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Abstract
The worldwide occurrence of diabetic kidney disease (DKD) is swiftly rising, primarily attributed to the growing population of individuals affected by type 2 diabetes. This surge has been transformed into a substantial global concern, placing additional strain on healthcare systems already grappling with significant demands. The pathogenesis of DKD is intricate, originating with hyperglycemia, which triggers various mechanisms and pathways: metabolic, hemodynamic, inflammatory, and fibrotic which ultimately lead to renal damage. Within each pathway, several mediators contribute to the development of renal structural and functional changes. Some of these mediators, such as inflammatory cytokines, reactive oxygen species, and transforming growth factor β are shared among the different pathways, leading to significant overlap and interaction between them. While current treatment options for DKD have shown advancement over previous strategies, their effectiveness remains somewhat constrained as patients still experience residual risk of disease progression. Therefore, a comprehensive grasp of the molecular mechanisms underlying the onset and progression of DKD is imperative for the continued creation of novel and groundbreaking therapies for this condition. In this review, we discuss the current achievements in fundamental research, with a particular emphasis on individual factors and recent developments in DKD treatment.
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Affiliation(s)
- Satyesh K. Sinha
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
- College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Susanne B. Nicholas
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
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Juin SK, Ouseph R, Gondim DD, Jala VR, Sen U. Diabetic Nephropathy and Gaseous Modulators. Antioxidants (Basel) 2023; 12:antiox12051088. [PMID: 37237955 DOI: 10.3390/antiox12051088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Diabetic nephropathy (DN) remains the leading cause of vascular morbidity and mortality in diabetes patients. Despite the progress in understanding the diabetic disease process and advanced management of nephropathy, a number of patients still progress to end-stage renal disease (ESRD). The underlying mechanism still needs to be clarified. Gaseous signaling molecules, so-called gasotransmitters, such as nitric oxide (NO), carbon monoxide (CO), and hydrogen sulfide (H2S), have been shown to play an essential role in the development, progression, and ramification of DN depending on their availability and physiological actions. Although the studies on gasotransmitter regulations of DN are still emerging, the evidence revealed an aberrant level of gasotransmitters in patients with diabetes. In studies, different gasotransmitter donors have been implicated in ameliorating diabetic renal dysfunction. In this perspective, we summarized an overview of the recent advances in the physiological relevance of the gaseous molecules and their multifaceted interaction with other potential factors, such as extracellular matrix (ECM), in the severity modulation of DN. Moreover, the perspective of the present review highlights the possible therapeutic interventions of gasotransmitters in ameliorating this dreaded disease.
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Affiliation(s)
- Subir Kumar Juin
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Department of Microbiology & Immunology, Brown Cancer Center, Center for Microbiomics, Inflammation and Pathogenicity, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Rosemary Ouseph
- Division of Nephrology & Hypertension, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Dibson Dibe Gondim
- Department of Pathology, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Venkatakrishna Rao Jala
- Department of Microbiology & Immunology, Brown Cancer Center, Center for Microbiomics, Inflammation and Pathogenicity, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Utpal Sen
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
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Rangaswamaiah H, Somashekar P, Gutlur Nagarajaiah Setty R, Ganesh V. Urinary nephrin linked nephropathy in type-2 diabetes mellitus. Bioinformation 2022; 18:1131-1135. [PMID: 37701508 PMCID: PMC10492904 DOI: 10.6026/973206300181131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/20/2022] [Accepted: 12/31/2022] [Indexed: 09/14/2023] Open
Abstract
Diabetic nephropathy is a one of the risk factor for end stage renal disease in patients with type 2 diabetes mellitus. Urinary micr oalbumin currently marker using for diagnosis of nephropathy in type 2 diabetes mellitus due to its larger variability and less specificity. Urinary nephrin is podocyte protein can be act as a early predictable and prognostic marker than micro albumin for nephropathy in type 2 diabetes mellitus. This case-control prospective observational study included 60 type 2 diabetes mellitus and 30 controls after applying criteria. Basic biochemical, clinical and experimental data were measured and recorded. There was a significantly elevated level of urinary nephrin in type 2 diabetes mellitus patients when compared to controls. The urinary nephrin significantly elevated in normo albuminuria group only when compared to urinary ACR and it is positive association with kidney damage. This study concluded significantly elevated levels of urinary nephrin might be used for early diagnosis and prognostic marker for nephropathy in type 2 diabetes mellitus.
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Affiliation(s)
- Hareesh Rangaswamaiah
- Department of General Medicine, Akash Institute of Medical Sciences and Research Centre, Bangalore - 562110, Karnataka, India
| | - Pallavi Somashekar
- Department of General Medicine, Akash Institute of Medical Sciences and Research Centre, Bangalore - 562110, Karnataka, India
| | | | - Veluri Ganesh
- Department of Biochemistry, Akash Institute of Medical Sciences and Research Centre, Bangalore - 562110, Karnataka, India
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Veluri G, Mannangatti M. Urinary Nephrin is a Sensitive Marker to Predict Early Onset of Nephropathy in Type 2 Diabetes Mellitus. J Lab Physicians 2022; 14:497-504. [PMID: 36531542 PMCID: PMC9750756 DOI: 10.1055/s-0042-1757718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective The present study has been designed to evaluate urinary nephrin that best predicts the occurrence of renal dysfunction in type 2 diabetes mellitus patients and its correlation with clinical parameters of nephropathy. Materials and Methods A total of 80 type 2 diabetes mellitus and 40 age- and gender-matched healthy controls were recruited. Biochemical and clinical parameters were analyzed in all the study participants. Analysis of variance was performed to compare the differences between the groups. Pearson's correlation analysis was used to analyze the association of nephrin with clinical parameters of nephropathy. Receiver operating characteristic curves were constructed to study the diagnostic accuracy of markers to identify diabetic nephropathy. Results The levels of nephrin were significantly elevated in both groups of type 2 diabetes mellitus patients when compared with healthy individuals ( p = 0.0001). The urinary nephrin was positively correlated with hemoglobin A1c and urinary albumin creatinine ratio ( r = 0.520, 0.657, p < 0.0001) and negatively correlated with estimated glomerular filtration rate ( r = -0.539, p < 0.0001). The diagnostic sensitivity and specificity of nephrin for nephropathy were 100 and 88%, respectively, and urinary albumin creatinine ratio was 43 and 76%, respectively. Conclusion The study findings suggest that nephrin levels are strongly and positively associated with nephropathy in type 2 diabetes mellitus patients and it has a greater potential to be an early predictable marker of nephropathy than urinary albumin creatinine ratio.
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Affiliation(s)
- Ganesh Veluri
- Department of Biochemistry, Arupadai Veedu Medical College and Hospital, Vinayaka Missions Research Foundation (deemed to be university, Salem, Tamil Nadu), Kirumampakkam, Puducherry, India
| | - Murugan Mannangatti
- Department of Biochemistry, Arupadai Veedu Medical College and Hospital, Vinayaka Missions Research Foundation (deemed to be university, Salem, Tamil Nadu), Kirumampakkam, Puducherry, India
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Gholaminejad A, Moein S, Roointan A, Mortazavi M, Nouri R, Mansourian M, Gheisari Y. Circulating β2 and α1 microglobulins predict progression of nephropathy in diabetic patients: a meta-analysis of prospective cohort studies. Acta Diabetol 2022; 59:1417-1427. [PMID: 35939238 DOI: 10.1007/s00592-022-01940-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Abstract
AIMS To study the association of circulating β2 (B2M) and α1 microglobulins (A1M) with diabetic nephropathy (DN) progression, a meta-analysis was performed on the prospective cohort studies. METHODS Up to October 2021, a comprehensive search of the PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library databases was performed. The primary outcome (progression of DN) was defined as a decrease in eGFR or the occurrence of end stage renal disease or DN-related mortality. Eligible studies were included in a pooled analysis that used either fixed-effect or random-effect models to compensate for variation in measurement standards between studies. The funnel plot and Egger's test were used to assess publication bias. RESULTS The meta-analysis included 4398 people from 9 prospective trials (8 cohorts) for B2M and 3110 people from 4 prospective trials (3 cohorts) for A1M. Diabetic individuals with higher B2M levels had an increased risk for DN (relative risk [RR]: 1.81, 95% confidence interval [CI]: 1.56-2.09). Likewise, higher A1M was associated with augmented probability of DN (RR: 1.96, 95% CI: 1.46-2.62). The funnel plot and Egger's tests indicated no publication bias for A1M. Additionally, to compensate for putative publication bias for B2M, using trim and fill analysis, four studies were filled for this marker and the results remained significant (RR: 1.62, 95% CI: 1.37-1.92). CONCLUSIONS The elevated serum levels of B2M and A1M could be considered as potential predictors of DN progression in diabetic patients. PROTOCOL REGISTRATION PROSPERO CRD42021278300.
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Affiliation(s)
- Alieh Gholaminejad
- Regenerative Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, 8174673461, Iran
| | - Shiva Moein
- Regenerative Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, 8174673461, Iran
| | - Amir Roointan
- Regenerative Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, 8174673461, Iran
| | - Mojgan Mortazavi
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rasool Nouri
- Department of Medical Library and Information Sciences, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yousof Gheisari
- Regenerative Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, 8174673461, Iran.
- Department of Genetics and Molecular Biology, Isfahan University of Medical Sciences, Isfahan, Iran.
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Khanijou V, Zafari N, Coughlan MT, MacIsaac RJ, Ekinci EI. Review of potential biomarkers of inflammation and kidney injury in diabetic kidney disease. Diabetes Metab Res Rev 2022; 38:e3556. [PMID: 35708187 PMCID: PMC9541229 DOI: 10.1002/dmrr.3556] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/18/2022] [Accepted: 04/02/2022] [Indexed: 11/17/2022]
Abstract
Diabetic kidney disease is expected to increase rapidly over the coming decades with rising prevalence of diabetes worldwide. Current measures of kidney function based on albuminuria and estimated glomerular filtration rate do not accurately stratify and predict individuals at risk of declining kidney function in diabetes. As a result, recent attention has turned towards identifying and assessing the utility of biomarkers in diabetic kidney disease. This review explores the current literature on biomarkers of inflammation and kidney injury focussing on studies of single or multiple biomarkers between January 2014 and February 2020. Multiple serum and urine biomarkers of inflammation and kidney injury have demonstrated significant association with the development and progression of diabetic kidney disease. Of the inflammatory biomarkers, tumour necrosis factor receptor-1 and -2 were frequently studied and appear to hold most promise as markers of diabetic kidney disease. With regards to kidney injury biomarkers, studies have largely targeted markers of tubular injury of which kidney injury molecule-1, beta-2-microglobulin and neutrophil gelatinase-associated lipocalin emerged as potential candidates. Finally, the use of a small panel of selective biomarkers appears to perform just as well as a panel of multiple biomarkers for predicting kidney function decline.
