Indices Indicating Early Renal Microvascular Disease in Diabetes

Abstract

Abstract:Renal microvascular disease is crucial to renal disease progression. Renal microvascular disease in late stage diabetic nephropathy is associated with defective angiogenesis and fails to respond to vasodilator treatment. Recognition of early renal microvascular disease is necessary, since in this stage, the vascular homeostasis is adequately functional and responsive to vasodilator treatment. Indices that can screen early renal microvascular disease include creatinine clearance or glomerular filtration rate, renal plasma flow or peritubular capillary flow and fractional excretion of magnesium (FE Mg).

Early stage of vascular disease and diabetic kidney disease: an under-recognized entity

“…With respect to FE Mg, it has been demonstrated that FE Mg correlates directly with the degree of tubulointerstitial fibrosis, 33,34 and inversely correlates with creatinine clearance. 8 The preceding information renders support that an appropriate therapeutic strategy should be implemented at an early stage of DKD. To support this alternative conceptual view, recent study on vascular homeostasis in both diabetic at early stage during normoalbuminuria and non-DKD with mildly impaired renal function reveals a rather normal angiogenic as well as antiangiogenic factors; indicating that such normal vascular homeostasis would be able to be adequately functional with an adequate nitric oxide production, and thus respond to vasodilator treatment.…”

“…[1][2][3][4][5][6] Furthermore, biomarkers of endothelial injury has also been demonstrated such as an abnormally elevated circulating endothelial cells in early stage type 2 DKD. 2,7,8 In contrast, such information of renal microvascular disease in early stage of DKD would be unable to obtain under general practice due to the unavailability of the diagnostic instrument. In addition to the renal hemodynamic study, renal microvascular disease can be assessed by an invasive renal histopathology such as endothelial factor VIII staining in renal microcirculation.…”

Is Diabetic Nephropathy a Restorative Disease?

“…In fact, this early stage DN associated with normal serum creatinine value and normoalbuminuria can be recognized by (1) a depleted creatinine clearance; (2) an abnormally elevated fractional excretion of magnesium (FE Mg; normal 1.6 AE 0.6%) indicating the presence of tubulointerstitial fibrosis, since FE Mg has previously been demonstrated to correlate with the magnitude of tubulointerstitial fibrosis 5,6 ; and (3) a reduction in peritubular capillary flow or renal plasma flow indicating renal microvascular disease or ischemia. 7 Recent study on vascular homeostasis in early stage DN during normoalbuminuria and CKD stages 1-2 has supported this new conceptual view. The vascular homeostasis is adequately functional in early stage DN, which implies that the production of nitric oxide by the endothelial cell in the renal microcirculation would likely be sufficient to respond to vasodilator treatment.…”

Biomarkers of glomerular endothelial dysfunction in primary focal segmental glomerulosclerosis

“…2 A successful restoration of renal perfusion and function requires an index that can indicate early renal microvascular disease to recognize and treat the chronic kidney disease at an early stage in an environment favourable for renal angiogenesis. 4 We are grateful for the support of the Thailand Research Fund. Embolic tubular epithelial cells in the lumina of glomerular capillary loops have been described following percutaneous biopsy as a rare artefact.…”

“…Therapeutic benefit with anticoagulant, antiplatelet and vasodilating agents has previously been substantiated 2 . A successful restoration of renal perfusion and function requires an index that can indicate early renal microvascular disease to recognize and treat the chronic kidney disease at an early stage in an environment favourable for renal angiogenesis 4 …”