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Diabetic Proteinuria Revisited: Updated Physiologic Perspectives

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 furth...

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Autores principales: Heyman, Samuel N., Raz, Itamar, Dwyer, Jamie P., Weinberg Sibony, Roni, Lewis, Julia B., Abassi, Zaid
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9496872/
https://www.ncbi.nlm.nih.gov/pubmed/36139492
http://dx.doi.org/10.3390/cells11182917
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author Heyman, Samuel N.
Raz, Itamar
Dwyer, Jamie P.
Weinberg Sibony, Roni
Lewis, Julia B.
Abassi, Zaid
author_facet Heyman, Samuel N.
Raz, Itamar
Dwyer, Jamie P.
Weinberg Sibony, Roni
Lewis, Julia B.
Abassi, Zaid
author_sort Heyman, Samuel N.
collection PubMed
description 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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spelling pubmed-94968722022-09-23 Diabetic Proteinuria Revisited: Updated Physiologic Perspectives Heyman, Samuel N. Raz, Itamar Dwyer, Jamie P. Weinberg Sibony, Roni Lewis, Julia B. Abassi, Zaid Cells Review 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. MDPI 2022-09-18 /pmc/articles/PMC9496872/ /pubmed/36139492 http://dx.doi.org/10.3390/cells11182917 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Heyman, Samuel N.
Raz, Itamar
Dwyer, Jamie P.
Weinberg Sibony, Roni
Lewis, Julia B.
Abassi, Zaid
Diabetic Proteinuria Revisited: Updated Physiologic Perspectives
title Diabetic Proteinuria Revisited: Updated Physiologic Perspectives
title_full Diabetic Proteinuria Revisited: Updated Physiologic Perspectives
title_fullStr Diabetic Proteinuria Revisited: Updated Physiologic Perspectives
title_full_unstemmed Diabetic Proteinuria Revisited: Updated Physiologic Perspectives
title_short Diabetic Proteinuria Revisited: Updated Physiologic Perspectives
title_sort diabetic proteinuria revisited: updated physiologic perspectives
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9496872/
https://www.ncbi.nlm.nih.gov/pubmed/36139492
http://dx.doi.org/10.3390/cells11182917
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