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Futrakul N, Futrakul P. Biomarker for early renal microvascular and diabetic kidney diseases. Ren Fail 2017; 39:505-511. [PMID: 28494191 PMCID: PMC6014362 DOI: 10.1080/0886022x.2017.1323647] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/20/2017] [Accepted: 04/23/2017] [Indexed: 12/20/2022] Open
Abstract
Recognition of early stage of diabetic kidney disease, under common practice using biomarkers, namely microalbuminuria, serum creatinine level above 1 mg/dL and accepted definition of diabetic kidney disease associated with creatinine clearance value below 60 mL/min/1.73 m2, is unlikely. This would lead to delay treatment associated with therapeutic resistance to vasodilator due to a defective vascular homoeostasis. Other alternative biomarkers related to the state of microalbuminuria is not sensitive to screen for early diabetic kidney disease (stages I, II). In this regard, a better diagnostic markers to serve for this purpose are creatinine clearance, fractional excretion of magnesium (FE Mg), cystatin C. Recently, renal microvascular disease and renal ischemia have been demonstrated to correlate indirectly with the development of diabetic kidney disease and its function. Among these are angiogenic and anti-angiogenic factors, namely VEGF, VEGF receptors, angiopoietins and endostatin. With respect to therapeutic prevention, implementation of treatment at early stage of diabetic and nondiabetic kidney disease is able to restore renal perfusion and function.
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Affiliation(s)
- Narisa Futrakul
- Department of Physiology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Prasit Futrakul
- Academy of Science, The Royal Institute of Thailand and Bhumirajanagarindra Kidney Institute, Bangkok, Thailand
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Futrakul N, Chanakul A, Futrakul P, Deekajorndech T. Early stage of vascular disease and diabetic kidney disease: an under-recognized entity. Ren Fail 2015; 37:1243-6. [PMID: 26365595 DOI: 10.3109/0886022x.2015.1073054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Early stage of vascular disease and diabetic kidney disease (DKD stages 1 and 2) has been under-recognized, under common practice worldwide. The lack of sensitive diagnostic marker leads to late diagnosis and a progression of underlying vascular disease associated with chronic renal ischemia, which eventually intensifies the magnitude of DKD damage. Treatment at this late stage fails to correct the renal ischemia, or restore renal function, due to the altered vascular homeostasis associated with an impaired nitric oxide production. In contrast to the above information, early recognition of vascular disease and DKD with sensitive diagnostic markers would be able to implement an effective prevention of progression of vascular disease and DKD. Treatment at early stage under environment favorable for adequate vascular homeostasis is able to correct the renal ischemia and improve the renal function.
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Affiliation(s)
- Narisa Futrakul
- a Renal Microvascular Research Group, Department of Physiology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University , Bangkok , Thailand
| | - Ankanee Chanakul
- b Department of Pediatrics , King Chulalongkorn Memorial Hospital, Chulalongkorn University , Bangkok , Thailand , and
| | - Prasit Futrakul
- c Bhumirajanagarindra Kidney Institute, and Academy of Science, The Royal Institute of Thailand , Bangkok , Thailand
| | - Tawatchai Deekajorndech
- b Department of Pediatrics , King Chulalongkorn Memorial Hospital, Chulalongkorn University , Bangkok , Thailand , and
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Futrakul N, Futrakul P. Vascular response to vasodilator treatment in microalbuminuric diabetic kidney disease. World J Nephrol 2013; 2:125-128. [PMID: 24255895 PMCID: PMC3832868 DOI: 10.5527/wjn.v2.i4.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/04/2013] [Accepted: 09/04/2013] [Indexed: 02/06/2023] Open
Abstract
Under common practice, the conventional diagnostic marker such as microalbuminuria determination does not recognized early stage of diabetic kidney disease (normoalbuminuria, chronic kidney disease stage 1, 2); due to the insensitiveness of the available marker. Treatment at later stage (microalbuminuria) simply slows the renal disease progression, but is rather difficult to restore the renal perfusion. Intrarenal hemodynamic study in these patients revealed an impaired renal perfusion and abnormally elevated renal arteriolar resistances. Treatment with vasodilators such as angiotensin converting enzyme inhibitor and angiotensin receptor blocker fails to correct the renal ischemia. Recent study on vascular homeostasis revealed a defective mechanism associated with an impaired nitric oxide production which would explain the therapeutic resistance to vasodilator treatment in microalbuminuric diabetic kidney disease. This study implies that the appropriate therapeutic strategy should be implemented at earlier stage before the appearance of microalbuminuria.
