Role of Vitamin D Status in Diabetic Patients with Renal Disease

Gembillo, Guido; Cernaro, Valeria; Salvo, Antonino; Siligato, Rossella; Laudani, Agata; Buemi, Michele; Santoro, Domenico

doi:10.3390/medicina55060273

Cited by 41 publications

(37 citation statements)

References 139 publications

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“…A variety of studies have shown that reducing urinary albumin excretion by inhibiting RAAS is associated with preservation of renal function. There is a better reduction in albuminuria when RAAS inhibitors are combined with VD in DN [40]. The VDR-KO mice were more susceptible to hyperglycemia-induced kidney damage [41,42].…”

Section: The Mechanism Of Vd/vdr In Diabetic Nephropathymentioning

confidence: 99%

The Emerging Role of Vitamin D and Vitamin D Receptor in Diabetic Nephropathy

Lei

Liu

Guo

2020

BioMed Research International

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Diabetic nephropathy (DN), one of the most common and severe microvascular complications of diabetes mellitus (DM), is an important risk factor for DM patient’s death. Nowadays, DN has become the leading cause of end-stage renal disease (ESRD) in most countries without effective therapeutic methods. Recently, the renoprotective effects mediated by vitamin D (VD) and vitamin D receptor (VDR) have been evidenced. VD, a kind of steroid with the active form 1,25(OH)2D3, has been known for the crucial roles in the modulation of serum calcium and phosphorus concentrations. It exerts important functions by binding with its receptor VDR.VDR, a transcription factor located at chromosome 12 containing 9 exons, is one of the nonsteroid nuclear hormone receptor superfamily, which participates in transcriptional regulation of genes in tissue- and cell-specific ways. Increasing evidences have demonstrated that VD/VDR signaling pathway possesses a variety of kidney-protective effects in DN patients, such as antiproteinuria, antifibrosis, anti-inflammatory, and preventing podocyte damage. Although there are many studies on the role of the VD/VDR signaling pathway in DN, the effects and mechanisms still need to be further explained. This review summarized the multiple roles of VD/VDR in podocyte injury, tubule lesions, interstitial fibrosis, and inflammation, as well as the clinical applications about DN to explore much more and effective therapeutic methods for DN.

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Section: The Mechanism Of Vd/vdr In Diabetic Nephropathymentioning

confidence: 99%

The Emerging Role of Vitamin D and Vitamin D Receptor in Diabetic Nephropathy

Lei

Liu

Guo

2020

BioMed Research International

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“…For example, vitamin D may help to maintain immune function, reduce the risk of respiratory infections and downregulate inflammatory cytokines, suggesting that deficiency could have a negative impact on Covid-19 outcomes [40,49]. Furthermore, vitamin D is a known regulator of cardiovascular and renal function mediated via the interaction of Vitamin D receptors within the renin-angiotensin-aldosterone system (RAAS), highlighting the multisystemic effects of vitamin D deficiency [50].…”

Section: Vitamin D Status By Season and Locationmentioning

confidence: 99%

Geomapping Vitamin D Status in a Large City and Surrounding Population—Exploring the Impact of Location and Demographics

et al. 2020

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Vitamin D status was assessed in a large urban area to compare differences in deficiency and to geomap the results. In total, 36,466 participants from 28 geographical areas were identified in this cross-sectional, retrospective analysis of general practitioner (GP)-requested 25(OH)D tests at St James’s Hospital, Dublin between 2014 and 2018. The population were community-dwelling adults, median age 50.7 (18–109 years) with 15% of participants deficient (<30 nmol/L), rising to 23% in the winter. Deficiency was greatest in younger (18–39 years) and oldest (80+ years) adults, and in males versus females (18% vs. 11%, p < 0.001). Season was the biggest predictor of deficiency (OR 4.44, winter versus summer, p < 0.001), followed by location (west Dublin OR 2.17, north Dublin 1.54, south Dublin 1.42 versus rest of Ireland, p < 0.001) where several urban areas with an increased prevalence of deficiency were identified. There was no improvement in 25(OH)D over the 5-year period despite increased levels of testing. One in four adults were vitamin D deficient in the winter, with significant variations across locations and demographics. Overall this study identifies key groups at risk of 25(OH)D deficiency and insufficiency, thus providing important public health information for the targeting of interventions to optimise 25(OH)D. Mandatory fortification may be necessary to address this widespread inadequacy.

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“…Vitamin D exerts numerous pleiotropic effects unrelated to plasma calcium homeostasis. Indeed, various studies demonstrated that this hormone and its active analogs perform relevant anti-proteinuric, anti-fibrotic and anti-inflammatory actions in subjects with CKD and in experimental studies on animals with end-stage renal disease [11][12][13].…”

Section: Vitamin D: a Polymorphous Agent With Heterogeneous Functionsmentioning

confidence: 99%

Protective Role of Vitamin D in Renal Tubulopathies

et al. 2020

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Vitamin D is tightly linked with renal tubular homeostasis: the mitochondria of proximal convoluted tubule cells are the production site of 1α,25-dihydroxyvitamin D3. Patients with renal impairment or tubular injury often suffer from chronic inflammation. This alteration comes from oxidative stress, acidosis, decreased clearance of inflammatory cytokines and stimulation of inflammatory factors. The challenge is to find the right formula for each patient to correctly modulate the landscape of treatment and preserve the essential functions of the organism without perturbating its homeostasis. The complexity of the counter-regulation mechanisms and the different axis involved in the Vitamin D equilibrium pose a major issue on Vitamin D as a potential effective anti-inflammatory drug. The therapeutic use of this compound should be able to inhibit the development of inflammation without interfering with normal homeostasis. Megalin-Cubilin-Amnionless and the FGF23-Klotho axis represent two Vitamin D-linked mechanisms that could modulate and ameliorate the damage response at the renal tubular level, balancing Vitamin D therapy with an effect potent enough to contrast the inflammatory cascades, but which avoids potential severe side effects.

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Role of Vitamin D Status in Diabetic Patients with Renal Disease

Cited by 41 publications

References 139 publications

The Emerging Role of Vitamin D and Vitamin D Receptor in Diabetic Nephropathy

The Emerging Role of Vitamin D and Vitamin D Receptor in Diabetic Nephropathy

Geomapping Vitamin D Status in a Large City and Surrounding Population—Exploring the Impact of Location and Demographics

Protective Role of Vitamin D in Renal Tubulopathies

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