progression of DN. Despite the discrepant results of many studies, the eNOS gene is also a good candidate gene for DN.

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Diabetic nephropathy in type 2 diabetes mellitus: risk factors and prevention

Cited by 17 publications

References 121 publications

Epidemiology, management, complications and costs associated with type 2 diabetes in Brazil: a comprehensive literature review

Epidemiology, management, complications and costs associated with type 2 diabetes in Brazil: a comprehensive literature review

Clinical and genetic associations of renal function and diabetic kidney disease in the United Arab Emirates: a cross-sectional study

Nitric oxide system and diabetic nephropathy

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