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Fang H, Li X, Lin D, Wang L, Yang T, Yang B. Inhibition of intrarenal PRR-RAS pathway by Ganoderma lucidum polysaccharide peptides in proteinuric nephropathy. Int J Biol Macromol 2023; 253:127336. [PMID: 37852403 DOI: 10.1016/j.ijbiomac.2023.127336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/25/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023]
Abstract
Excessive proteinuria leads to renal dysfunction and damage. Ganoderma lucidum polysaccharide peptide (GL-PP) and Ganoderma lucidum polysaccharide peptide 2 (GL-PP2) are biologically active compounds extracted from Ganoderma lucidum. GL-PP has a relative molecular weight of 37,121 with 76.39 % polysaccharides and 16.35 % polypeptides, while GL-PP2 has a relative molecular weight of 31,130, composed of 64.14 % polysaccharides and 17.73 % polypeptides. The xylose: mannose: glucose monosaccharide ratios in GL-PP and GL-PP2 were 4.83:1:7.03 and 2.35:1:9.38, respectively. In this study, we investigated the protective effects of GL-PP and GL-PP2 on proteinuria-induced renal dysfunction and damage using rat and cell models. Both compounds reduced kidney injury, proteinuria, and inhibited the (pro)renin receptor (PRR)-renin-angiotensin system (RAS) pathway, inflammatory cell infiltration, oxidative stress, and fibrosis. GL-PP2 showed stronger inhibition of cyclooxygenase-2 and inducible nitric oxide synthase proteins compared to GL-PP. In cell models, both compounds displayed anti-inflammatory properties and improved cellular viability by inhibiting the PRR-RAS pathway. GL-PP2 has higher feasibility and productivity than GL-PP in pharmacology and industrial production. It shows promise in treating proteinuria-induced renal disease with superior anti-inflammatory effects and economic, safe industrial application prospects. Further research is needed to compare efficacy, mechanisms, clinical applications, and commercial feasibility of GL-PP and GL-PP2.
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Affiliation(s)
- Hui Fang
- Key Laboratory of Applied Pharmacology in Universities of Shandong, Department of Pharmacology, School of Pharmacy, Weifang Medical University, Weifang 261053, Shandong, China.
| | - Xinxuan Li
- Key Laboratory of Applied Pharmacology in Universities of Shandong, Department of Pharmacology, School of Pharmacy, Weifang Medical University, Weifang 261053, Shandong, China
| | - Dongmei Lin
- National Engineering Research Center of JUNCAO Technology, Fujian Agriculture and Forestry University, Fujian, Fuzhou 350002, China
| | - Lianfu Wang
- National Engineering Research Center of JUNCAO Technology, Fujian Agriculture and Forestry University, Fujian, Fuzhou 350002, China
| | - Teng Yang
- Key Laboratory of Applied Pharmacology in Universities of Shandong, Department of Pharmacology, School of Pharmacy, Weifang Medical University, Weifang 261053, Shandong, China
| | - Baoxue Yang
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Pharmacology, School of Basic Medical Sciences, Peking University, Beijing 100083, China
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Rivetti G, Gizzone P, Di Sessa A, Guarino S, Miraglia Del Giudice E, Marzuillo P. Renin angiotensin aldosterone inhibitors in the treatment of proteinuria in children with congenital anomalies of the kidney and urinary tract: more evidence needed. Expert Rev Clin Pharmacol 2023; 16:791-798. [PMID: 37577983 DOI: 10.1080/17512433.2023.2247985] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/31/2023] [Accepted: 08/11/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Congenital anomalies of the kidney and urinary tract (CAKUT) can be associated with proteinuria, possibly leading to a decline in kidney function. The aim of this review is to evaluate evidence on the efficacy of renin-angiotensin-aldosterone system inhibitors (RAASi) in children affected by CAKUT with proteinuria or chronic kidney disease (CKD). AREAS COVERED We conducted a bibliographic search between 1 December 2022 and 20 February 2023, including randomized controlled trials, case-control studies, observational studies, meta-analyses, and systematic reviews dealing with the efficacy of RAASi in reducing proteinuria and slowing the decline of kidney function in children. EXPERT OPINION RAASi are effective in reducing proteinuria and slowing CKD progression in many renal conditions; however, the efficacy of these drugs in patients affected by CAKUT with proteinuria is still unknown. While waiting for more evidence, when facing a child with CAKUT with isolated proteinuria or with proteinuria and CKD, a 6-12-month trial with RAASi with gradual increase to the maximal tolerated dose should be considered. If no improvement of proteinuria is obtained, the RAASi should be discontinued.
