Current Diabetes Reviews - Volume 7, Issue 1, 2011

Diabetic nephropathy (DN) affects both patient with type 1 and type 2 diabetes and represents a major burden to public health cost [1]. Tight glycemic and blood pressure control can dramatically slow the progression of the disease, particularly when diagnosed and intervened upon in the early stages [2]. However, a definitive cure remains to be found, and a large number of patients progress towards end-stage renal disea Read More

Diabetic kidney disease is the leading cause of end-stage renal disease worldwide. Podocytes are highly differentiated, pericyte-like cells that are essential for normal function of the kidney filter. Loss of podocytes is a hallmark of progressive kidney diseases including diabetic nephropathy. Podocytes are a direct target for angiotensin II -mediated injury by altered expression and distribution of podocyte proteins. Additionally, Read More

Aldosterone has emerged as a deleterious hormone in the kidney, for example as a potent inducer of proteinuria. We identified the podocyte, the final filtration barrier in the glomerulus, as a novel target of aldosterone. Activation of the mineralocorticoid receptor (MR) in the podocyte disrupts the filtration barrier and induces proteinuria. Recent clinical and experimental studies have shown the efficacy of MR antagonism in redu Read More

High plasma prorenin levels predict the onset of microvascular complications, such as albuminuria/proteinuria, in diabetic patients. In diabetic rats with elevated plasma prorenin levels, treatment with HRP, which competitively inhibits the binding of prorenin to the (pro)renin receptor [(P)RR] as a decoy peptide, significantly prevented the development of albuminuria/proteinuria and glomerulosclerosis, suggesting that (P)RR-boun Read More

Diabetic nephropathy (DN) presents with a gradual breakdown of the glomerular filtration barrier to protein, culminating in widespread glomerular damage and renal failure. The podocyte is the central cell of the glomerular filtration barrier, and possesses unique architectural and signaling properties guided by the expression of key podocyte specific proteins. How these cellular features are damaged by the diabetic milieu is Read More

It is generally accepted that estrogens affect and modulate the development and progression of chronic kidney diseases (CKD) not related to diabetes. Clinical studies have indeed demonstrated that the severity and rate of progression of renal damage tends to be greater among men, compared with women. Experimental studies also support the notion that female sex is protective and male sex permissive, for the dev Read More

Vitamin D deficiency is a prominent feature of chronic kidney disease (CKD) even in its early stages. While vitamin D deficiency leads to mineral imbalance and bone problems in CDK patients, it also accelerates the progression of kidney disease. Ever since the observation that vitamin D analogs reduce proteinuria in CKD patients, it has been postulated that podocytes are major target of the reno-protective action of vita Read More

Obesity is a risk factor for both de novo disease and as a complication of existing chronic kidney disease. Obesity related disease is characterized by albuminuria, glomerulomegaly and secondary focal glomerulosclerosis. Traditionally altered renal hemodynamics causing hyperfiltration and upregulated renin angiotensin system have been associated with these changes. Recently identified circulating factors produced by fat s Read More

Involvement of the growth hormone (GH) / insulin-like growth factor 1 (IGF-1) axis in the pathogenesis of diabetic nephropathy (DN) is strongly suggested by studies investigating the impact of GH excess and deficiency on renal structure and function. GH excess in both the human (acromegaly) and in transgenic animal models is characterized by significant structural and functional changes in the kidney. In the hum Read More

With the increased acceptance of glycated hemoglobin measurement as the test of choice for the diagnosis and detection of diabetes, doubts which surround the use of the oral glucose tolerance test (OGTT) in detecting disturbances in glucose levels have become even more apparent. Metabolically, there are still arguments to use the OGTT. Epidemiological studies though, have not always supported the efficacy of the Read More

A systematic review was conducted to evaluate the effectiveness of initiating insulin treatment with insulin glargine or insulin detemir for type 2 diabetes in a routine clinical practice setting. Medline, EMBASE and Cochrane literature databases were searched to identify published “real world” reports. Studies were included in the review if they reported the following; insulin dose, change in HbA1c, change in body weight and hy Read More