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Affiliation(s)
- Vuthi Khanijou
- Melbourne Medical SchoolUniversity of MelbourneAustin HealthMelbourneVictoriaAustralia
| | - Neda Zafari
- Department of MedicineUniversity of MelbourneAustin HealthMelbourneVictoriaAustralia
| | - Melinda T. Coughlan
- Department of DiabetesCentral Clinical SchoolMonash UniversityAlfred Medical Research AllianceMelbourneVictoriaAustralia
- Baker Heart & Diabetes InstituteMelbourneVictoriaAustralia
| | - Richard J. MacIsaac
- Department of Endocrinology & DiabetesSt. Vincent's Hospital Melbourne and University of MelbourneMelbourneVictoriaAustralia
| | - Elif I. Ekinci
- Melbourne Medical SchoolUniversity of MelbourneAustin HealthMelbourneVictoriaAustralia
- Department of EndocrinologyAustin HealthMelbourneVictoriaAustralia
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Muntean C, Starcea IM, Banescu C. Diabetic kidney disease in pediatric patients: A current review. World J Diabetes 2022; 13:587-599. [PMID: 36159227 PMCID: PMC9412860 DOI: 10.4239/wjd.v13.i8.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/13/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023] Open
Abstract
In the last decades, a significant increase in the incidence of diabetic kidney disease (DKD) was observed concomitant with rising diabetes mellitus (DM) incidence. Kidney disease associated with DM in children and adolescents is represented by persistent albuminuria, arterial hypertension, progressive decline in estimated glomerular filtration rate to end-stage renal disease and increased cardiovascular and all-cause morbidity and mortality of these conditions. In medical practice, the common and still the “gold standard” marker for prediction and detection of diabetic kidney involvement in pediatric diabetes is represented by microalbuminuria screening even if it has low specificity to detect early stages of DKD. There are some known limitations in albuminuria value as a predictor biomarker for DKD, as not all diabetic children with microalbuminuria or macroalbuminuria will develop end-stage renal disease. As tubular damage occurs before the glomerular injury, tubular biomarkers are superior to the glomerular ones. Therefore, they may serve for early detection of DKD in both type 1 DM and type 2 DM. Conventional and new biomarkers to identify diabetic children and adolescents at risk of renal complications at an early stage as well as renoprotective strategies are necessary to delay the progression of kidney disease to end-stage kidney disease. New biomarkers and therapeutic strategies are discussed as timely diagnosis and therapy are critical in the pediatric diabetic population.
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Affiliation(s)
- Carmen Muntean
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, Târgu Mures 540142, Romania
| | - Iuliana Magdalena Starcea
- Department of IVth Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi 700115, Romania
| | - Claudia Banescu
- Center for Advanced Medical and Pharmaceutical Research, University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Mureș, Târgu Mures 540142, Romania
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Harkin C, Smith KW, MacKay CL, Moore T, Brockbank S, Ruddock M, Cobice DF. Spatial localization of β-unsaturated aldehyde markers in murine diabetic kidney tissue by mass spectrometry imaging. Anal Bioanal Chem 2022; 414:6657-6670. [PMID: 35881173 PMCID: PMC9411223 DOI: 10.1007/s00216-022-04229-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 11/09/2022]
Abstract
Diabetic nephropathy (DN) is the leading cause of end-stage renal disease. Limitations in current diagnosis and screening methods have sparked a search for more specific and conclusive biomarkers. Hyperglycemic conditions generate a plethora of harmful molecules in circulation and within tissues. Oxidative stress generates reactive α-dicarbonyls and β-unsaturated hydroxyhexenals, which react with proteins to form advanced glycation end products. Mass spectrometry imaging (MSI) enables the detection and spatial localization of molecules in biological tissue sections. Here, for the first time, the localization and semiquantitative analysis of “reactive aldehydes” (RAs) 4-hydroxyhexenal (4-HHE), 4-hydroxynonenal (4-HNE), and 4-oxo-2-nonenal (4-ONE) in the kidney tissues of a diabetic mouse model is presented. Ionization efficiency was enhanced through on-tissue chemical derivatization (OTCD) using Girard’s reagent T (GT), forming positively charged hydrazone derivatives. MSI analysis was performed using matrix-assisted laser desorption ionization (MALDI) coupled with Fourier-transform ion cyclotron resonance mass spectrometry (FT-ICR). RA levels were elevated in diabetic kidney tissues compared to lean controls and localized throughout the kidney sections at a spatial resolution of 100 µm. This was confirmed by liquid extraction surface analysis–MSI (LESA-MSI) and liquid chromatography–mass spectrometry (LC–MS). This method identified β-unsaturated aldehydes as “potential” biomarkers of DN and demonstrated the capability of OTCD-MSI for detection and localization of poorly ionizable molecules by adapting existing chemical derivatization methods. Untargeted exploratory distribution analysis of some precursor lipids was also assessed using MALDI-FT-ICR-MSI.
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Affiliation(s)
- Carla Harkin
- Mass Spectrometry Centre, Biomedical Sciences Research Institute (BMSRI), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Karl W Smith
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, FL, 32310-4005, USA.,Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany
| | - C Logan MacKay
- Scottish Instrumentation and Research Centre for Advanced Mass Spectrometry (SIRCAMS), EastChem School of Chemistry, University of Edinburgh, Edinburgh, Scotland, UK
| | - Tara Moore
- Genomic Medicine, Biomedical Sciences Research Institute (BMSRI), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | | | - Mark Ruddock
- Randox Laboratories Ltd, 55 The Diamond Rd, Crumlin, UK
| | - Diego F Cobice
- Mass Spectrometry Centre, Biomedical Sciences Research Institute (BMSRI), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK.
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Surya M, Rajappa M, M V. Utility of Urinary Nephrin in Patients With and Without Diabetic Nephropathy and Its Correlation With Albuminuria. Cureus 2022; 13:e20102. [PMID: 34993041 PMCID: PMC8720236 DOI: 10.7759/cureus.20102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Nephrin is a podocyte-specific protein that may serve as a urinary biomarker in patients with diabetic nephropathy. The objectives of the study were to determine urinary nephrin levels in patients with and without type 2 diabetic nephropathy and to assess the correlation between urinary nephrin and albuminuria. Methods This was a cross-sectional comparative study that was carried out at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry over 18 months. Diabetic study subjects were divided into three groups-normoalbuminuria, microalbuminuria, and macroalbuminuria. Urinary albumin was detected by the dipstick method in a spot urine sample for all study subjects. In subjects with trace or no albuminuria, nephelometry was used to quantify urinary albumin levels. Urinary nephrin was estimated by the ELISA technique for all study subjects. Results Subjects in the microalbuminuria group had higher urinary nephrin levels than those in the normoalbuminuria and macroalbuminuria groups. There was a weak positive correlation between urinary albumin and nephrin levels among the study subjects (p < 0.001). Conclusion Urinary nephrin levels are increased in patients with diabetic nephropathy. There was a weak positive correlation between urinary albumin and nephrin levels among these patients.
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Affiliation(s)
- Manupati Surya
- Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Medha Rajappa
- Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Vadivelan M
- Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Popykhova EB, Ivanov AN, Stepanova TV, Lagutina DD, Savkina AA. Diabetic Nephropathy - possibilities of early laboratory diagnostics and course prediction (review of literature). Klin Lab Diagn 2021; 66:593-602. [PMID: 34665945 DOI: 10.51620/0869-2084-2021-66-10-593-602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The medical and social significance of diabetes mellitus is determined by a progressive increase in the incidence of the disease, as well as the development of disabling and reducing the quality of life of macro- and microvascular complications in patients of working age, in particular, with the development of diabetic nephropathy (DN), which develops in one third of patients with type 1 and 2 diabetes. DN is the third leading cause of death after diseases of the cardiovascular system and oncological pathologies. In this regard, the identification of DN at the early stages is an important task both from the standpoint of prevention and a more favorable prognosis of the course of diabetes. This review presents data on the possibilities of early diagnosis of DN using blood and urine biomarkers, as well as information on their diagnostic and prognostic value. The analysis of the interpretation of the indicator of microalbuminuria in type 1 and 2 diabetes was carried out. In addition, the literature data of recent years on the informative value of determining markers of podocyte damage, on the role of oxidative stress products, immune-inflammatory factors, and vascular endothelial growth factor in the process of the onset and development of DN are presented. The possibility of their practical use for the diagnosis of DN in clinical practice is discussed. The literature search for this review was carried out using the databases of the RSCI, CyberLeninka, Scopus, Web of Science, MedLine, PubMed for the period from 2011 to 2021. using the following keywords: diabetes mellitus, diabetic nephropathy, markers of diabetic nephropathy; kidney damage, early diagnosis of diabetic nephropathy.
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Affiliation(s)
- E B Popykhova
- Saratov State Medical University named after V.I. Razumovsky
| | - A N Ivanov
- Saratov State Medical University named after V.I. Razumovsky
| | - T V Stepanova
- Saratov State Medical University named after V.I. Razumovsky
| | - D D Lagutina
- Saratov State Medical University named after V.I. Razumovsky
| | - A A Savkina
- Saratov State Medical University named after V.I. Razumovsky
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Khan NU, Lin J, Liu X, Li H, Lu W, Zhong Z, Zhang H, Waqas M, Shen L. Insights into predicting diabetic nephropathy using urinary biomarkers. Biochimica et Biophysica Acta (BBA) - Proteins and Proteomics 2020; 1868:140475. [DOI: 10.1016/j.bbapap.2020.140475] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/27/2020] [Accepted: 06/14/2020] [Indexed: 12/20/2022]
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Xu C, Zhou X, Xie T, Zhou Y, Zhang Q, Jiang S, Zhang R, Liao L, Dong J. Renal tubular Bim mediates the tubule-podocyte crosstalk via NFAT2 to induce podocyte cytoskeletal dysfunction. Theranostics 2020; 10:6806-6824. [PMID: 32550905 PMCID: PMC7295056 DOI: 10.7150/thno.43145] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/03/2020] [Indexed: 12/17/2022] Open
Abstract
Diabetic nephropathy (DN) is mainly regarded as diabetic glomerulopathy, and its progression is tightly correlated with tubular epithelial lesions. However, the underlying molecular mechanisms linking tubular damage and glomerulopathy are poorly understood. Methods: We previously reported that the upregulation of Bim mediated proximal tubular epithelial cell (PTEC) apoptosis and was crucial in the early stages of DN. Herein we modulated Bim expression in PTECs and subsequently determined podocyte (PC) cytoskeletal arrangement by building a Transwell co-culture system in high glucose (HG). Results: Compared to normal glucose, exposure to 40 mM of HG for 48 h induced significant expression of Bim in PTECs and disorganization in the PC cytoskeleton. When cocultured with PTECs in HG, exacerbated filamentous actin (F-actin) rearrangement and reduced synaptopodin levels were detected in PCs. In contrast, gene knockdown of Bim in PTECs was correlated with the absence of PC cytoskeletal disorganization. NFAT2 level and its nuclear translocation in PTECs were decreased by suppressing Bim expression. Upregulating NFAT2 disrupted the beneficial effects on F-actin organization in PCs obtained by inhibiting Bim. LncRNA microarray analysis identified NONHSAT179542.1, which was implicated in Bim-mediated PC cytoskeletal disorder. Conclusion: Our study clarified the functional role of Bim, a pro-apoptotic factor, which is involved in the crosstalk between PTECs and PCs. Bim promotes NFAT2 activation in PTECs, inducing the downregulation of lncRNA NONHSAT179542.1 in PCs, contributing to the cytoskeletal damage. Identification of the role of the Bim/NFAT2 pathway may represent a promising research direction for a better understanding of DN development.