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Futrakul N, Futrakul P. Urgent call for reconsideration of chronic kidney disease. World J Nephrol 2012; 1:155-9. [PMID: 24175254 PMCID: PMC3782220 DOI: 10.5527/wjn.v1.i6.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 11/13/2012] [Accepted: 11/25/2012] [Indexed: 02/06/2023] Open
Abstract
Circulating toxins namely: free radicals, cytokines and metabolic products induce glomerular endothelial dysfunction, hemodynamic maladjustment and chronic ischemic state;this leads to tubulointerstitial fibrosis in chronic kidney disease (CKD). Altered vascular homeostasis observed in late stage CKD revealed defective angiogenesis and impaired nitric oxide production explaining therapeutic resistance to vasodilator treatment in late stage CKD. Under current practice, CKD patients are diagnosed and treated at a rather late stage due to the lack of sensitivity of the diagnostic markers available. This suggests the need for an alternative therapeutic strategy implementing the therapeutic approach at an early stage. This view is supported by the normal or mildly impaired vascular homeostasis observed in early stage CKD. Treatment at this early stage can potentially enhance renal perfusion, correct the renal ischemic state and restore renal function. Thus, this alternative therapeutic approach would effectively prevent end-stage renal disease.
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Affiliation(s)
- Narisa Futrakul
- Narisa Futrakul, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
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Ito H, Mifune M, Abe M, Oshikiri K, Antoku S, Takeuchi Y, Togane M, Ando S, Tsugami E. Hypertension resistant to antihypertensive agents commonly occurs with the progression of diabetic nephropathy in Japanese patients with type 2 diabetes mellitus: a prospective observational study. BMC Nephrol 2012; 13:48. [PMID: 22738384 PMCID: PMC3437202 DOI: 10.1186/1471-2369-13-48] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 06/27/2012] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND We investigated 1) the frequency of hypertension in patients with type 2 diabetes graded by the new classification of chronic kidney disease (CKD) reported by the Kidney Disease: Improving Global Outcomes (KDIGO) and 2) the number of antihypertensive agents needed to achieve treatment goals using a prospective observational study. METHODS A population of 2018 patients with type 2 diabetes mellitus was recruited for the study. The CKD stage was classified according to the eGFR and the urinary albumin excretion levels. RESULTS Hypertension was found in 1420 (70%) of the patients, and the proportion of subjects showing a blood pressure<130/80 mmHg was 31% at the baseline. Although the mean blood pressure was approximately 130/75 mmHg, the rate of patients with a blood pressure of <130/80 mmHg became limited to 41-50% during the observation period. The number of antihypertensive agents required for treatment was significantly higher at the endpoint (2.0±1.3) than at the baseline (1.6±1.2). Furthermore, it increased with the progression of the CKD stage at both the baseline and the endpoint of the observation. However, the frequency of subjects who did not achieve the blood pressure target was found to increase in the group demonstrating the later stage of CKD. CONCLUSIONS Hypertension resistant to antihypertensive agents was common in the patients with type 2 diabetes mellitus and increased with the progression of CKD. Although powerful combination therapy using antihypertensive agents is considered necessary for the strict control of blood pressure, this became difficult in individuals who were in advanced stages as graded based on the eGFR and the urinary albumin excretion levels.
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Affiliation(s)
- Hiroyuki Ito
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, 2-24-18, Higashi-Koiwa, Edogawa, Tokyo, 133-0052, Japan
| | - Mizuo Mifune
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, 2-24-18, Higashi-Koiwa, Edogawa, Tokyo, 133-0052, Japan
| | - Mariko Abe
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, 2-24-18, Higashi-Koiwa, Edogawa, Tokyo, 133-0052, Japan
| | - Koshiro Oshikiri
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, 2-24-18, Higashi-Koiwa, Edogawa, Tokyo, 133-0052, Japan
| | - Shinichi Antoku
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, 2-24-18, Higashi-Koiwa, Edogawa, Tokyo, 133-0052, Japan
| | - Yuichiro Takeuchi
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, 2-24-18, Higashi-Koiwa, Edogawa, Tokyo, 133-0052, Japan
| | - Michiko Togane
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, 2-24-18, Higashi-Koiwa, Edogawa, Tokyo, 133-0052, Japan
| | - Shigenori Ando
- Pharmaceutical Department, Edogawa Hospital, 2-24-18, Higashi-Koiwa, Edogawa, Tokyo, 133-0052, Japan
| | - Emiko Tsugami
- Pharmaceutical Department, Edogawa Hospital, 2-24-18, Higashi-Koiwa, Edogawa, Tokyo, 133-0052, Japan
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Is Diabetic Nephropathy a Restorative Disease? Ren Fail 2012; 34:667-8. [DOI: 10.3109/0886022x.2012.664764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Futrakul N, Futrakul P. A progression in peritubular capillary flow reduction and tubulointerstitial fibrosis reflected by FE Mg predict the decline in glomerular filtration rate. Kidney Int 2012; 81:707; author reply 707. [DOI: 10.1038/ki.2011.487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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