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Hsu CY, Yeh CY, Yen TY, Chen CC, Chen JF, Chu CH, Huang CN, Lin CL, Lin SY, Liu FH, Ou HY, Wang CY. The expert consensus on care and education for patients with diabetic kidney disease in Taiwan. Prim Care Diabetes 2024; 18:284-290. [PMID: 38423826 DOI: 10.1016/j.pcd.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
Increasing prevalence of type 2 DM (T2DM) and diabetic kidney disease (DKD) has posed a great impact in Taiwan. However, guidelines focusing on multidisciplinary patient care and patient education remain scarce. By literature review and expert discussion, we propose a consensus on care and education for patients with DKD, including general principles, specifics for different stages of chronic kidney disease (CKD), and special populations. (i.e. young ages, patients with atherosclerotic cardiovascular disease or heart failure, patients after acute kidney injury, and kidney transplant recipients). Generally, we suggest performing multidisciplinary patient care and education in alignment with the government-led Diabetes Shared Care Network to improve the patients' outcomes for all patients with DKD. Also, close monitoring of renal function with early intervention, control of comorbidities in early stages of CKD, and nutrition adjustment in advanced CKD should be emphasized.
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Affiliation(s)
- Chih-Yao Hsu
- Endocrinology and Metabolism Division, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | | | - Tsung-Yi Yen
- Family Medicine Department, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Ching-Chu Chen
- Endocrinology and Metabolism Division, China Medical University Hospital, Taichung, Taiwan
| | - Jung-Fu Chen
- Endocrinology and Metabolism Division, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
| | - Chih-Hsun Chu
- Endocrinology and Metabolism Division, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chien-Ning Huang
- Endocrinology and Metabolism Division, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ching-Ling Lin
- Endocrinology and Metabolism Division, Cathay General Hospital, Taipei, Taiwan
| | - Shih-Yi Lin
- Endocrinology and Metabolism Division, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Feng-Hsuan Liu
- Endocrinology and Metabolism Division, Chang Gung Memorial Hospital, Taipei Branch, Taipei, Taiwan
| | - Horng-Yih Ou
- Endocrinology and Metabolism Division, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Chih-Yuan Wang
- Endocrinology and Metabolism Division, National Taiwan University Hospital, Taipei, Taiwan.
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Zeng JY, Wang Y, Hong FY, Miao M, Jiang YY, Qiao ZX, Wang YT, Bao XR. Tanshinone IIA is superior to paricalcitol in ameliorating tubulointerstitial fibrosis through regulation of VDR/Wnt/β-catenin pathway in rats with diabetic nephropathy. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:3959-3977. [PMID: 37991543 PMCID: PMC11111530 DOI: 10.1007/s00210-023-02853-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/11/2023] [Indexed: 11/23/2023]
Abstract
Glomerulosclerosis and tubulointerstitial fibrosis (TIF) are closely involved in the development of diabetic nephropathy (DN). Moreover, the development of TIF is closely related to epithelial-to-mesenchymal transition (EMT). Tanshinone IIA (Tan) has various pharmacological effects, especially the anti-fibrotic effect. And it is mainly used in the clinical treatment of cardiovascular diseases. Currently, the protective effect of Tan on DN and its possible mechanism have not been clearly elucidated. Our previous studies illustrated that Tan could improve the EMT of HK-2 cells induced by high glucose by regulating the vitamin D receptor (VDR)/Wnt/β-catenin pathway. Here, we collected demographic information and laboratory results from the National Health and Nutrition Examination Survey (NHANES) database in order to investigate the relationship between VD and DN. Then, we established a DN model and treated DN rats with Tan and paricalcitol (Par) for 6 weeks. We subsequently compared the changes in general condition, renal function, pathological changes, and TIF-related protein expression levels of control rats, DN rats induced by STZ, DN rats with Tan at 5.4 mg/kg, DN rats with Tan at 10.8 mg/kg, and DN rats with Par at 0.054 µg/kg, to explore the effect and mechanism of Tan and Par on DN rats. The results showed that VD had a protective effect against DN in diabetic patients. And we found that Tan had a protective effect on renal fibrosis in DN rats, which was superior to Par in improving the symptoms of "three more and one less," reducing fasting blood glucose level, improving renal index, BUN/SCr, and UACR, reducing histopathological damage of kidney, and improving the expression of fibrosis-related proteins in kidney tissue by regulating VDR/Wnt/β-catenin pathway. Tan was superior to Par in ameliorating tubulointerstitial fibrosis by regulating VDR/Wnt/β-catenin pathway in rats with diabetic nephropathy.
