Slowing Nephropathy Progression

Bakris, George L.

doi:10.2215/cjn.03250807

Cited by 117 publications

(104 citation statements)

References 35 publications

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“…[3][4][5][6][7][8][9] Despite these single predictive factors, an individual prediction of CKD progression remains difficult. Interestingly, all of the factors described above additionally influence the microcirculation and contribute to intraglomerular pressure.…”

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confidence: 99%

Microcirculatory Marker for the Prediction of Renal End Points

2014

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T he prevalence of chronic kidney disease (CKD) has increased during the past years worldwide, 1 imposing a major burden on health-care systems. It is important to prevent CKD, thereby to reduce the need for renal replacement therapy and the rising morbidity and mortality associated with end-stage renal disease.2 Therefore, an efficient individual prediction of CKD progression is warranted.Several factors are involved in CKD progression, including baseline renal function, age, ethnicity, diabetes mellitus, blood pressure, use of renin-angiotensin system (RAS) blocker, and albuminuria.3-9 Despite these single predictive factors, an individual prediction of CKD progression remains difficult. Interestingly, all of the factors described above additionally influence the microcirculation and contribute to intraglomerular pressure.10-16 Thus, it is not surprising that renal microvascular pathology has been considered an important factor in CKD progression. 17 One pathophysiological aspect of the microcirculation is vascular remodeling in small arteries, including microvascular narrowing. 18,19 The latter can be assessed by noninvasive retinal vessel analysis.20,21 Narrow retinal arterioles are associated with age, black race, hypertension, and albuminuria. Ooi et al 22 and our group described narrow retinal arteries in patients with advanced CKD. 23,24 Similar to systemic arteriolar narrowing, the retinal and preglomerular arterioles could show the same effects.25 Narrow preglomerular arterioles increase intraglomerular pressure and contribute to the glomerular defect, determined by albuminuria, as has been demonstrated in spontaneously hypertensive rats and in patients with diabetes mellitus. [25][26][27][28] We hypothesize that retinal arteriolar narrowing predicts CKD progression and subsequently renal end points. Moreover and of importance to clinical practice, we hypothesize that Abstract-Retinal arteriolar narrowing reflects aging, hypertension, chronic kidney disease (CKD), and other vascular processes. We examined the predictive value of retinal arteriolar narrowing alone and in combination with albuminuria on renal disease progression in CKD. A white CKD stage 2 to 4 cohort of 164 men and women (60.8±13.8 years) underwent retinal photography and determination of albuminuria. The calibers of all retinal arterioles were measured after digital conversion of the photographs. Cases of incident renal end points defined as 50% renal function loss and start of renal replacement therapy were identified and validated by case record reviews. Over an average period of 1410 (range, 106-1606) days, 25 patients with CKD had incident renal end points. Kaplan-Meier analysis revealed that patients with CKD within the tertile of narrowest arterioles had more renal end points (log-rank P<0.001). Cox regression analysis confirmed this before (β=1.183±0.411) and after adjusting for age and baseline renal function (β=1.204±0.416). With respect to renal end points, a significant interaction was present between narrow arterioles and a...

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confidence: 99%

Microcirculatory Marker for the Prediction of Renal End Points

2014

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“…Accumulated evidence has indicated that albuminuria is a leading risk factor for the progression of renal disease (29,30). TGP significantly attenuated the high level of albuminuria in all of the diabetic groups ( Table 1).…”

Section: Tgp Attenuated An Increase In Albuminuria In Diabetic Ratsmentioning

confidence: 88%

TGP attenuates endoplasmic reticulum stress and regulates the expression of thioredoxin-interacting protein in the kidneys of diabetic rats

Shao

et al. 2016

BST

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“…This loss can also explain the reason why ACEIs are less effective in diabetics with nephropathy. Multiple trials have shown the effectiveness in reducing proteinuria on combining ACEIs and ARBs compared to using either agents alone [72].…”

Section: Discussionmentioning

confidence: 99%

A Review on the Role of Chymase in Hypertensive Heart Disease

Boamah¹,

Armah²

2017

IJPHC

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Hypertensive heart disease is the commonest cardiac complication resulting from longstanding hypertension. Hypertensive patients inevitably develop hypertensive heart disease but the intensity and progression vary. Poor control is associated with a fast progression and worse outcome while the outcome of adequately controlled blood pressure is antithetical to the former. Various biochemical mediators have been implicated in hypertension and its related complications. Angiotensin-II is involved in both hypertension and remodeling of the cardiac and vascular architecture. The focus on Chymase and its inhibitors in modulating angiotensin-II levels have cast some doubts on the efficacy of solely using angiotensin converting enzyme inhibitors.

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Slowing Nephropathy Progression

Cited by 117 publications

References 35 publications

Microcirculatory Marker for the Prediction of Renal End Points

Microcirculatory Marker for the Prediction of Renal End Points

TGP attenuates endoplasmic reticulum stress and regulates the expression of thioredoxin-interacting protein in the kidneys of diabetic rats

A Review on the Role of Chymase in Hypertensive Heart Disease

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