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Liu KZ, Tian G, Ko ACT, Geissler M, Brassard D, Veres T. Detection of renal biomarkers in chronic kidney disease using microfluidics: progress, challenges and opportunities. Biomed Microdevices 2020; 22:29. [PMID: 32318839 DOI: 10.1007/s10544-020-00484-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chronic kidney disease (CKD) typically evolves over many years in a latent period without clinical signs, posing key challenges to detection at relatively early stages of the disease. Accurate and timely diagnosis of CKD enable effective management of the disease and may prevent further progression. However, long turn-around times of current testing methods combined with their relatively high cost due to the need for established laboratory infrastructure, specialized instrumentation and trained personnel are drawbacks for efficient assessment and monitoring of CKD, especially in underserved and resource-poor locations. Among the emerging clinical laboratory approaches, microfluidic technology has gained increasing attention over the last two decades due to the possibility of miniaturizing bioanalytical assays and instrumentation, thus potentially improving diagnostic performance. In this article, we review current developments related to the detection of CKD biomarkers using microfluidics. A general trend in this emerging area is the search for novel, sensitive biomarkers for early detection of CKD using technology that is improved by means of microfluidics. It is anticipated that these innovative approaches will be soon adopted and utilized in both clinical and point-of-care settings, leading to improvements in life quality of patients.
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Affiliation(s)
- Kan-Zhi Liu
- Medical Devices Research Centre, National Research Council Canada, 435 Ellice Avenue, Winnipeg, MB, R3B1Y6, Canada.
| | - Ganghong Tian
- Medical Devices Research Centre, National Research Council Canada, 435 Ellice Avenue, Winnipeg, MB, R3B1Y6, Canada
| | - Alex C-T Ko
- Medical Devices Research Centre, National Research Council Canada, 435 Ellice Avenue, Winnipeg, MB, R3B1Y6, Canada
| | - Matthias Geissler
- Medical Devices Research Centre, National Research Council Canada, 75 de Mortagne Boulevard, Boucherville, QC, J4B6Y4, Canada
| | - Daniel Brassard
- Medical Devices Research Centre, National Research Council Canada, 75 de Mortagne Boulevard, Boucherville, QC, J4B6Y4, Canada
| | - Teodor Veres
- Medical Devices Research Centre, National Research Council Canada, 75 de Mortagne Boulevard, Boucherville, QC, J4B6Y4, Canada
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Petrica L, Pusztai AM, Vlad M, Vlad A, Gadalean F, Dumitrascu V, Vlad D, Velciov S, Gluhovschi C, Bob F, Ursoniu S, Petrica M, Matusz P, Cretu O, Radu D, Milas O, Secara A, Simulescu A, Popescu R, Jianu DC. MiRNA Expression is Associated with Clinical Variables Related to Vascular Remodeling in the Kidney and the Brain in Type 2 Diabetes Mellitus Patients. Endocr Res 2020; 45:119-130. [PMID: 31724439 DOI: 10.1080/07435800.2019.1690505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The association of vascular remodeling in the kidney and the brain with a particular microRNAs (miRNA) profile is not well studied.Methods: Seventy-six patients with Type 2 diabetes and 11 healthy subjects were assessed concerning urine albumin: creatinine ratio (UACR), biomarkers of podocyte injury and of proximal tubule (PT) dysfunction. MiRNA were quantified in blood and urine by a real-time PCR System. Cerebrovascular ultrasound measurements were performed in the carotid and middle cerebral arteries.Results: MiRNA21 and miRNA124 correlated positively with nephrin, podocalyxin, synaptopodin, urinary N-acetyl-D-glucosaminidase (NAG), urinary kidney-injury molecule-1 (KIM-1), UACR, and negatively with eGFR; miRNA125a, 126, 146a, 192 correlated negatively with nephrin, podocalyxin, synaptopodin, urinary NAG, urinary KIM-1, UACR, and directly with eGFR. Plasma miRNA-21 and miRNA192 correlated directly with cerebral hemodynamics parameters of atherosclerosis and arteriosclerosis. MiRNA-124, 125a, 126, 146a showed negative correlations with the same parameters.Conclusions: In Type 2 diabetes patients there is an association of vascular remodeling in the brain and the kidney with a specific miRNAs pattern. Cerebrovascular changes occur even in normoalbuminuric patients, with 'high-to-normal' levels of podocyte injury and PT dysfunction biomarkers. These phenomena may be explained by the variability of miRNA expression within the two organs in early DKD.
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Affiliation(s)
- Ligia Petrica
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
- "Victor Babes" University of Medicine and Pharmacy, Centre of Translational and Systems Medicine, Timisoara, Romania
| | - Agneta-Maria Pusztai
- Dept. of Anatomy and Embryology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Mihaela Vlad
- Dept. of Endocrinology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Adrian Vlad
- Dept. of Diabetes and Metabolic Diseases, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Florica Gadalean
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Victor Dumitrascu
- Dept. of Pharmacology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Daliborca Vlad
- Dept. of Pharmacology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Silvia Velciov
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Cristina Gluhovschi
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Flaviu Bob
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Sorin Ursoniu
- Dept. of Public Health Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Maxim Petrica
- Dept. of Neurology, "Pius Brinzeu" County Emergency Hospital, Timisoara, Romania
| | - Petru Matusz
- Dept. of Anatomy and Embryology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Octavian Cretu
- Dept. of Surgery I, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Daniela Radu
- Dept. of Surgery II, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Oana Milas
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Alina Secara
- Dept. of Nephrology, "Pius Brinzeu" County Emergency Hospital, Timisoara, Romania
| | - Anca Simulescu
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Roxana Popescu
- Dept. of Cellular and Molecular Biology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Dragos Catalin Jianu
- Dept. of Neurology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
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15
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Milas O, Gadalean F, Vlad A, Dumitrascu V, Velciov S, Gluhovschi C, Bob F, Popescu R, Ursoniu S, Jianu DC, Matusz P, Pusztai AM, Secara A, Simulescu A, Stefan M, Patruica M, Petrica F, Vlad D, Petrica L. Pro-inflammatory cytokines are associated with podocyte damage and proximal tubular dysfunction in the early stage of diabetic kidney disease in type 2 diabetes mellitus patients. J Diabetes Complications 2020; 34:107479. [PMID: 31806428 DOI: 10.1016/j.jdiacomp.2019.107479] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/30/2019] [Accepted: 11/03/2019] [Indexed: 01/18/2023]
Abstract
AIMS To evaluate if there is a link between inflammation (expressed by inflammatory cytokines) and the early stage of diabetic kidney disease (DKD), as shown by markers of podocyte damage and proximal tubular (PT) dysfunction. METHODS In this study were enrolled 117 type 2 DM patients (36-normoalbuminuria, 42-microalbuminuria, 39- macroalbuminuria), and 11 healthy subjects. Serum and urinary IL-1 alpha, IL-8, IL-18, urinary albumin:creatinine ratio (UACR), eGFR, biomarkers of podocyte damage (podocalyxin, synaptopodin, nephrin) and of PT dysfunction (KIM-1, NAG) were assessed. RESULTS In multivariable regression urinary Il-1 alpha correlated positively with podocalyxin and NAG (p < 0.0001, R2= 0.57); urinary IL-8 correlated directly with synaptopodin, NAG, nephrin, and KIM-1 (p < 0.0001, R2 = 0.67); urinary IL-18 correlated directly with synaptopodin, NAG, and nephrin (p < 0.0001, R2 = 0.59). Serum IL-1 alpha correlated positively with nephrin, synaptopodin, NAG (P < 0.0001, R2 = 0.68); serum IL-8 correlated directly with synaptopodin and NAG (p < 0.0001, R2 = 0.66); serum IL-18 correlated directly with NAG, KIM-1, and podocalyxin (p < 0.0001, R2=0.647). CONCLUSIONS Pro-inflammatory interleukins are associated with podocyte injury and PT dysfunction in early DKD. These could exert a key role in the pathogenesis of early DKD, before the development of albuminuria.
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Affiliation(s)
- Oana Milas
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Florica Gadalean
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania.
| | - Adrian Vlad
- Dept. of Diabetes and Metabolic Diseases, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania.
| | - Victor Dumitrascu
- Dept. of Pharmacology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Silvia Velciov
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Cristina Gluhovschi
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania.
| | - Flaviu Bob
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Roxana Popescu
- Dept. of Cellular and Molecular Biology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Sorin Ursoniu
- Dept. of Public Health Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; Centre of Translational Research and Systems Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Dragos Catalin Jianu
- Dept. of Neurology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Petru Matusz
- Dept. of Anatomy and Embryology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania.
| | - Agneta-Maria Pusztai
- Dept. of Anatomy and Embryology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Alina Secara
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Anca Simulescu
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Maria Stefan
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Mihaela Patruica
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Flaviu Petrica
- Nefrotim Medical Center, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Daliborca Vlad
- Dept. of Pharmacology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Ligia Petrica
- Dept. of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; Centre of Translational Research and Systems Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania; "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
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16
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Chen J, Li G, Wang S, Hu X, Sun Y, Dai X, Bai Z, Pan J, Li X, Wang J, Li Y. Urinary Nephrin as a Biomarker of Glomerular Maturation and Injury Is Associated with Acute Kidney Injury and Mortality in Critically Ill Neonates. Neonatology 2019; 116:58-66. [PMID: 30982033 DOI: 10.1159/000499083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nephrin is a key component of the slit diaphragm of the glomerular podocyte, and increased urinary nephrin level may reflect glomerular injury. OBJECTIVES To determine whether urinary nephrin is a useful biomarker of glomerular maturation and injury and whether it is associated with acute kidney injury (AKI) and neonatal intensive care unit (NICU) mortality in critically ill neonates. METHODS Urinary samples were serially collected in 234 neonates during NICU stay for measurements of nephrin, cystatin C (CysC), and albumin. AKI diagnosis was based on neonatal Kidney Disease: Improving Global Outcome (KDIGO) criteria. RESULTS Of the neonates, 26 developed AKI and 24 died during NICU stay. The independent contributors to the initial urinary nephrin level obtained on the first 24 h admitted to NICU were gestational age (p = 0.004) and initial urinary CysC level (p < 0.001). Both initial (p = 0.037) and peak (p = 0.039) urinary nephrin were significantly associated with AKI, even after controlling for significant covariates, and had an area under the receiver-operating characteristic curve (AUC) of 0.71 and 0.70, respectively, for predicting AKI. At the optimal cutoff value of 0.375 μg/mg urinary creatinine, the initial urinary nephrin displayed sensitivity of 61.5% and specificity of 76.9% for predicting AKI. The AUCs for initial and peak urinary nephrin to predict NICU mortality were 0.81 and 0.83, respectively. CONCLUSIONS Urinary nephrin, which may decrease with increasing glomerular maturity, is significantly associated with increased risk for AKI and NICU mortality even after adjustment for potential confounders. A higher level of urinary nephrin may be independently predictive of AKI and NICU mortality in critically ill neonates.