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Affiliation(s)
- Giulio Rivetti
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Pietro Gizzone
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Anna Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
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Kitamura M, Arai H, Abe S, Ota Y, Muta K, Furusu A, Mukae H, Kohno S, Nishino T. Renal outcomes of treatment with telmisartan in patients with stage 3-4 chronic kidney disease: A prospective, randomized, controlled trial (JINNAGA). SAGE Open Med 2020; 8:2050312120973502. [PMID: 33282300 PMCID: PMC7686635 DOI: 10.1177/2050312120973502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives: Although angiotensin II receptor blockers are effective for patients with
chronic kidney disease, dose-dependent renoprotective effects of angiotensin
II receptor blockers in patients with moderate to severe chronic kidney
disease with non-nephrotic proteinuria are not known. Our aim was to
elucidate the dose-dependent renoprotective effects of angiotensin II
receptor blockers on such patients. Methods: A multicenter, prospective, randomized trial was conducted from 2009 to 2014.
Patients with non-nephrotic stage 3–4 chronic kidney disease were randomized
for treatment with either 40 or 80 mg telmisartan and were observed for up
to 104 weeks. Overall, 32 and 29 patients were allocated to the 40 and 80 mg
telmisartan groups, respectively. The composite primary outcome was renal
death, doubling of serum creatinine level, transition to stage 5 chronic
kidney disease, and death from any cause. Secondary outcomes included the
level of urinary proteins and changes in the estimated glomerular filtration
rate. Results: There was no difference in the primary outcome (p = 0.78) and eGFR (p = 0.53)
between the two groups; however, after 24 weeks, urinary protein level was
significantly lower in the 80 mg group than in the 40 mg group
(p < 0.05). No severe adverse events occurred in either group, and the
occurrence of adverse events did not significantly differ between them
(p = 0.56). Conclusion: Our findings do not demonstrate a direct dose-dependent renoprotective effect
of telmisartan. The higher telmisartan dose resulted in a decrease in the
amount of urinary protein. Even though high-dose angiotensin II receptor
blockers may be preferable for patients with stage 3–4 chronic kidney
disease, the clinical importance of the study results may be limited. The
study was registered in the UMIN-CTR (https://www.umin.ac.jp/ctr) with the registration number
UMIN000040875.