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Affiliation(s)
- Jing-Yi Zeng
- Department of Nephrology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Nephrology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Yu Wang
- Department of Nephrology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Fu-Yuan Hong
- Department of Nephrology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Miao Miao
- Department of Nephrology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Yu-Ying Jiang
- Department of Nephrology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Zi-Xuan Qiao
- Department of Nephrology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Yun-Tao Wang
- Department of Nephrology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Xiao-Rong Bao
- Department of Nephrology, Jinshan Hospital of Fudan University, Shanghai, China.
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Okada A, Yamaguchi S, Imaizumi T, Oba K, Kurakawa KI, Yamauchi T, Kadowaki T, Nangaku M. Modification Effects of Albuminuria on the Association Between Kidney Function and Development of Anemia in Diabetes. J Clin Endocrinol Metab 2024; 109:1012-1032. [PMID: 37955878 PMCID: PMC10940265 DOI: 10.1210/clinem/dgad660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/26/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
CONTEXT Previous studies failed to adjust for estimated glomerular filtration rate (eGFR) in evaluating the association between albuminuria and anemia development, and we aimed to investigate whether albuminuria independently affects anemia development. METHODS We conducted a retrospective cohort study and retrospectively identified adults with diabetes from a Japanese nationwide clinical database (JMDC, Tokyo, Japan). To assess the modification effects of albuminuria on the association between eGFR and anemia development, we estimated prevalence of anemia, defined as hemoglobin < 13 g/dL in men and < 12 g/dL in women, using a modified Poisson regression and marginal standardization form of predictive margins, stratified by albuminuria severity after adjusting for eGFR. Hence, we revealed at which eGFR level this modification effect appeared and the extent to which this modification effect increased the prevalence of anemia. RESULTS We identified 327 999 data points from 48 056 individuals [normoalbuminuria: 186 472 (56.9%), microalbuminuria: 107 170 (32.7%), and macroalbuminuria: 34 357 (10.5%)]. As eGFR declined, anemia prevalence increased. Albuminuria severity modified this association induced by decreased eGFR among individuals with eGFR <30 mL/min/1.73 m2 after adjusting for multivariable factors, including age, sex, comorbidities, and medication use. Compared with the normoalbuminuric group, the macroalbuminuric group had a 5% to 20% higher anemia prevalence among individuals with eGFR of <30 mL/min/1.73 m2. CONCLUSION We revealed that the severity of albuminuria modified the association between eGFR and anemia development among individuals with eGFR <30 mL/min/1.73 m2, highlighting the modification effect of albuminuria on the association between kidney function and anemia development in diabetes.