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Affiliation(s)
- Jiao Chen
- Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China
| | - Gen Li
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Sanfeng Wang
- Department of Nephrology, Children's Hospital of Soochow University, Suzhou, China
| | - Xiaohan Hu
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Yunqing Sun
- Department of Nephrology, Children's Hospital of Soochow University, Suzhou, China
| | - Xiaomei Dai
- Department of Nephrology, Children's Hospital of Soochow University, Suzhou, China
| | - Zhenjiang Bai
- Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China
| | - Jian Pan
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Xiaozhong Li
- Department of Nephrology, Children's Hospital of Soochow University, Suzhou, China
| | - Jian Wang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Yanhong Li
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China, .,Department of Nephrology, Children's Hospital of Soochow University, Suzhou, China,
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17
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Gilbert A, Liu J, Cheng G, An C, Deo K, Gorret AM, Qin X. A review of urinary angiotensin converting enzyme 2 in diabetes and diabetic nephropathy. Biochem Med (Zagreb) 2018; 29:010501. [PMID: 30591810 PMCID: PMC6294158 DOI: 10.11613/bm.2019.010501] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/25/2018] [Indexed: 12/20/2022] Open
Abstract
Urinary angiotensin converting enzyme 2 (ACE2) is significantly increased in diabetes and diabetic nephropathy. While studies on its clinical significance are still underway, its urinary expression, association with metabolic and renal parameters has been in the recent past considerably studied. The recent studies have demystified urine ACE2 in many ways and suggested the roles it could play in the management of diabetic nephropathy. In all studies the expression of urinary ACE2 was determined by enzyme activity assay and/with the quantification of ACE2 protein and mRNA by methods whose reliability are yet to be evaluated. This review summarizes recent findings on expression of urinary ACE2, examines its relationship with clinical parameters and highlights possible applications in management of diabetic nephropathy.
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Affiliation(s)
- Akankwasa Gilbert
- Department of laboratory medicine, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Jianhua Liu
- Department of laboratory medicine, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Guixue Cheng
- Department of laboratory medicine, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Changjuan An
- Department of laboratory medicine, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Kabuye Deo
- Department of laboratory medicine, First Teaching Hospital of China Medical University, Shenyang, People's Republic of China
| | - Abalinda Mary Gorret
- Department of medical laboratory science, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Xiaosong Qin
- Department of laboratory medicine, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
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18
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Żyłka A, Dumnicka P, Kuśnierz-Cabala B, Gala-Błądzińska A, Ceranowicz P, Kucharz J, Ząbek-Adamska A, Maziarz B, Drożdż R, Kuźniewski M. Markers of Glomerular and Tubular Damage in the Early Stage of Kidney Disease in Type 2 Diabetic Patients. Mediators Inflamm 2018; 2018:7659243. [PMID: 30158836 DOI: 10.1155/2018/7659243] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/25/2018] [Accepted: 07/10/2018] [Indexed: 01/17/2023] Open
Abstract
Diabetic kidney disease develops in half of genetically predisposed patients with type 2 diabetes (T2DM). Early diagnosis of kidney damage and nephroprotective treatment are the ways of preventing the disease progression. Our aim was to evaluate selected laboratory markers of glomerular and tubular damage in T2DM patients with early stages of chronic kidney disease (G1/G2, A1/A2) for their associations with A2 albuminuria and early decline in the estimated glomerular filtration rate (eGFR). Among 80 T2DM patients with median eGFR of 92.4 ml/min/1.73 m2 and median urinary albumin to creatinine ratio (uACR) of 4.69 mg/g, 19 had uACR > 30 mg/g (A2). Higher serum cystatin C, serum and urine neutrophil gelatinase associated lipocalin (NGAL), urine kidney injury molecule 1 (KIM-1), detectable urine transferrin and IgG, and lower serum uromodulin significantly predicted A2 albuminuria, urine KIM-1/creatinine ratio, and IgG being the best predictors. Albuminuria, urine NGAL/creatinine, and IgG correlated with diabetes duration. Albuminuria, urine NGAL, transferrin, IgG, and uromodulin correlated with diabetes control. In a subgroup of 29 patients, retrospective data were available on changes in eGFR and uACR over one year. Decline in eGFR was observed in 17 patients and increase in uACR in 10 patients. Serum and urine NGAL correlated with eGFR changes. Higher urine NGAL, KIM-1/creatinine ratio, and detectable IgG were significantly associated with the increase in uACR. Widely available markers, serum cystatin C, urine IgG, transferrin, and NGAL, may help in early assessment of kidney disease in T2DM patients; however, large prospective studies are needed to confirm the conclusion.
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19
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Akankwasa G, Jianhua L, Guixue C, Changjuan A, Xiaosong Q. Urine markers of podocyte dysfunction: a review of podocalyxin and nephrin in selected glomerular diseases. Biomark Med 2018; 12:927-935. [PMID: 29976076 DOI: 10.2217/bmm-2018-0152] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Urinary podocalyxin and nephrin are urine markers of podocyte dysfunction that may reflect the integrity of kidney's filtration barrier. Studies on their respective roles in glomerular diseases are still underway. However, the isolated and unsystematic manner in which they are being studied does not permit proper identification of their roles in each glomerular disease. As such, there is little or no appreciation of what research has already achieved and what remains to be achieved as the research direction is not clearly defined. We explored the recent studies and outlined the major findings regarding the value of both biomarkers in each of the three glomerular disease entities. Our review covered diabetic nephropathy, membranous nephropathy and IgA nephropathy.
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Affiliation(s)
- Gilbert Akankwasa
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District Shenyang, Liaoning 110004, PR China
| | - Liu Jianhua
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District Shenyang, Liaoning 110004, PR China
| | - Cheng Guixue
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District Shenyang, Liaoning 110004, PR China
| | - An Changjuan
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District Shenyang, Liaoning 110004, PR China
| | - Qin Xiaosong
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District Shenyang, Liaoning 110004, PR China
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20
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Abstract
Diabetic kidney disease (DKD) remains one of the leading causes of reduced lifespan in diabetes. The quest for both prognostic and surrogate endpoint biomarkers for advanced DKD and end-stage renal disease has received major investment and interest in recent years. However, at present no novel biomarkers are in routine use in the clinic or in trials. This review focuses on the current status of prognostic biomarkers. First, we emphasise that albuminuria and eGFR, with other routine clinical data, show at least modest prediction of future renal status if properly used. Indeed, a major limitation of many current biomarker studies is that they do not properly evaluate the marginal increase in prediction on top of these routinely available clinical data. Second, we emphasise that many of the candidate biomarkers for which there are numerous sporadic reports in the literature are tightly correlated with each other. Despite this, few studies have attempted to evaluate a wide range of biomarkers simultaneously to define the most useful among these correlated biomarkers. We also review the potential of high-dimensional panels of lipids, metabolites and proteins to advance the field, and point to some of the analytical and post-analytical challenges of taking initial studies using these and candidate approaches through to actual clinical biomarker use.
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Affiliation(s)
- Helen M Colhoun
- MRC Institute of Genetics & Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.
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21
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Zhang Q, Jiang X, Cui X, Liu R. A study on the biological reference interval of urinary alpha 1-microglobulin in a group of Chinese people. J Clin Lab Anal 2018; 32:e22305. [PMID: 28771883 PMCID: PMC6816998 DOI: 10.1002/jcla.22305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/11/2017] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore the possible influences of age and gender on urinary Alpha 1-Microglobulin (α1-MG) concentrations and establish specific reference values of urinary α1-MG in a group of healthy adults. METHODS Two hundred and ninety-nine adults (141 males and 158 females) aged 20-60 were selected and grouped by gender and age. Urinary levels of α1-MG were detected in morning spot-urine samples, and statistical analysis was performed to explore the association between urinary α1-MG and clinical parameters, and the differences between groups were compared. The 95th percentile of distribution was used as the normal upper limit. RESULTS The value of urinary α1-MG was sex-dependent (P<0.001), the 95th percentile of urinary α1-MG of males was 26.4 mg/L, whereas females was 8.6 mg/L. Whereas urinary α1-microglobulin-to-creatinine ratio (α1-MG/Cr) was both gender-and age-dependent (both P<0.001), and age 30 may be the cut-off point in this study. The 95th percentile of males and females aged 20-30 was 16.9 mg/g, of males aged 31-60 was 19.8 mg/g, of females aged 31-60 was 28.5 mg/g. DISCUSSIONS The relationship between urinary α1-MG concentrations and gender, age is different from previous studies. It is recommended that hospitals and laboratories should develop their own α1-MG reference intervals based on their experimental conditions.
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Affiliation(s)
- Qian Zhang
- Graduate School of Tianjin Medical UniversityTianjinChina
- Department of Clinical LaboratoryTianjin Union Medical CenterTianjinChina
| | - Xu Jiang
- Graduate School of Tianjin Medical UniversityTianjinChina
| | - Xiao‐Fan Cui
- Department of Clinical LaboratoryTianjin Union Medical CenterTianjinChina
| | - Rui Liu
- Department of Clinical LaboratoryTianjin Union Medical CenterTianjinChina
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22
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Kato T, Hagiyama M, Takashima Y, Yoneshige A, Ito A. Cell adhesion molecule-1 shedding induces apoptosis of renal epithelial cells and exacerbates human nephropathies. Am J Physiol Renal Physiol 2018; 314:F388-F398. [PMID: 29070574 PMCID: PMC6048447 DOI: 10.1152/ajprenal.00385.2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 12/15/2022] Open
Abstract
Chronic kidney disease (CKD) is an important problem throughout the world, associated with the increase of blood urea nitrogen (BUN) and serum creatinine (sCre) and with renal tubular injuries. It is crucial to elucidate the molecular mechanisms of renal injuries to identify the new therapeutics and early diagnostic methods. We focused on cell adhesion molecule-1 (CADM1) protein. CADM1, its isoform SP4, is expressed in the epithelial cells of various tissues, including renal distal tubules, localized on the lateral cell membrane, mediates cell-cell adhesion via trans-homophilic binding, and interacts with various proteins. We previously reported that its expression was downregulated by post-proteolytic cleavage (α- and β-shedding) in pulmonary diseases. To investigate whether CADM1 α-shedding occurs in human nephropathies, we performed Western blotting and immunohistochemical analysis of specimens with arterionephrosclerosis (AS) and diabetic nephropathy (DN) from autopsied kidneys. CADM1 α-shedding was induced in AS and DN kidneys and derived from the decrease in full-length CADM1 (FL-CADM1) and increase of the COOH-terminal fragment (α-CTF). In particular, the reduced FL-CADM1 level was correlated with tubular and tubulointerstitial injuries and the increases in BUN and sCre levels. Apoptosis of renal tubular epithelial cells (TECs) was promoted in both nephropathies, and it was significantly correlated with the decrease in the FL-CADM1. Furthermore, FL-CADM1 knockdown by small interfering RNA downregulated anti-apoptotic Bcl-2 protein and promoted apoptosis of cultured renal TECs. The present study suggests that the reduction of FL-CADM1 leads to renal TEC apoptosis and could exacerbate renal tubular and tubulointerstitial injuries, which contribute to the development of CKD.