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Affiliation(s)
- Mineaki Kitamura
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Hideyuki Arai
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan.,Department of Nephrology, JCHO Isahaya General Hospital, Isahaya, Nagasaki, Japan
| | - Shinichi Abe
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Yuki Ota
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Kumiko Muta
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Akira Furusu
- Department of Nephrology, Wajinkai Hospital, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Unit of Basic Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shigeru Kohno
- Department of Respiratory Medicine, Unit of Basic Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
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Lau WL, Khazaeli M, Savoj J, Manekia K, Bangash M, Thakurta RG, Dang A, Vaziri ND, Singh B. Dietary tetrahydrocurcumin reduces renal fibrosis and cardiac hypertrophy in 5/6 nephrectomized rats. Pharmacol Res Perspect 2018; 6:e00385. [PMID: 29468071 PMCID: PMC5817151 DOI: 10.1002/prp2.385] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/27/2017] [Indexed: 01/14/2023] Open
Abstract
Tetrahydrocurcumin (THC) is the principal metabolite of curcumin and has antioxidant properties. In the present investigation, the effect of THC on renal and cardiovascular outcomes was studied in rats with chronic kidney disease (CKD). CKD rats were randomized following 5/6 nephrectomy to a special diet for 9 weeks which contained 1% THC (CKD+THC group). Low-dose polyenylphosphatidylcholine was used as a lipid carrier to increase bioavailability. Endpoints included tail blood pressure, normalized heart weight, plasma and urine biochemical data, and kidney tissue analyses. CKD animals demonstrated increased proteinuria, decreased creatinine clearance, hypertension, and cardiac hypertrophy. The antioxidant proteins CuZn SOD and glutathione peroxidase were decreased in the remnant kidney, while apoptosis (caspase-3) and fibrosis (alpha-SM actin) were increased. Renal fibrosis was confirmed histologically on trichrome staining. These pathologic changes were ameliorated in the CKD+THC group with significant decrease in proteinuria, hypertension, and kidney fibrosis. THC therapy restored levels of CuZn SOD and glutathione peroxidase. Consistent with prior reports, dietary THC did not improve nuclear Nrf2 levels. In summary, dietary THC therapy improved expression of antioxidant proteins in the remnant kidney, decreased renal fibrosis and proteinuria, and ameliorated hypertension in 5/6 nephrectomized rats.
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Affiliation(s)
- Wei Ling Lau
- Division of Nephrology and HypertensionDepartment of MedicineUniversity of California‐IrvineOrangeCA
| | - Mahyar Khazaeli
- Division of Nephrology and HypertensionDepartment of MedicineUniversity of California‐IrvineOrangeCA
| | - Javad Savoj
- Department of Internal MedicineRiverside Community HospitalUniversity of California‐Riverside School of MedicineRiversideCA
| | - Kasim Manekia
- Division of Nephrology and HypertensionDepartment of MedicineUniversity of California‐IrvineOrangeCA
| | - Maria Bangash
- Division of Nephrology and HypertensionDepartment of MedicineUniversity of California‐IrvineOrangeCA
| | | | - Anhthu Dang
- Division of Nephrology and HypertensionDepartment of MedicineUniversity of California‐IrvineOrangeCA
| | - Nosratola D. Vaziri
- Division of Nephrology and HypertensionDepartment of MedicineUniversity of California‐IrvineOrangeCA
| | - Bhupinder Singh
- Division of Nephrology and HypertensionDepartment of MedicineUniversity of California‐IrvineOrangeCA
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Abstract
Chronic kidney disease (CKD) and its associated morbidity pose a worldwide health problem. As well as risk of endstage renal disease requiring renal replacement therapy, cardiovascular disease is the leading cause of premature death among the CKD population. Proteinuria is a marker of renal injury that can often be detected earlier than any tangible decline in glomerular filtration rate. As well as being a risk marker for decline in renal function, proteinuria is now widely accepted as an independent risk factor for cardiovascular morbidity and mortality. This review will address the prognostic implications of proteinuria in the general population as well as other specific disease states including diabetes, hypertension and heart failure. A variety of pathophysiological mechanisms that may underlie the relationship between renal and cardiovascular disease have been proposed, including insulin resistance, inflammation, and endothelial dysfunction. As proteinuria has evolved into a therapeutic target for cardiovascular risk reduction in the clinical setting we will also review therapeutic strategies that should be considered for patients with persistent proteinuria.