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Affiliation(s)
- Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya 466-8560, Japan
| | - Koji Oba
- Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kayo Ikeda Kurakawa
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolism, Graduate School of Medicine, The University of TokyoTokyo, 113-8655, Japan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
- Department of Diabetes and Metabolism, Graduate School of Medicine, The University of TokyoTokyo, 113-8655, Japan
- Toranomon Hospital, Tokyo 105-8470, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
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Liang Y, Chen Q, Chang Y, Han J, Yan J, Chen Z, Zhou J. Critical role of FGF21 in diabetic kidney disease: from energy metabolism to innate immunity. Front Immunol 2024; 15:1333429. [PMID: 38312833 PMCID: PMC10834771 DOI: 10.3389/fimmu.2024.1333429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
Diabetic kidney disease (DKD) stands as the predominant cause of chronic kidney disease (CKD) on a global scale, with its incidence witnessing a consistent annual rise, thereby imposing a substantial burden on public health. The pathogenesis of DKD is primarily rooted in metabolic disorders and inflammation. Recent years have seen a surge in studies highlighting the regulatory impact of energy metabolism on innate immunity, forging a significant area of research interest. Within this context, fibroblast growth factor 21 (FGF21), recognized as an energy metabolism regulator, assumes a pivotal role. Beyond its role in maintaining glucose and lipid metabolism homeostasis, FGF21 exerts regulatory influence on innate immunity, concurrently inhibiting inflammation and fibrosis. Serving as a nexus between energy metabolism and innate immunity, FGF21 has evolved into a therapeutic target for diabetes, nonalcoholic steatohepatitis, and cardiovascular diseases. While the relationship between FGF21 and DKD has garnered increased attention in recent studies, a comprehensive exploration of this association has yet to be systematically addressed. This paper seeks to fill this gap by summarizing the mechanisms through which FGF21 operates in DKD, encompassing facets of energy metabolism and innate immunity. Additionally, we aim to assess the diagnostic and prognostic value of FGF21 in DKD and explore its potential role as a treatment modality for the condition.
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Affiliation(s)
- Yingnan Liang
- Department of Nephrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qi Chen
- Department of Nephrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Chang
- Department of Nephrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Junsong Han
- Department of Nephrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jiaxin Yan
- Department of Nephrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhenjie Chen
- Department of Nephrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jingwei Zhou
- Department of Nephrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Teuma L, Eshwaran R, Tawokam Fongang U, Wieland J, Shao F, Lagana ML, Wang Y, Agaci A, Hammes HP, Feng Y. Glucosamine inhibits extracellular matrix accumulation in experimental diabetic nephropathy. Front Nutr 2022; 9:1048305. [PMID: 36532524 PMCID: PMC9751334 DOI: 10.3389/fnut.2022.1048305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Glucosamine, the intermediate metabolite of the hexosamine biosynthesis pathway (HBP), is widely used as a supplementary drug in patients with osteoarthritis. However, its consequences in such patients concomitantly suffering from diabetic nephropathy is unknown. METHODS The aim of the study was to investigate the effect of exogenous administration of glucosamine in the diabetic kidney. A mouse model of streptozotocin-induced diabetic nephropathy in vivo and cultured endothelial cells in vitro were used in the study. The mice were treated with glucosamine for 6 months. Renal function was evaluated by metabolic cage, and histology of the kidney was estimated by periodic acid-schiff (PAS) staining. The expression of related genes was assessed by real-time PCR, immunofluorescence staining, immunoblotting and ELISA. RESULTS There was no significant difference in urinary albumin secretion, relative kidney weight, or creatinine clearance between the groups treated with glucosamine and controls. Assessment of the kidney demonstrated reduction in mesangial expansion and fibronectin expression in the diabetic glomeruli treated with glucosamine. Glucosamine treatment significantly decreased α-smooth muscle actin (α-SMA) protein expression in both diabetic and control kidneys, whereas the expression of other fibrosis-related genes and inflammatory factors was unaltered. Moreover, α-SMA colocalized with the endothelial marker CD31 in the diabetic and control kidneys, and glucosamine reduced α-SMA+ ECs in the diabetic glomeruli. In addition, glucosamine suppressed α-SMA expression in endothelial cells treated with or without high glucose. DISCUSSION In summary, this is the first report to show that glucosamine reduces mesangial expansion and inhibits endothelial-mesenchymal transition in diabetic nephropathy. The underlying mechanisms need to be further investigated.
