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Proximal Tubule Dysfunction Is Dissociated from Endothelial Dysfunction in Normoalbuminuric Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study
- Source :
- Nephron Clinical Practice. 118:c155-c164
- Publication Year :
- 2010
- Publisher :
- S. Karger AG, 2010.
-
Abstract
- Introduction: The aim of our study was to clarify the hypothesis that proximal tubule (PT) dysfunction may be responsible for early diabetic nephropathy (DN), independently of preceding glomerular endothelial dysfunction. The pattern of endothelial dysfunction and its potential variability was evaluated in two vascular beds, the kidney and the brain. Methods: A total of 68 normoalbuminuric type 2 diabetes mellitus (DM) patients were enrolled in a cross-sectional study and the following parameters were assessed: urinary albumin:creatinine ratio (UACR), urinary α1-microglobulin, urinary β2-microglobulin, plasma asymmetric dimethyl-arginine (ADMA), serum creatinine, glomerular filtration rate (GFR), C-reactive protein (CRP), fibrinogen, HbA1c; pulsatility and resistance indices in the internal carotid artery and middle cerebral artery and intima-media thickness (IMT) in the common carotid artery; cerebrovascular reactivity was evaluated through the breath-holding test. Results: Plasma ADMA was increased in 12 patients (17.5%), urinary α1-microglobulin in 19 patients (27.9%) and urinary β2-microglobulin in 16 patients (23.5%). Cerebral hemodynamic indices correlated with plasma ADMA, CRP, fibrinogen, duration of DM, HbA1c and GFR. ADMA correlated with fibrinogen, CRP, HbA1c, duration of DM and GFR. There were no correlations between ADMA and UACR, and urinary α1-/β2-microglobulin. Also, no correlations were found between urinary α1-/β2-microglobulin and UACR, HbA1c, duration of DM and GFR. Conclusion: The increase in urinary α1-/β2-microglobulin precedes the stage of albuminuria. It may be assumed that early DN is related to PT dysfunction. Endothelial dysfunction plays a pivotal role in the brain vasculature, while its involvement in the development of early DN is not conditional on the occurrence of albuminuria.
- Subjects :
- Male
medicine.medical_specialty
Endothelium
Urinary system
Type 2 diabetes
Kidney Tubules, Proximal
Diabetic nephropathy
Internal medicine
Diabetes mellitus
medicine
Albuminuria
Humans
Diabetic Nephropathies
Endothelial dysfunction
Aged
business.industry
Type 2 Diabetes Mellitus
General Medicine
Middle Aged
medicine.disease
Cross-Sectional Studies
Endocrinology
medicine.anatomical_structure
Diabetes Mellitus, Type 2
Cardiovascular Diseases
Nephrology
Female
Endothelium, Vascular
business
Glomerular Filtration Rate
Kidney disease
Subjects
Details
- ISSN :
- 16602110
- Volume :
- 118
- Database :
- OpenAIRE
- Journal :
- Nephron Clinical Practice
- Accession number :
- edsair.doi.dedup.....1ceb1d70687454ca644a8205b03a83a9