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Affiliation(s)
- Gemma Currie
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Christian Delles
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
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Patil MR, Mishra A, Jain N, Gutch M, Tewari R. Weight loss for reduction of proteinuria in diabetic nephropathy: Comparison with angiotensin-converting enzyme inhibitor therapy. Indian J Nephrol 2013; 23:108-13. [PMID: 23716916 PMCID: PMC3658287 DOI: 10.4103/0971-4065.109412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Reduction of weight in obese type 2 diabetes mellitus (T2DM) individuals is emerging as a significant strategy in the reduction of proteinuria in diabetic nephropathy along with control of hyperglycemia, hypertension, and dyslipidemia. The objective was to evaluate the reduction in 24-h proteinuria in T2DM patients with nephropathy by weight loss, with conventional therapy (angiotensin-converting enzyme [ACE] inhibitors) as the control arm. A prospective, randomized controlled trial was conducted between June 2010 and May 2011. T2DM patients with confirmed nephropathy by 24-h urinary protein estimation with a body mass index (BMI) of >25 kg/m2 were studied. Patients who had nondiabetic nephropathy, uncontrolled hypertension (>125/75 mmHg) irrespective of antihypertensive drugs, excess weight due to edema or obesity due to other specific diseases, alcoholics, smokers, and patients who were on hemodialysis were excluded from the study. The patients were divided into three groups, namely, group A, patients on ACE inhibitor therapy; group B, patients on lifestyle modifications for weight loss; and group C, patients on an antiobesity drug (orlistat) and lifestyle modifications. At the end of 6 months, all the three groups were compared. Data were analyzed using software SPSS version 15.0. This study encompassed a total of 88 patients; 12 patients were dropped during the study period and 76 (group A: 22, group B: 23, and group C: 31) patients remained. The mean age of the patients was 58.36 ± 10.87 years (range: 30-70 years). At baseline, age, gender, mean BMI, waist-to-hip ratio (WHR), and 24-h proteinuria did not vary significantly among the three groups. At 6 months, the mean BMI significantly decreased in group C (P < 0.001) compared to that in the other two groups. Among the parameters BMI and WHR, the proportional form of BMI correlated well with the degree of reduction in proteinuria (r = 0.397, P = 0.01). Reduction in weight using lifestyle modifications and antiobesity drugs might improve renal function and proteinuria safely as observed in obese patients with diabetic nephropathy.
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Affiliation(s)
- M R Patil
- Department of Internal Medicine, C.S.M. Medical University, Lucknow, India
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Surman S, Couto CG, Dibartola SP, Chew DJ. Arterial blood pressure, proteinuria, and renal histopathology in clinically healthy retired racing greyhounds. J Vet Intern Med 2012; 26:1320-9. [PMID: 23083217 DOI: 10.1111/j.1939-1676.2012.01008.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 06/12/2012] [Accepted: 08/16/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Physiologic peculiarities of Greyhounds as compared to other dogs make interpretation of laboratory results in this breed challenging for veterinarians. Hypertension in retired racing Greyhounds (RRG) can contribute to microalbuminuria (MA), overt proteinuria, and renal histologic lesions. OBJECTIVES To evaluate clinicopathologic findings, hemodynamic status, and renal histology in a population of healthy RRG. ANIMALS RRG presented to Ohio State University College of Veterinary Medicine for inclusion in a spay and neuter program. METHODS Cross-sectional study. RRG were classified as normotensive (<160 mmHg) or hypertensive (>160 mmHg) based on blood pressure (BP) determinations using Doppler and oscillometric methods. Of the dogs evaluated, 62% (n = 29) were hypertensive and 38% (n = 18) were normotensive. Health status was evaluated using routine clinicopathologic tests (CBC, serum biochemistry, urinalysis) as well as evaluation of fractional excretion of electrolytes and MA determinations. Adequate renal biopsy specimens (n = 15) were evaluated using light, immunofluoresence, and electron microscopy. RESULTS All serum biochemistry results were normal in 45/49 dogs, but MA was more common in hypertensive (84% positive for MA) as compared with normotensive (18% positive for MA) RRG. Observed renal lesions were mild and renal biopsy scores were low in this sample of RRG. CONCLUSIONS Hypertension is common in RRG and might be breed-related. It is associated with MA, but observed renal lesions are mild. Whether or not hypertension and MA in RRG leads to progressive renal damage requires longitudinal study.
