Glucose and Blood Pressure-Dependent Pathways–The Progression of Diabetic Kidney Disease

Abstract

The major clinical associations with the progression of diabetic kidney disease (DKD) are glycemic control and systemic hypertension. Recent studies have continued to emphasize vasoactive hormone pathways including aldosterone and endothelin which suggest a key role for vasoconstrictor pathways in promoting renal damage in diabetes. The role of glucose per se remains difficult to define in DKD but appears to involve key intermediates including reactive oxygen species (ROS) and dicarbonyls such as methylglyoxal which activate intracellular pathways to promote fibrosis and inflammation in the kidney. Recent studies have identified a novel molecular interaction between hemodynamic and metabolic pathways which could lead to new treatments for DKD. This should lead to a further improvement in the outlook of DKD building on positive results from RAAS blockade and more recently newer classes of glucose-lowering agents such as SGLT2 inhibitors and GLP1 receptor agonists.

Should We Be Concerned about the Association of Diabetes Mellitus and Periodontal Disease in the Risk of Infection by SARS-CoV-2? A Systematic Review and Hypothesis

“…These events culminate in acute complications, including ketoacidosis, hyperglycemia, a hyperosmolar state, respiratory infections due to an impaired immune response, periodontal disease, and diabetic coma [ 57 , 58 ]. Therefore, diabetic patients are at increased risk for the development of hypertension, myocardial infarction, renal disease, and stroke [ 59 , 60 ].…”

“…These events culminate in acute complications, including ketoacidosis, hyperglycemia, a hyperosmolar state, respiratory infections due to an impaired immune response, periodontal disease, and diabetic coma [57,58]. Therefore, diabetic patients are at increased risk for the development of hypertension, myocardial infarction, renal disease, and stroke [59,60]. The main condition underlying the development of complications in T2DM patients is poor glycemic control, which alters microvascular function in vascular beds in the lungs, kidneys, and periodontal tissue [61,62].…”

Non-Coding RNAs as Biomarkers and Therapeutic Targets for Diabetic Kidney Disease

“…In patients with diabetes, hyperglycemia may trigger oxidative stress, renal inflammation, and fibrosis in kidneys ( Matoba et al, 2019 ; Patel et al, 2020 ). Among those pathogenic factors, renal fibrogenesis is the major driving force in the development of DKD ( Hills and Squires, 2011 ; Lan, 2012a ).…”

CD28 Genetic Variants Increase Susceptibility to Diabetic Kidney Disease in Chinese Patients with Type 2 Diabetes: A Cross-Sectional Case Control Study

“…The prevalence of DKD in type II DM (T2DM) is approximately 30-50% among US diabetic adults [4]. It is recognized that intensive glucose control reduces the risk of DKD [5]. Despite advances in glycemic control therapies, the development of ESRD remains a growing problem globally, and it has generated a substantial public health burden over the past 2 decades [2,6].…”