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Affiliation(s)
- Takashi Kato
- Department of Pathology, Faculty of Medicine, Kindai University , Osaka , Japan
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Man Hagiyama
- Department of Pathology, Faculty of Medicine, Kindai University , Osaka , Japan
| | - Yasutoshi Takashima
- Department of Pathology, Faculty of Medicine, Kindai University , Osaka , Japan
| | - Azusa Yoneshige
- Department of Pathology, Faculty of Medicine, Kindai University , Osaka , Japan
| | - Akihiko Ito
- Department of Pathology, Faculty of Medicine, Kindai University , Osaka , Japan
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23
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Milas O, Gadalean F, Vlad A, Dumitrascu V, Gluhovschi C, Gluhovschi G, Velciov S, Popescu R, Bob F, Matusz P, Pusztai AM, Cretu OM, Secara A, Simulescu A, Ursoniu S, Vlad D, Petrica L. Deregulated profiles of urinary microRNAs may explain podocyte injury and proximal tubule dysfunction in normoalbuminuric patients with type 2 diabetes mellitus. J Investig Med 2017; 66:747-754. [PMID: 29279420 DOI: 10.1136/jim-2017-000556] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2017] [Indexed: 12/14/2022]
Abstract
MicroRNAs (miRNAs) are short non-coding RNA species that are important post-transcriptional regulators of gene expression. The aim of the study was to establish a potential explanation of podocyte damage and proximal tubule (PT) dysfunction induced by deregulated miRNAs expression in the course of type 2 diabetes mellitus (DM). A total of 68 patients with type 2 DM and 11 healthy subjects were enrolled in a cross-sectional study and assessed concerning urinary albumin:creatinine ratio (UACR), urinary N-acetyl-β-D-glucosamininidase (NAG), urinary kidney injury molecule-1, urinary nephrin, podocalyxin, synaptopodin, estimated glomerular filtration rate (eGFR), urinary miRNA21, miRNA124, and miRNA192. In univariable regression analysis, miRNA21, miRNA124, and miRNA192 correlated with urinary nephrin, synaptopodin, podocalyxin, NAG, KIM-1, UACR, and eGFR. Multivariable regression analysis yielded models in which miRNA192 correlated with synaptopodin, uNAG, and eGFR (R2=0.902; P<0.0001), miRNA124 correlated with synaptopodin, uNAG, UACR, and eGFR (R2=0.881; P<0.0001), whereas miRNA21 correlated with podocalyxin, uNAG, UACR, and eGFR (R2=0.882; P<0.0001). Urinary miRNA192 expression was downregulated, while urinary miRNA21 and miRNA124 expressions were upregulated. In patients with type 2 DM, there is an association between podocyte injury and PT dysfunction, and miRNA excretion, even in the normoalbuminuria stage. This observation documents a potential role of the urinary profiles of miRNA21, miRNA124, and miRNA192 in early DN. Despite their variability across the segments of the nephron, urinary miRNAs may be considered as a reliable tool for the identification of novel biomarkers in order to characterize the genetic pattern of podocyte damage and PT dysfunction in early DN of type 2 DM.
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Affiliation(s)
- Oana Milas
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Florica Gadalean
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Adrian Vlad
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Diabetes and Metabolic Diseases, County Emergency Hospital Timisoara, Timisoara, Romania
| | - Victor Dumitrascu
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Pharmacology, Timisoara, Romania
| | - Cristina Gluhovschi
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Gheorghe Gluhovschi
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Silvia Velciov
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Roxana Popescu
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Cellular and Molecular Biology, Timisoara, Romania
| | - Flaviu Bob
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Petru Matusz
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Anatomy and Embryology, Timisoara, Romania
| | - Agneta-Maria Pusztai
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Anatomy and Embryology, Timisoara, Romania
| | - Octavian M Cretu
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Surgery I, Timisoara, Romania
| | - Alina Secara
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Anca Simulescu
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Sorin Ursoniu
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Public Health Medicine, Timisoara, Romania.,Centre of Translational Research and Systems Medicine, Timisoara, Romania
| | - Daliborca Vlad
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Pharmacology, Timisoara, Romania
| | - Ligia Petrica
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Centre of Translational Research and Systems Medicine, Timisoara, Romania
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24
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Zhang J, Zhang X, Zhao Y, Lv G. Association Between Urinary Alpha1-Microglobulin Levels and Nonalcoholic Fatty Liver Disease: A Cross-Sectional Study. Ann Nutr Metab 2017; 72:30-36. [PMID: 29232673 DOI: 10.1159/000484255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/04/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND We aimed to explore the association between urinary alpha1-microglobulin (A1M) levels and nonalcoholic fatty liver disease (NAFLD) in a Chinese population. STUDY We performed a cross-sectional study among 2,215 Chinese who attended their annual health examination at First Affiliated Hospital, College of Medicine, Zhejiang University. Urinary A1M-creatinine ratio and other clinical and laboratory parameters were measured. RESULTS A total of 20.9% of subjects fulfilled the diagnostic criteria of NAFLD. NAFLD subjects had significantly higher urinary A1M-creatinine ratios. These levels were positively associated with NAFLD prevalence. The association between A1M-creatinine ratio and NAFLD was independent of hyperglycemia status. Stepwise regression showed that urinary A1M-creatinine ratio was significantly associated with the risk for NAFLD. Urinary A1M-creatinine ratio was an independent factor predicting advanced fibrosis (FIB-4 ≥1.3) in NAFLD patients. CONCLUSIONS Our results showed a significant association between urinary A1M-creatinine ratio and NAFLD.
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Affiliation(s)
- Juanwen Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xuyao Zhang
- Clinical Medicine, Hangzhou Normal University Qianjiang College, Hangzhou, China
| | - Ying Zhao
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Guocai Lv
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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25
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Vlad A, Vlad M, Petrica L, Ursoniu S, Gadalean F, Popescu R, Vlad D, Dumitrascu V, Gluhovschi G, Gluhovschi C, Velciov S, Bob F, Matusz P, Secara A, Simulescu A, Jianu DC. Therapy with atorvastatin versus rosuvastatin reduces urinary podocytes, podocyte-associated molecules, and proximal tubule dysfunction biomarkers in patients with type 2 diabetes mellitus: a pilot study. Ren Fail 2017; 39:112-119. [PMID: 27841047 PMCID: PMC6014491 DOI: 10.1080/0886022x.2016.1254657] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 09/28/2016] [Accepted: 10/25/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diabetic nephropathy is a severe complication of Type 2 diabetes. Tubular lesions may play an important role in its early stages. The aim of our study was to determine if atorvastatin protects the podocytes and the proximal tubule in patients with Type 2 diabetes. METHODS A total of 63 patients with Type 2 diabetes completed this 6-months prospective pilot study. They were randomized to continue rosuvastatin therapy (control group) or to be administered an equipotent dose of atorvastatin (intervention group), and were assessed regarding urinary podocytes, podocyte-associated molecules, and biomarkers of proximal tubule dysfunction. RESULTS The patients from the intervention group presented a significant reduction in podocyturia (from 7.0 to 4.0 cells/ml, p < .05), urinary nephrin (from 1.7 to 1.3 mg/g, p < .001), urinary vascular endothelial growth factor (from 262.8 to 256.9, p < .01), urinary alpha1-microglobulin (from 10.0 to 8.3 mg/g, p < .01), urinary kidney injury molecule-1 (from 139.5 to 136.3 ng/g, p < .001), and urinary advanced glycation end-products (from 112.6 to 101.3 pg/ml, p < .001). Podocyturia correlated directly with the podocyte damage biomarkers, proximal tubule dysfunction biomarkers, albumin to creatinine ratio, and advanced glycation end-products, and inversely with the glomerular filtration rate. CONCLUSIONS In patients with Type 2 diabetes, atorvastatin exerts favorable effects on the kidney. There is a correlation between the evolution of the podocytes and of the proximal tubule biomarkers, supporting the hypothesis that the glomerular changes parallel proximal tubule dysfunction in the early stages of diabetic nephropathy.
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Affiliation(s)
- Adrian Vlad
- Department of Diabetes and Metabolic Diseases, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Mihaela Vlad
- Department of Endocrinology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Ligia Petrica
- Department of Nephrology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Sorin Ursoniu
- Department of Public Health Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Florica Gadalean
- Department of Nephrology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Roxana Popescu
- Department of Cellular and Molecular Biology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Daliborca Vlad
- Department of Pharmacology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Victor Dumitrascu
- Department of Pharmacology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Gheorghe Gluhovschi
- Department of Nephrology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Cristina Gluhovschi
- Department of Nephrology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Silvia Velciov
- Department of Nephrology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Flaviu Bob
- Department of Nephrology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Petru Matusz
- Department of Anatomy, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Alina Secara
- Department of Nephrology, “Pius Brinzeu”, County Emergency Hospital, Timisoara, Romania
| | - Anca Simulescu
- Department of Nephrology, “Pius Brinzeu”, County Emergency Hospital, Timisoara, Romania
| | - Dragos Catalin Jianu
- Department of Neurology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
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26
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Papadopoulou-Marketou N, Kanaka-Gantenbein C, Marketos N, Chrousos GP, Papassotiriou I. Biomarkers of diabetic nephropathy: A 2017 update. Crit Rev Clin Lab Sci 2017; 54:326-342. [DOI: 10.1080/10408363.2017.1377682] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Nektaria Papadopoulou-Marketou
- Diabetes Centre of the Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
- Department of Endocrinology, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Christina Kanaka-Gantenbein
- Diabetes Centre of the Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | | | - George P. Chrousos
- Diabetes Centre of the Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, “Aghia Sophia” Children’s Hospital, Athens, Greece
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27
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Petrica L, Vlad M, Vlad A, Gluhovschi G, Gadalean F, Dumitrascu V, Popescu R, Gluhovschi C, Matusz P, Velciov S, Bob F, Ursoniu S, Vlad D. Podocyturia parallels proximal tubule dysfunction in type 2 diabetes mellitus patients independently of albuminuria and renal function decline: A cross-sectional study. J Diabetes Complications 2017; 31:1444-1450. [PMID: 28161386 DOI: 10.1016/j.jdiacomp.2017.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/21/2016] [Accepted: 01/03/2017] [Indexed: 01/01/2023]
Abstract
AIMS Detection of podocytes in the urine of patients with type 2 diabetes may indicate severe injury to the podocytes. In the course of type 2 diabetes the proximal tubule is involved in urinary albumin processing. We studied the significance of podocyturia in relation with proximal tubule dysfunction in type 2 diabetes. METHODS A total of 86 patients with type 2 diabetes (34-normoalbuminuria; 30-microalbuminuria; 22-macroalbuminuria) and 28 healthy subjects were enrolled in the study and assessed concerning urinary podocytes, podocyte-associated molecules, and biomarkers of proximal tubule dysfunction. Urinary podocytes were examined in cell cultures by utilizing monoclonal antibodies against podocalyxin and synaptopodin. RESULTS Podocytes were detected in the urine of 10% of the healthy controls, 24% of the normoalbuminuric, 40% of the microalbuminuric, and 82% of the macroalbuminuric patients. In multivariate logistic regression analysis, urinary podocytes correlated with urinary albumin:creatinine ratio (p=0.006), urinary nephrin/creat (p=0.001), urinary vascular endothelial growth factor/creat (p=0.001), urinary kidney injury molecule-1/creat (p=0.003), cystatin C (p=0.001), urinary advanced glycation end-products (p=0.002), eGFR (p=0.001). CONCLUSIONS In patients with type 2 diabetes podocyturia parallels proximal tubule dysfunction independently of albuminuria and renal function decline. Advanced glycation end-products may impact the podocytes and the proximal tubule.