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Affiliation(s)
- S Surman
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, USA.
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Michaelson JS, Wisniacki N, Burkly LC, Putterman C. Role of TWEAK in lupus nephritis: a bench-to-bedside review. J Autoimmun 2012; 39:130-42. [PMID: 22727560 DOI: 10.1016/j.jaut.2012.05.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 05/17/2012] [Indexed: 01/17/2023]
Abstract
There is significant unmet need in the treatment of lupus nephritis (LN) patients. In this review, we highlight the role of the TWEAK/Fn14 pathway in mediating key pathologic processes underlying LN involving both glomerular and tubular injury, and thus the potential for renal protection via blockade of this pathway. The specific pathological mechanisms of TWEAK - namely promoting inflammation, renal cell proliferation and apoptosis, vascular activation and fibrosis - are described, with supporting data from animal models and in vitro systems. Furthermore, we detail the translational relevance of these mechanisms to clinical readouts in human LN. We present the opportunity for an anti-TWEAK therapeutic as a renal protective agent to improve efficacy relative to current standard of care treatments hopefully without increased safety risk, and highlight a phase II trial with BIIB023, an anti-TWEAK neutralizing antibody, designed to assess efficacy in LN patients. Taken together, targeting the TWEAK/Fn14 axis represents a potential new therapeutic paradigm for achieving renal protection in LN patients.
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Villa L, Boor P, Konieczny A, Kunter U, van Roeyen CR, Denecke B, Gan L, Kupper MB, Hoffmann K, Eitner F, Ostendorf T, Floege J. Effects and mechanisms of angiotensin II receptor blockade with telmisartan in a normotensive model of mesangioproliferative nephritis. Nephrol Dial Transplant 2011; 26:3131-43. [DOI: 10.1093/ndt/gfr096] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Georgaki-Angelaki H, Stergiou N, Manolaki N, Nakopoulou L, Syriopoulou VP, Roma-Giannikou E. Histological deterioration of obesity-related glomerulopathy despite the loss of proteinuria with weight reduction. Pediatr Nephrol 2010; 25:1573-4. [PMID: 20174828 DOI: 10.1007/s00467-010-1475-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 01/20/2010] [Accepted: 01/22/2010] [Indexed: 11/24/2022]
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Praga Terente M. Insuficiencia renal crónica en pacientes con diabetes tipo 2. Med Clin (Barc) 2010; 134:353-4. [DOI: 10.1016/j.medcli.2009.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 10/29/2009] [Indexed: 10/20/2022]
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Ohtomo S, Izuhara Y, Nangaku M, Dan T, Ito S, van Ypersele de Strihou C, Miyata T. Body weight control by a high-carbohydrate/low-fat diet slows the progression of diabetic kidney damage in an obese, hypertensive, type 2 diabetic rat model. J Obes 2010; 2010:136502. [PMID: 20700413 PMCID: PMC2911582 DOI: 10.1155/2010/136502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 10/07/2009] [Accepted: 11/16/2009] [Indexed: 01/09/2023] Open
Abstract
Obesity is one of several factors implicated in the genesis of diabetic nephropathy (DN). Obese, hypertensive, type 2 diabetic rats SHR/NDmcr-cp were given, for 12 weeks, either a normal, middle-carbohydrate/middle-fat diet (MC/MF group) or a high-carbohydrate/low-fat diet (HC/LF group). Daily caloric intake was the same in both groups. Nevertheless, the HC/LF group gained less weight. Despite equivalent degrees of hypertension, hyperglycemia, hyperlipidemia, hyperinsulinemia, and even a poorer glycemic control, the HC/LF group had less severe renal histological abnormalities and a reduced intrarenal advanced glycation and oxidative stress. Mediators of the renoprotection, specifically linked to obesity and body weight control, include a reduced renal inflammation and TGF-beta expression, together with an enhanced level of adiponectin. Altogether, these data identify a specific role of body weight control by a high-carbohydrate/low-fat diet in the progression of DN. Body weight control thus impacts on local intrarenal advanced glycation and oxidative stress through inflammation and adiponectin levels.
