Indices Indicating Early Renal Microvascular Disease in Diabetes

N Futrakul,P Futrakul

doi:10.2174/1875318301104010018

Abstract

Renal microvascular disease is crucial to renal disease progression. Renal microvascular disease in late stage diabetic nephropathy is associated with defective angiogenesis and fails to respond to vasodilator treatment. Recognition of early renal microvascular disease is necessary, since in this stage, the vascular homeostasis is adequately functional and responsive to vasodilator treatment. Indices that can screen early renal microvascular disease include creatinine clearance or glomerular filtration rate, renal plasma flow or peritubular capillary flow and fractional excretion of magnesium (FE Mg).

Highlights

Renal microvascular disease is a progressive entity that usually remains asymptomatic, and is recognized only when the disease is associated with advanced renal insufficiency
Intrarenal hemodynamic study confirms the cause- and -effect relationship that the peritubular capillary flow reduction precedes the development of tubulointerstitial fibrosis in chronic kidney disease (CKD) indicating chronic renal ischemia is the crucial mechanism of renal disease progression [4]
Treatment with vasodilators at late stage (CKD stages 3-5) fails to correct renal ischemia, or restore renal function which is due to the altered vascular homeostasis and an impaired nitric oxide production observed in late CKD leading to the therapeutic resistance to vasodilators [5]

Summary

Introduction

Renal microvascular disease is a progressive entity that usually remains asymptomatic, and is recognized only when the disease is associated with advanced renal insufficiency. Intrarenal hemodynamic study confirms the cause- and -effect relationship that the peritubular capillary flow reduction precedes the development of tubulointerstitial fibrosis in chronic kidney disease (CKD) indicating chronic renal ischemia is the crucial mechanism of renal disease progression [4]. Treatment to correct renal ischemia with vasodilators at early CKD or early diabetic nephropathy during normoalbuminuria can enhance renal perfusion as well as restore renal function; inasmuch as the vascular homeostasis is adequately functional in this early stage.

Results

Conclusion