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Affiliation(s)
- Ligia Petrica
- "Victor Babes" University of Medicine and Pharmacy, Department of Nephrology, P-ta Eftimie Murgu 2A, 300041 Timisoara, Romania
| | - Mihaela Vlad
- "Victor Babes" University of Medicine and Pharmacy, Department of Endocrinology, P-ta Eftimie Murgu 2A, 300041 Timisoara, Romania.
| | - Adrian Vlad
- "Victor Babes" University of Medicine and Pharmacy, Department of Diabetes and Metabolic Diseases, P-ta Eftimie Murgu 2A, 300041 Timisoara, Romania
| | - Gheorghe Gluhovschi
- "Victor Babes" University of Medicine and Pharmacy, Department of Nephrology, P-ta Eftimie Murgu 2A, 300041 Timisoara, Romania
| | - Florica Gadalean
- "Victor Babes" University of Medicine and Pharmacy, Department of Nephrology, P-ta Eftimie Murgu 2A, 300041 Timisoara, Romania
| | - Victor Dumitrascu
- "Victor Babes" University of Medicine and Pharmacy, Department of Pharmacology, P-ta Eftimie Murgu 2A, 300041 Timisoara, Romania
| | - Roxana Popescu
- "Victor Babes" University of Medicine and Pharmacy, Department of Cellular and Molecular Biology, P-ta Eftimie Murgu 2A, 300041 Timisoara, Romania
| | - Cristina Gluhovschi
- "Victor Babes" University of Medicine and Pharmacy, Department of Nephrology, P-ta Eftimie Murgu 2A, 300041 Timisoara, Romania
| | - Petru Matusz
- "Victor Babes" University of Medicine and Pharmacy, Department of Anatomy and Embryology, P-ta Eftimie Murgu 2A, 300041 Timisoara, Romania
| | - Silvia Velciov
- "Victor Babes" University of Medicine and Pharmacy, Department of Nephrology, P-ta Eftimie Murgu 2A, 300041 Timisoara, Romania
| | - Flaviu Bob
- "Victor Babes" University of Medicine and Pharmacy, Department of Nephrology, P-ta Eftimie Murgu 2A, 300041 Timisoara, Romania
| | - Sorin Ursoniu
- "Victor Babes" University of Medicine and Pharmacy, Department of Public Health Medicine, P-ta Eftimie Murgu 2A, 300041 Timisoara, Romania
| | - Daliborca Vlad
- "Victor Babes" University of Medicine and Pharmacy, Department of Pharmacology, P-ta Eftimie Murgu 2A, 300041 Timisoara, Romania
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Abstract
Diabetic nephropathy (DN) is a common complication of Diabetes Mellitus (DM) Types 1 and 2, and prevention of end stage renal disease (ESRD) remains a major challenge. Despite its high prevalence, the pathogenesis of DN is still controversial. Initial glomerular disease manifested by hyperfiltration and loss of glomerular size and charge permselectivity may initiate a cascade of injuries, including tubulo-interstitial disease. Clinically, ‘microalbuminuria’ is still accepted as an early biomarker of glomerular damage, despite mounting evidence that its predictive value for DN is questionable, and findings that suggest the proximal tubule is an important link in the development of DN. The concept of ‘diabetic tubulopathy’ has emerged from recent studies, and its causative role in DN is supported by clinical and experimental evidence, as well as plausible pathogenetic mechanisms. This review explores the ‘tubulocentric’ view of DN. The recent finding that inhibition of proximal tubule (PT) glucose transport (via SGLT2) is nephro-protective in diabetic patients is discussed in relation to the tubule’s potential role in DN. Studies with a tubulocentric view of DN have stimulated alternative clinical approaches to the early detection of diabetic kidney disease. There are tubular biomarkers considered as direct indicators of injury of the proximal tubule (PT), such as N-acetyl-β-D-glucosaminidase, Neutrophil Gelatinase-Associated Lipocalin and Kidney Injury Molecule-1, and other functional PT biomarkers, such as Urine free Retinol-Binding Protein 4 and Cystatin C, which reflect impaired reabsorption of filtered proteins. The clinical application of these measurements to diabetic patients will be reviewed in the context of the need for better biomarkers for early DN.
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Affiliation(s)
- Letizia Zeni
- Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Piazza del Mercato 15, 25121, Brescia, Italy. .,UCL Centre for Nephrology, UCL Medical School, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK. .,Operative Unit of Nephrology, ASST Spedali Civili, Piazzale Spedali Civili 1, Brescia, Italy.
| | - Anthony G W Norden
- UCL Centre for Nephrology, UCL Medical School, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Giovanni Cancarini
- Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Piazza del Mercato 15, 25121, Brescia, Italy.,Operative Unit of Nephrology, ASST Spedali Civili, Piazzale Spedali Civili 1, Brescia, Italy
| | - Robert J Unwin
- UCL Centre for Nephrology, UCL Medical School, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.,Cardiovascular and Metabolic Diseases iMED ECD, AstraZeneca Gothenburg, Mölndal, Sweden
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29
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Abstract
Diabetic nephropathy (DN) is one of the microvascular complications of the kidney arising commonly from type 1 diabetes mellitus (T1DM), and occasionally from type 2 diabetes mellitus (T2DM). Microalbuminuria serves as an early indicator of DN risk and a predictor of its progression as well as cardiovascular disease risk in both T1DM and T2DM. Although microalbuminuria remains the gold standard for early detection of DN, it is not a sufficiently accurate predictor of DN risk due to some limitations. Thus, there is a paradigm shift to novel biomarkers which would help to predict DN risk early enough and possibly prevent the occurrence of end-stage kidney disease. These new biomarkers have been broadly classified into glomerular biomarkers, tubular biomarkers, biomarkers of inflammation, biomarkers of oxidative stress, and miscellaneous biomarkers which also include podocyte biomarkers, some of which are also considered as tubular and glomerular biomarkers. Although they are potentially useful for the evaluation of DN, current data still preclude the routine clinical use of majority of them. However, their validation using high-quality and large longitudinal studies is of paramount importance, as well as the subsequent development of a biomarker panel which can reliably predict and evaluate this renal microvascular disease. This paper aims to review the predictive role of these biomarkers in the evaluation of DN.
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Affiliation(s)
- Samuel N Uwaezuoke
- Pediatric Nephrology Firm, Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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30
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Campion CG, Sanchez-Ferras O, Batchu SN. Potential Role of Serum and Urinary Biomarkers in Diagnosis and Prognosis of Diabetic Nephropathy. Can J Kidney Health Dis 2017; 4:2054358117705371. [PMID: 28616250 PMCID: PMC5461910 DOI: 10.1177/2054358117705371] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 02/17/2017] [Indexed: 12/11/2022] Open
Abstract
Purpose of review: Diabetic nephropathy (DN) is a progressive kidney disease caused by alterations in kidney architecture and function, and constitutes one of the leading causes of end-stage renal disease (ESRD). The purpose of this review is to summarize the state of the art of the DN-biomarker field with a focus on the new strategies that enhance the sensitivity of biomarkers to predict patients who will develop DN or are at risk of progressing to ESRD. Objective: In this review, we provide a description of the pathophysiology of DN and propose a panel of novel putative biomarkers associated with DN pathophysiology that have been increasingly investigated for diagnosis, to predict disease progression or to provide efficient personal treatment. Methods: We performed a review of the literature with PubMed and Google Scholar to collect baseline data about the pathophysiology of DN and biomarkers associated. We focused our research on new and emerging biomarkers of DN. Key findings: In this review, we summarized the critical signaling pathways and biological processes involved in DN and highlighted the pathogenic mediators of this disease. We next proposed a large review of the major advances that have been made in identifying new biomarkers which are more sensitive and reliable compared with currently used biomarkers. This includes information about emergent biomarkers such as functional noncoding RNAs, microRNAs, long noncoding RNAs, exosomes, and microparticles. Limitations: Despite intensive strategies and constant investigation, no current single treatment has been able to reverse or at least mitigate the progression of DN, or reduce the morbidity and mortality associated with this disease. Major difficulties probably come from the renal disease being heterogeneous among the patients. Implications: Expanding the proteomics screening, including oxidative stress and inflammatory markers, along with metabolomics approaches may further improve the prognostic value and help in identifying the patients with diabetes who are at high risk of developing kidney diseases.