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Affiliation(s)
- Shuichi Ohtomo
- Research Division, Chugai Pharmaceutical Co., LTD., Shizuoka 412-8513, Japan
- Institute of Medical Sciences, Tokai University, Kanagawa 259-1193, Japan
- *Shuichi Ohtomo:
| | - Yuko Izuhara
- Institute of Medical Sciences, Tokai University, Kanagawa 259-1193, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, University of Tokyo School of Medicine, Tokyo 113-8655, Japan
| | - Takashi Dan
- Center for Translational and Advanced Research, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Sadayoshi Ito
- Department of Nephrology, Hypertension and Endocrinology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | | | - Toshio Miyata
- Center for Translational and Advanced Research, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
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Sigmundsson TS, Palsson R, Hardarson S, Edvardsson V. Resolution of proteinuria in a patient with X-linked Alport syndrome treated with cyclosporine. ACTA ACUST UNITED AC 2009; 40:522-5. [PMID: 17130107 DOI: 10.1080/00365590600830417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report a 9-year-old Icelandic male with Alport syndrome and nephrotic-range proteinuria who responded well to cyclosporine therapy. He presented at the age of 2 years with gross hematuria and proteinuria during an episode of upper respiratory tract infection. Three years later he had developed persistent proteinuria; kidney function was normal. A renal biopsy revealed marked irregularities in the glomerular basement membrane consistent with Alport syndrome. Mutation analysis revealed a single base insertion in COL4A5 which was predicted to cause a major structural defect in the collagen IV alpha5 chain. Despite angiotensin-converting enzyme inhibitor therapy his proteinuria progressed to the nephrotic range associated with edema. At the age of 7 years, cyclosporine therapy was instituted, which promptly resulted in almost complete resolution of proteinuria. Three years later his urinary protein excretion was close to the normal range and serum creatinine remained within normal limits. We conclude that closely monitored cyclosporine therapy may be a safe and effective treatment in patients with severe proteinuria and Alport syndrome.
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Palmer BF. Supratherapeutic doses of angiotensin receptor blockers to decrease proteinuria in patients with chronic kidney disease. Am J Nephrol 2007; 28:381-90. [PMID: 18063856 DOI: 10.1159/000112270] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Accepted: 11/05/2007] [Indexed: 11/19/2022]
Abstract
An important endpoint in treating chronic kidney disease, a prevalent disease that can lead to kidney failure and cardiovascular disease, is reducing proteinuria. Proteinuria is an independent risk factor for disease progression and the development of cardiovascular disease and is a key factor that can be used to guide therapy designed to maximize kidney protection. Proteinuria is targeted by using pharmacologic agents that suppress the renin-angiotensin-aldosterone system (RAAS), a regulator of intravascular volume and blood pressure; this has been shown to decrease proteinuria, slow disease progression, and improve coronary disease outcome, independent of effects on blood pressure. The efficacy of RAAS blockers, including angiotensin receptor blockers and angiotensin-converting enzyme inhibitors, may be limited by currently recommended doses, which are based on treatment of hypertension. Data are now emerging from clinical trials demonstrating that use of 'supratherapeutic doses' (doses greater than those approved for lowering blood pressure), compared with standard doses, has favorable safety, tolerability, and efficacy in reducing proteinuria in both diabetic and nondiabetic patients with chronic kidney disease. Supratherapeutic dosing may be a valuable approach for optimizing RAAS blockade and providing renoprotection.
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Affiliation(s)
- Biff F Palmer
- Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX 75225-8856, USA.
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Karuparthi PR, Yerram P, Saab G, McFarlane SI, Whaley-Connell A. Obesity and chronic kidney disease: therapeutic implications. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/14750708.4.5.585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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