Current concepts of renal hemodynamics in diabetes

Sharon Anderson, Jiten P. Vora

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Glomerular hyperfiltration has long been recognized in insulin-dependent diabetes, and has been more recently recognized in patients with non-insulin dependent diabetes mellitus as well. Experimentally, glomerular hyperfiltration has been shown to result from elevations in the glomerular capillary blood flow and the glomerular capillary hydraulic pressure (PGC). Of the hemodynamic determinants of hyperfiltration, it is glomerular hypertension that is most damaging to the glomerulus. Experimental and clinical studies have confirmed that antihypertensive agents that lower PGC more consistently slow the progression of injury than do those that fail to control glomerular hypertension. The pathogenesis of diabetic hyperfiltration is multifactoral. Many mediators have been proposed, including changes due to the altered metabolic milieu, and alterations in endogenous levels of such vasoactive mediators as atrial natriuretic peptide, endothelial-derived relaxing factor, angiotensin II, prostaglandins, thromboxanes, and kinins, among others. It has more recently been suggested that local renal tissue levels, rather than circulating levels, play the more profound role in hemodynamic regulation. For example, the renin-angiotensin system (RAS) appears to be disproportionately active in the renal tissue, potentially explaining the renal vascular responsiveness to angiotensin-converting enzyme inhibition despite absence of systemic RAS activation. Little is yet known of the mechanisms by which glomerular hypertension leads to injury. Innovative new in vitro systems have been developed to address this question. These studies postulate that glomerular hemodynamic factors (shear stress, pulsatile flow) modify the growth and activity of glomerular component cells, inducing the expression of cytokines and other mediators, which then stimulate matrix production and promote structural injury.

Original languageEnglish (US)
Pages (from-to)304-307
Number of pages4
JournalJournal of Diabetes and its Complications
Volume9
Issue number4
DOIs
StatePublished - 1995

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Hemodynamics
Renin-Angiotensin System
Hypertension
Kidney
Wounds and Injuries
Pulsatile Flow
Kinins
Thromboxanes
Atrial Natriuretic Factor
Peptidyl-Dipeptidase A
Cellular Structures
Angiotensin II
Type 2 Diabetes Mellitus
Antihypertensive Agents
Prostaglandins
Blood Vessels
Insulin
Cytokines
Pressure
Growth

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

Cite this

Current concepts of renal hemodynamics in diabetes. / Anderson, Sharon; Vora, Jiten P.

In: Journal of Diabetes and its Complications, Vol. 9, No. 4, 1995, p. 304-307.

Research output: Contribution to journalArticle

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