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Affiliation(s)
- Carole G Campion
- Centre de recherche, Centre Hospitalier de l'Université de Montréal (CRCHUM), Québec, Canada
| | - Oraly Sanchez-Ferras
- Department of Biochemistry, Goodman Cancer Research Centre, McGill University, Montreal, Québec, Canada
| | - Sri N Batchu
- St. Michael's Hospital, University of Toronto, Ontario, Canada
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31
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Petrica L, Ursoniu S, Gadalean F, Vlad A, Gluhovschi G, Dumitrascu V, Vlad D, Gluhovschi C, Velciov S, Bob F, Matusz P, Milas O, Secara A, Simulescu A, Popescu R. Urinary podocyte-associated mRNA levels correlate with proximal tubule dysfunction in early diabetic nephropathy of type 2 diabetes mellitus. Diabetol Metab Syndr 2017; 9:31. [PMID: 28484521 PMCID: PMC5420400 DOI: 10.1186/s13098-017-0228-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 04/27/2017] [Indexed: 02/07/2023] Open
Abstract
AIM The study assessed mRNA expression of podocyte-associated molecules in urinary sediments of patients with type 2 diabetes mellitus (DM) in relation to urinary podocytes, biomarkers of podocyte injury and of proximal tubule (PT) dysfunction. METHODS A total of 76 patients with type 2 DM and 20 healthy subjects were enrolled in a cross-sectional study, and assessed concerning urinary podocytes, urinary mRNA of podocyte-associated genes, urinary biomarkers of podocyte damage and of PT dysfunction. RESULTS We found significant differences between urinary mRNA of podocyte-associated molecules in relation with albuminuria stage. In multivariable regression analysis, urinary mRNA of nephrin, podocin, alpha-actinin-4, CD2-associated protein, glomerular epithelial protein 1 (GLEPP1), ADAM 10, and NFκB correlated directly with urinary podocytes, albuminuria, urinary alpha1-microglobulin, urinary kidney-injury molecule-1, nephrinuria, urinary vascular endothelial growth factor, urinary advanced glycation end-products (AGE), and indirectly with eGFR (p < 0.0001, R2 = 0.808; p < 0.0001, R2 = 0.825; p < 0.0001, R2 = 0.805; p < 0.0001, R2 = 0.663; p < 0.0001, R2 = 0.726; p < 0.0001, R2 = 0.720; p < 0.0001, R2 = 0.724). CONCLUSIONS In patients with type 2 DM there is an association between urinary mRNA of podocyte-associated molecules, biomarkers of podocyte damage, and of PT dysfunction. GLEPP1, ADAM10, and NFκB may be considered additional candidate molecules indicative of early diabetic nephropathy. AGE could be involved in this association.
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Affiliation(s)
- Ligia Petrica
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- Centre for Translational Research and Systems Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Sorin Ursoniu
- Department of Public Health Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Florica Gadalean
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Adrian Vlad
- Department of Diabetes and Metabolic Diseases, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Gheorghe Gluhovschi
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Victor Dumitrascu
- Department of Pharmacology, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Daliborca Vlad
- Department of Pharmacology, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Cristina Gluhovschi
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Silvia Velciov
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Flaviu Bob
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Petru Matusz
- Department of Anatomy and Embryology, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Oana Milas
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Alina Secara
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Anca Simulescu
- Department of Nephrology, ‘Victor Babes’ University of Medicine and Pharmacy, Str. Iuliu Grozescu, No 6, Bl T27, Ap 10, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
| | - Roxana Popescu
- Department of Cellular and Molecular Biology, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
- County Emergency Hospital, Timisoara, Romania
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Leung WK, Gao L, Siu PM, Lai CW. Diabetic nephropathy and endothelial dysfunction: Current and future therapies, and emerging of vascular imaging for preclinical renal-kinetic study. Life Sci 2016; 166:121-130. [PMID: 27765534 DOI: 10.1016/j.lfs.2016.10.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 02/07/2023]
Abstract
An explosion in global epidemic of type 2 diabetes mellitus poses major rise in cases with vascular endothelial dysfunction ranging from micro- (retinopathy, nephropathy and neuropathy) to macro-vascular (atherosclerosis and cardiomyopathy) conditions. Functional destruction of endothelium is regarded as an early event that lays the groundwork for the development of renal microangiopathy and subsequent clinical manifestation of nephropathic symptoms. Recent research has shed some light on the molecular mechanisms of type 2 diabetes-associated comorbidity of endothelial dysfunction and nephropathy. Stemming from currently proposed endothelium-centered therapeutic strategies for diabetic nephropathy, this review highlighted some most exploited pathways that involve the intricate coordination of vasodilators, vasoconstrictors and vaso-modulatory molecules in the pathogenesis of diabetic nephropathy. We also emphasized the emerging roles of oxidative and epigenetic modifications of microvasculature as our prospective therapeutics for diabetic renal diseases. Finally, this review in particular addressed the potential use of multispectral optoacoustic tomography in real-time, minimally-invasive vascular imaging of small experimental animals for preclinical renal-kinetic drug trials.
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Affiliation(s)
- Wilson Kc Leung
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, HKSAR, China
| | - L Gao
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, HKSAR, China
| | - Parco M Siu
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, HKSAR, China
| | - Christopher Wk Lai
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, HKSAR, China.
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Mariana CP, Ramona PA, Ioana BC, Diana M, Claudia RC, Stefan VD, Maria KI. Urinary angiotensin converting enzyme 2 is strongly related to urinary nephrin in type 2 diabetes patients. Int Urol Nephrol 2016; 48:1491-7. [PMID: 27312782 DOI: 10.1007/s11255-016-1334-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/23/2016] [Indexed: 01/27/2023]
Abstract
PURPOSE Podocyte lesion is recently recognized as an early event in diabetic kidney disease (DKD) and is reflected by urinary (u) nephrin (Neph) shedding. Angiotensin II plays an important role in podocyte dysfunction of diabetes. Angiotensin converting enzyme 2 (ACE2) is the main ACE variant in podocytes and counteracts deleterious angiotensin II effects. We assessed for the first time the relation of uACE2 and uNeph in type 2 diabetes subjects. MATERIAL AND METHOD Seventy-five type 2 diabetes patients were included in a transversal study. History, clinical and laboratory data, urinary albumin-to-creatinine ratio (uACR), and ELISA determination of uNeph and uACE2 were obtained. RESULTS uNeph was 349.00 ± 133.42 pg/ml, and uACE2 was 45.50 (36.35-62.60) pg/ml. uNeph correlated to uACE2 (r = 0.44, p < 0.001) and to uACR (r = 0.25, p = 0.032). In multivariate regression, introducing parameters that are known to be related to DKD, uACE2 (p < 0.0001), LDL cholesterol (p = 0.02) and glycated hemoglobin (p = 0.03) remained significant predictors of uNeph. Normoalbuminuric patients had lower uNeph than patients with uACR > 30 mg/g (325.50 ± 135.45 vs 391.03 ± 121.40 pg/ml, p = 0.04); they also had a tendency versus lower uACE2 [41.40 (34.30-60.65) vs 52.57 (37.95-69.85) pg/ml, p = 0.06]. A cutoff for uNeph of 451.6 pg/ml was derived from the ROC curve analysis; uACE2 was the main determinant for uNeph being above or below this cutoff-OR = 1.09; 95 %CI (1.04-1.15), p = 0.001. Patients taking blockers of the renin angiotensin system had similar uNeph and uACE2. uNeph and uACE2 were not influenced by renal function. CONCLUSION uNeph is significantly correlated to uACE2 and uACR in type 2 diabetes patients.
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Affiliation(s)
- Ciorba Pop Mariana
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Potra Alina Ramona
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania.
| | - Bondor Cosmina Ioana
- Department of Informatics and Biostatistics, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj, 6 Pasteur Street, 400349, Cluj-Napoca, Romania
| | - Moldovan Diana
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Rusu Crina Claudia
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Vladutiu Dan Stefan
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Kacso Ina Maria
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
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34
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Audzeyenka I, Rogacka D, Piwkowska A, Rychlowski M, Bierla JB, Czarnowska E, Angielski S, Jankowski M. Reactive oxygen species are involved in insulin-dependent regulation of autophagy in primary rat podocytes. Int J Biochem Cell Biol 2016; 75:23-33. [DOI: 10.1016/j.biocel.2016.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 03/10/2016] [Accepted: 03/25/2016] [Indexed: 01/09/2023]
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Fiseha T, Tamir Z. Urinary Markers of Tubular Injury in Early Diabetic Nephropathy. Int J Nephrol 2016; 2016:4647685. [PMID: 27293888 DOI: 10.1155/2016/4647685] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/26/2016] [Indexed: 01/08/2023] Open
Abstract
Diabetic nephropathy (DN) is a common and serious complication of diabetes associated with adverse outcomes of renal failure, cardiovascular disease, and premature mortality. Early and accurate identification of DN is therefore of critical importance to improve patient outcomes. Albuminuria, a marker of glomerular involvement in early renal damage, cannot always detect early DN. Thus, more sensitive and specific markers in addition to albuminuria are needed to predict the early onset and progression of DN. Tubular injury, as shown by the detection of tubular injury markers in the urine, is a critical component of the early course of DN. These urinary tubular markers may increase in diabetic patients, even before diagnosis of microalbuminuria representing early markers of normoalbuminuric DN. In this review we summarized some new and important urinary markers of tubular injury, such as neutrophil gelatinase associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid binding protein (L-FABP), N-acetyl-beta-glucosaminidase (NAG), alpha-1 microglobulin (A1M), beta 2-microglobulin (B2-M), and retinol binding protein (RBP) associated with early DN.
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36
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Abstract
Diabetes mellitus (DM) commonly leads to progressive chronic kidney disease despite current best medical practice. The pathogenesis of diabetic kidney disease (DKD) involves a complex network of primary and secondary mechanisms with both intra-renal and systemic components. Apart from inhibition of the renin angiotensin aldosterone system, targeting individual pathogenic mediators with drug therapy has not, thus far, been proven to have high clinical value. Stem or progenitor cell therapies offer an alternative strategy for modulating complex disease processes through suppressing multiple pathogenic pathways and promoting pro-regenerative mechanisms. Mesenchymal stem cells (MSCs) have shown particular promise based on their accessibility from adult tissues and their diverse mechanisms of action including secretion of paracrine anti-inflammatory and cyto-protective factors. In this review, the progress toward clinical translation of MSC therapy for DKD is critically evaluated. Results from animal models suggest distinct potential for systemic MSC infusion to favourably modulate DKD progression. However, only a few early phase clinical trials have been initiated and efficacy in humans remains to be proven. Key knowledge gaps and research opportunities exist in this field. These include the need to gain greater understanding of in vivo mechanism of action, to identify quantifiable biomarkers of response to therapy and to define the optimal source, dose and timing of MSC administration. Given the rising prevalence of DM and DKD worldwide, continued progress toward harnessing the inherent regenerative functions of MSCs and other progenitor cells for even a subset of those affected has potential for profound societal benefits.
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Affiliation(s)
- Tomás P Griffin
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Saolta University Health Group, Galway, Ireland
| | - William Patrick Martin
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Saolta University Health Group, Galway, Ireland
| | - Nahidul Islam
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Timothy O'Brien
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Saolta University Health Group, Galway, Ireland
| | - Matthew D Griffin
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland.
- Nephrology Services, Galway University Hospitals, Saolta University Health Group, Galway, Ireland.
