Microvascular dysfunction in normotensive, normoalbuminuric, normo- or hyperfiltrate type 2 diabetes

Futrakul, Narisa; Chaisuriya, Papada; Ratanabanangkoon, Kavi; Futrakul, Prasit

doi:10.3109/0886022x.2013.819728

Cited by 6 publications

(5 citation statements)

References 11 publications

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“…Indirectly, the study of vascular homeostasis such as angiogenic factors namely VEGF, VEGF receptor 1, angiopoietin 1, as well as antiangiogenic factors, namely angiopoietin 2, VEGF receptor 2 and endostatin would also reflect the early stage of renal microvascular disease. Furthermore, recent study on vascular biomarkers, namely nitric oxide, endothelin, angiotensin converting enzyme in normotensive, normoalbuminuric, normal or increased creatinine clearance in patients associated with type-2 diabetes, has revealed a significant alteration indicating an abnormal vascular status or renal microvascular disease in this early stage of diabetic kidney disease [ 54,55 ]. Further support to this conceptual view, Fernand Mae-Moune Lai and associated had reported an isolate diffuse thickening of glomerular basement membrane indicating an early renal microvascular disease in prediabetes [ 56 ].…”

Section: Subclinical Manifestation Of Renal Microvascular Disease In mentioning

confidence: 99%

Biomarker for early renal microvascular and diabetic kidney diseases

Futrakul

2017

Renal Failure

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Recognition of early stage of diabetic kidney disease, under common practice using biomarkers, namely microalbuminuria, serum creatinine level above 1 mg/dL and accepted definition of diabetic kidney disease associated with creatinine clearance value below 60 mL/min/1.73 m2, is unlikely. This would lead to delay treatment associated with therapeutic resistance to vasodilator due to a defective vascular homoeostasis. Other alternative biomarkers related to the state of microalbuminuria is not sensitive to screen for early diabetic kidney disease (stages I, II). In this regard, a better diagnostic markers to serve for this purpose are creatinine clearance, fractional excretion of magnesium (FE Mg), cystatin C. Recently, renal microvascular disease and renal ischemia have been demonstrated to correlate indirectly with the development of diabetic kidney disease and its function. Among these are angiogenic and anti-angiogenic factors, namely VEGF, VEGF receptors, angiopoietins and endostatin. With respect to therapeutic prevention, implementation of treatment at early stage of diabetic and nondiabetic kidney disease is able to restore renal perfusion and function.

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Section: Subclinical Manifestation Of Renal Microvascular Disease In mentioning

confidence: 99%

Biomarker for early renal microvascular and diabetic kidney diseases

Futrakul

2017

Renal Failure

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“…And in the post-hoc analysis of the INNOVATION study [7], treatment with telmisartan not only prevents the progression of microalbuminuria, but also reverts from microalbuminuria to normoalbuminuria in Japanese normotensive type 2 diabetic patients. Early stages of diabetes mellitus are characterized by increases in intracapsular pressure and reduction in renal plasma flow despite the patients are normotensive [19]. Evidence from clinical trials and animal experiments suggests that the effect of renin angiotensin system (RAS) inhibitors in the kidney is to decrease efferent arteriolar resistance with resulting reduction of intraglomerular capillary pressure [10].…”

Section: Discussionmentioning

confidence: 99%

Effects of ACE Inhibitors and Angiotensin Receptor Blockers in Normotensive Patients with Diabetic Kidney Disease

Zhang

et al. 2020

Horm Metab Res

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The role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in reducing the progression of albuminuria and risk of cardiovascular events in hypertensive patients with diabetic kidney disease (DKD) is well-documented. However, the efficacy and safety of these agents in normotensive patients with DKD are still controversial. MEDLINE, Embase, and Cochrane Library were searched for relevant random controlled trials. The odd risk (OR) reductions were calculated with a random-effects model. Decrease in albuminuria, changes in eGFR, major cardiovascular events, and drug-related adverse events were analyzed. Thirteen RCTs including 1282 patients were retrieved. Compared with placebo or other active agent groups, ACEIs or ARBs significantly decreased albuminuria (MD –80.28 mg/d, 95% CI –104.79 mg/d to –55.77 mg/d), and the efficacy is independent of changes in blood pressure and systolic blood pressure at baseline. The result of subanalysis showed the declining of albuminuria was more significantly in normotensive DKD patients with 2DM (p=0.005). No significant differences were found with regard to the declining of evaluated glomerular filtration rate (eGFR) (MD –0.29 ml/min/1.73 m2, 95% CI –2.99 to 2.41 ml/min/1.73 m2). There were no significant differences in the side effect of the drugs such as hypotension and hyperkalemia. This meta-analysis demonstrated that ACEIs or ARBs can decrease albuminuria to varying degree in normotensive patients with DKD, and better response occurred in patients with 2DM.

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“…With respect to the latter, microvascular dysfunction such as peritubular capillary flow reduction, an increased arteriolar resistance and endostatin has been demonstrated in early stage of diabetic nephropathy associated with normoalbuminuria, normotension, normal creatinine clearance [ 2 , 5 ]. Another vascular biomarkers reflecting macrovascular disease such as abnormal values of endothelin-1, angioconverting enzyme (ACE) endostatin, cardio ankle vascular index have already been revealed in DKD stage 1 [ 6 ].…”

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confidence: 99%