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Affiliation(s)
- Loic Teuma
- Experimental Pharmacology Mannheim, Medical Faculty Mannheim, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany
| | - Rachana Eshwaran
- Experimental Pharmacology Mannheim, Medical Faculty Mannheim, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany
| | - Ulrich Tawokam Fongang
- Experimental Pharmacology Mannheim, Medical Faculty Mannheim, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany
| | - Johanna Wieland
- Experimental Pharmacology Mannheim, Medical Faculty Mannheim, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany
| | - Feng Shao
- Experimental Pharmacology Mannheim, Medical Faculty Mannheim, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany
| | - Maria Luisa Lagana
- Experimental Pharmacology Mannheim, Medical Faculty Mannheim, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany
- Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Yixin Wang
- Experimental Pharmacology Mannheim, Medical Faculty Mannheim, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany
| | - Ane Agaci
- Experimental Pharmacology Mannheim, Medical Faculty Mannheim, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany
| | - Hans-Peter Hammes
- 5th Medical Clinic, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Yuxi Feng
- Experimental Pharmacology Mannheim, Medical Faculty Mannheim, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany
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Heyman SN, Raz I, Dwyer JP, Weinberg Sibony R, Lewis JB, Abassi Z. Diabetic Proteinuria Revisited: Updated Physiologic Perspectives. Cells 2022; 11:2917. [PMID: 36139492 PMCID: PMC9496872 DOI: 10.3390/cells11182917] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Albuminuria, a hallmark of diabetic nephropathy, reflects not only injury and dysfunction of the filtration apparatus, but is also affected by altered glomerular hemodynamics and hyperfiltration, as well as by the inability of renal tubular cells to fully retrieve filtered albumin. Albuminuria further plays a role in the progression of diabetic nephropathy, and the suppression of glomerular albumin leak is a key factor in its prevention. Although microalbuminuria is a classic manifestation of diabetic nephropathy, often progressing to macroalbuminuria or overt proteinuria over time, it does not always precede renal function loss in diabetes. The various components leading to diabetic albuminuria and their associations are herein reviewed, and the physiologic rationale and efficacy of therapeutic interventions that reduce glomerular hyperfiltration and proteinuria are discussed. With these perspectives, we propose that these measures should be initiated early, before microalbuminuria develops, as substantial renal injury may already be present in the absence of proteinuria. We further advocate that the inhibition of the renin-angiotensin axis or of sodium-glucose co-transport likely permits the administration of a normal recommended or even high-protein diet, highly desirable for sarcopenic diabetic patients.
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Affiliation(s)
- Samuel N. Heyman
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem 9765422, Israel
- Division of Geriatrics, Herzog Hospital, Jerusalem 9765422, Israel
| | - Itamar Raz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9765422, Israel
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem 9124001, Israel
| | - Jamie P. Dwyer
- Clinical and Translational Science Institute, University of Utah Health, Salt Lake City, UT 84112, USA
| | | | - Julia B. Lewis
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Departments of Medicine and Nephrology, Vanderbilt University Medical Center, Nashville, TN 37011, USA
| | - Zaid Abassi
- Department of Physiology and Biophysics, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
- Department of Laboratory Medicine, Rambam Health Care Campus, Haifa 3109601, Israel
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Sasaki T, Ninomiya T. Response to "Letter Regarding Normal Albuminuria in Patients With Autopsy-Proven Advanced Diabetic Nephropathy". Kidney Int Rep 2022; 7:662-663. [PMID: 35257084 PMCID: PMC8897476 DOI: 10.1016/j.ekir.2022.01.1044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Takaya Sasaki
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Letter regarding normal albuminuria in patients with autopsy-proven advanced diabetic nephropathy. Kidney Int Rep 2022; 7:662. [PMID: 35257085 PMCID: PMC8897483 DOI: 10.1016/j.ekir.2021.12.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 11/22/2022] Open
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Affiliation(s)
- Amy Yau
- Division of Nephrology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Samir V. Parikh
- Division of Nephrology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Salem Almaani
- Division of Nephrology, The Ohio State University Medical Center, Columbus, Ohio, USA
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