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Abstract
Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease (ESRD) and dialysis in the Western world. Early DKD, including microalbuminuria and renal hyperfiltration, is common in adolescents with type 2 diabetes (T2D). Furthermore, youth-onset T2D carries a higher risk of progressive DKD than adult-onset T2D of similar diabetes duration. DKD is characterized by a long clinically silent period without signs of disease. Therefore, a major challenge in preventing DKD is the difficulty in identifying high-risk T2D patients at an early stage. The Type 2 Diabetes in Adolescents and Youth (TODAY) study demonstrated a high initial prevalence that increased over time, irrespective of treatment arm. This key observation underscores the importance of discovering new therapeutic targets to supplement conventional management, in order to reduce DKD risk. In this review, we focus on early DKD in T2D and summarize potential novel biomarkers and therapeutic targets.
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Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA.
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA.
| | - David Z Cherney
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - David M Maahs
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA
- Department of Medicine, Division of Nephrology, University of Colorado, Aurora, CO, USA
| | - Kristen J Nadeau
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA
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Gluhovschi C, Gluhovschi G, Petrica L, Timar R, Velciov S, Ionita I, Kaycsa A, Timar B. Urinary Biomarkers in the Assessment of Early Diabetic Nephropathy. J Diabetes Res 2016; 2016:4626125. [PMID: 27413755 PMCID: PMC4927990 DOI: 10.1155/2016/4626125] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/12/2016] [Indexed: 12/12/2022] Open
Abstract
Diabetic nephropathy (DN) is a frequent and severe complication of diabetes mellitus (DM). Its diagnosis in incipient stages may allow prompt interventions and an improved prognosis. Towards this aim, biomarkers for detecting early DN can be used. Microalbuminuria has been proven a remarkably useful biomarker, being used for diagnosis of DN, for assessing its associated condition-mainly cardiovascular ones-and for monitoring its progression. New researches are pointing that some of these biomarkers (i.e., glomerular, tubular, inflammation markers, and biomarkers of oxidative stress) precede albuminuria in some patients. However, their usefulness is widely debated in the literature and has not yet led to the validation of a new "gold standard" biomarker for the early diagnosis of DN. Currently, microalbuminuria is an important biomarker for both glomerular and tubular injury. Other glomerular biomarkers (transferrin and ceruloplasmin) are under evaluation. Tubular biomarkers in DN seem to be of a paramount importance in the early diagnosis of DN since tubular lesions occur early. Additionally, biomarkers of inflammation, oxidative stress, podocyte biomarkers, and vascular biomarkers have been employed for assessing early DN. The purpose of this review is to provide an overview of the current biomarkers used for the diagnosis of early DN.
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Affiliation(s)
- Cristina Gluhovschi
- Division of Nephrology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
- *Cristina Gluhovschi:
| | | | - Ligia Petrica
- Division of Nephrology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Romulus Timar
- Department of Diabetes and Metabolic Diseases, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Silvia Velciov
- Division of Nephrology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Ioana Ionita
- Division of Hematology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Adriana Kaycsa
- Department of Biochemistry, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Bogdan Timar
- Department of Diabetes and Metabolic Diseases, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
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39
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Abstract
Diabetic nephropathy (DN) is a serious complication of diabetes associated with increased risk of mortality, and cardiovascular and renal outcomes. Diagnostic markers to detect DN at early stage are important as early intervention can slow loss of kidney function and improve patient outcomes. Urinary biomarkers may be elevated in diabetic patients even before the appearance of microalbuminuria, and can be used as useful marker for detecting nephropathy in patients with normoalbuminuria (early DN). We reviewed some new and important urinary biomarkers, such as: Neutrophil gelatinase associated lipocalin (NGAL), N-acetyl-beta-glucosaminidase (NAG), Cystatin C, alpha 1-microglobulin, immunoglobulin G or M, type IV collagen, nephrin, angiotensinogen and liver-type fatty acid–binding protein (L-FABP) associated with early DN in type 2 diabetic patients. Our search identified a total of 42 studies that have been published to date. Urinary levels of these biomarkers were elevated in type 2 diabetic patients compared with non-diabetic controls, including in patients who had no signs indicating nephropathy (without microalbuminuria), and showed positive correlation with albuminuria. Despite the promise of these new urinary biomarkers, further large, multicenter prospective studies are still needed to confirm their clinical utility as a screening tool for early type 2 DN in every day practice.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Ma J, Bai J. Protective effects of heparin on endothelial cells in sepsis. Int J Clin Exp Med 2015; 8:5547-5552. [PMID: 26131136 PMCID: PMC4484034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/26/2015] [Indexed: 06/04/2023]
Abstract
This study aims to observe the protective effects of heparin on endothelial cells in sepsis and explore the involved signal pathway regulated by heparin. Methods Human vascular endothelial cells were treated by TNFα in vitro to simulate the inflammatory environment when sepsis occurred. They were intervened by heparin and the expression levels of soluble thrombomodulin (sTM) and serum activated protein C (APC) were detected by ELISA, the regulatory mechanism of heparin improving vascular endothelial cells injury induced by TNFα was detected by Western Blotting method, the methylation of histone in the gene promoter region of endothelial nitric oxide synthase (eNOS) and monocyte chemotactic protein-1 (MCP-1) were detected using chromatin immunoprecipitation method. Results Heparin could inhibit the secretion of sTM and APC protein and the expression of MCP-1 gene which involved in NF-κB signal pathway. Conclusions Heparin could protect vascular endothelial cells from injury induced by TNFα and sepsis, the mechanisms were related with the effects of heparin on the histone methylation of promoter region and the regulation of heparin on the MAPK and NF-κB signal pathways. These results provide a theoretical basis for the application of heparin in the prevention and treatment of vascular disease related with sepsis.
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Affiliation(s)
- Jianqi Ma
- Department of Critical Care Medicine, Liaoning Cancer Hospital Institute No. 44 Xiaoheyan Road, Shenyang 110042, P. R. China
| | - Jinghui Bai
- Department of Critical Care Medicine, Liaoning Cancer Hospital Institute No. 44 Xiaoheyan Road, Shenyang 110042, P. R. China
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Petrica L, Vlad A, Gluhovschi G, Gadalean F, Dumitrascu V, Vlad D, Popescu R, Velciov S, Gluhovschi C, Bob F, Ursoniu S, Petrica M, Jianu DC. Glycated peptides are associated with the variability of endothelial dysfunction in the cerebral vessels and the kidney in type 2 diabetes mellitus patients: a cross-sectional study. J Diabetes Complications 2015; 29:230-7. [PMID: 25511877 DOI: 10.1016/j.jdiacomp.2014.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 11/23/2014] [Accepted: 11/25/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Diabetic atherosclerosis and microangiopathy parallel diabetic nephropathy. The aim of our study was to evaluate the pattern of endothelial dysfunction in two vascular territories, the kidney and the brain, both affected by diabetic vasculopathic complications. The endothelial variability was evaluated in relation to advanced glycation end-products modified peptides. METHODS Seventy patients with type 2 diabetes mellitus and 11 healthy subjects were assessed concerning urine albumin: creatinine ratio, plasma and urinary advanced glycation end-products, plasma asymmetric dimethyl-arginine, serum cystatin C, intima-media thickness in the common carotid arteries, the pulsatility index, the resistance index in the internal carotid arteries and the middle cerebral arteries, the cerebrovascular reactivity through the breath-holding test. RESULTS The breath-holding index correlated with asymmetric dimethyl-arginine (R²=0.151; p<0.001), plasma advanced glycation end-products (R²=0.173; p<0.001), C-reactive protein (R²=0.587; p<0.001), duration of diabetes mellitus (R²=0.146; p=0.001), cystatin C (R²=0.220; p<0.001), estimated glomerular filtration rate (R²=0.237; p=0.001). Urine albumin: creatinine ratio correlated with urinary advanced glycation end-products (R²=0.257; p<0.001), but not with asymmetric dimethyl-arginine (R²=0.029; p=0.147). CONCLUSIONS In type 2 diabetic patients endothelial dysfunction in the cerebral vessels appears to be dissociated from glomerular endothelial dysfunction in early diabetic nephropathy. Advanced glycation end-products could impact both the cerebral vessels and the glomerular endothelium.
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MESH Headings
- Aged
- Albuminuria/etiology
- Arginine/analogs & derivatives
- Arginine/blood
- Biomarkers/blood
- Biomarkers/urine
- Breath Holding
- Cohort Studies
- Cross-Sectional Studies
- Diabetes Mellitus, Type 2/complications
- Diabetic Angiopathies/blood
- Diabetic Angiopathies/metabolism
- Diabetic Angiopathies/physiopathology
- Diabetic Angiopathies/urine
- Diabetic Nephropathies/blood
- Diabetic Nephropathies/metabolism
- Diabetic Nephropathies/physiopathology
- Diabetic Nephropathies/urine
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/physiopathology
- Female
- Glomerular Filtration Rate
- Glycation End Products, Advanced/blood
- Glycation End Products, Advanced/metabolism
- Glycation End Products, Advanced/urine
- Humans
- Kidney/blood supply
- Kidney/metabolism
- Kidney/physiopathology
- Male
- Middle Aged
- Outpatient Clinics, Hospital
- Romania
- Severity of Illness Index
- Vasculitis, Central Nervous System/complications
- Vasculitis, Central Nervous System/metabolism
- Vasculitis, Central Nervous System/physiopathology
- Vasculitis, Central Nervous System/urine
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Affiliation(s)
- Ligia Petrica
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Adrian Vlad
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Diabetes and Metabolic Diseases, County Emergency Hospital, Timisoara, Romania.
| | - Gheorghe Gluhovschi
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Florica Gadalean
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Victor Dumitrascu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Pharmacology, County Emergency Hospital, Clinical Laboratory, Timisoara, Romania.
| | - Daliborca Vlad
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Pharmacology, County Emergency Hospital, Clinical Laboratory, Timisoara, Romania.
| | - Roxana Popescu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Clinical Laboratory, Department of Cellular Biology, County Emergency Hospital, Timisoara, Romania.
| | - Silvia Velciov
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Cristina Gluhovschi
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Flaviu Bob
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Sorin Ursoniu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Public Health Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
| | - Maxim Petrica
- Department of Neurology, County Emergency Hospital, Timisoara, Romania.
| | - Dragos Catalin Jianu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Neurology, County Emergency Hospital, Timisoara, Romania.
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Lewko B, Welsh GI, Jankowski M. Editorial: Podocyte Pathology and Nephropathy. Front Endocrinol (Lausanne) 2015; 6:145. [PMID: 26441835 PMCID: PMC4585015 DOI: 10.3389/fendo.2015.00145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/02/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Barbara Lewko
- Department of Pathophysiology, Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland
- Laboratory of Molecular and Cellular Nephrology Gdansk, Miroslaw Mossakowski Medical Research Center of the Polish Academy of Sciences, Warsaw, Poland
- *Correspondence: Barbara Lewko,
| | | | - Maciej Jankowski
- Laboratory of Molecular and Cellular Nephrology Gdansk, Miroslaw Mossakowski Medical Research Center of the Polish Academy of Sciences, Warsaw, Poland
- Department of Clinical Chemistry, Medical University of Gdansk, Gdansk, Poland
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