Preventive effects of vasohibin-2-targeting peptide vaccine for diabetic nephropathy.

Diabetic nephropathy remains the leading cause of end-stage kidney disease in many countries, and additional therapeutic targets are needed to prevent its development and progression. Some angiogenic factors are involved in the pathogenesis of diabetic nephropathy. Vasohibin-2 (VASH2) is a novel proangiogenic factor, and our previous study showed that glomerular damage is inhibited in diabetic Vash2 homozygous knockout mice. Therefore, we established a VASH2-targeting peptide vaccine as a tool for anti-VASH2 therapy in diabetic nephropathy. In this study, the preventive effects of the VASH2-targeting peptide vaccine against glomerular injury were examined in a streptozotocin (STZ)-induced diabetic mouse model. The mice were subcutaneously injected with the vaccine at two doses 2 wk apart and then intraperitoneally injected with 50 mg/kg STZ for 5 consecutive days. Glomerular injury was evaluated 20 wk after the first vaccination. Treatment with the VASH2-targeting peptide vaccine successfully induced circulating anti-VASH2 antibody without inflammation in major organs. Although the vaccination did not affect blood glucose levels, it significantly prevented hyperglycemia-induced increases in urinary albumin excretion and glomerular volume. The vaccination did not affect increased VASH2 expression but significantly inhibited renal angiopoietin-2 (Angpt2) expression in the diabetic mice. Furthermore, it significantly prevented glomerular macrophage infiltration. The preventive effects of vaccination on glomerular injury were also confirmed in db/db mice. Taken together, the results of this study suggest that the VASH2-targeting peptide vaccine may prevent diabetic glomerular injury in mice by inhibiting Angpt2-mediated microinflammation.NEW & NOTEWORTHY This study demonstrated preventive effects of VASH2-targeting peptide vaccine therapy on albuminuria and glomerular microinflammation in STZ-induced diabetic mouse model by inhibiting renal Angpt2 expression. The vaccination was also effective in db/db mice. The results highlight the importance of VASH2 in the pathogenesis of early-stage diabetic nephropathy and the practicability of anti-VASH2 strategy as a vaccine therapy.

Tangshen formula protects against podocyte apoptosis via enhancing the TFEB-mediated autophagy-lysosome pathway in diabetic nephropathy.

ETHNOPHARMACOLOGICAL RELEVANCE: Diabetic nephropathy (DN) is the leading cause of end-stage kidney disease and currently there are no specific and effective drugs for its treatment. Podocyte injury is a detrimental feature and the major cause of albuminuria in DN. We previously reported Tangshen Formula (TSF), a Chinese herbal medicine, has shown therapeutic effects on DN. However, the underlying mechanisms remain obscure. AIM OF THE STUDY: This study aimed to explore the protective effect of TSF on podocyte apoptosis in DN and elucidate the potential mechanism. MATERIALS AND METHODS: The effects of TSF were assessed in a murine model using male KKAy diabetic mice, as well as in advanced glycation end products-stimulated primary mice podocytes. Transcription factor EB (TFEB) knockdown primary podocytes were employed for mechanistic studies. In vivo and in vitro studies were performed and results assessed using transmission electron microscopy, immunofluorescence staining, and western blotting. RESULTS: TSF treatment alleviated podocyte apoptosis and structural impairment, decreased albuminuria, and mitigated renal dysfunction in KKAy mice. Notably, TSF extracted twice showed a more significant reduction in proteinuria than TSF extracted three times. Accumulation of autophagic biomarkers p62 and LC3, and aberrant autophagic flux in podocytes of DN mice were significantly altered by TSF therapy. Consistent with the in vivo results, TSF prevented the apoptosis of primary podocytes exposed to AGEs and activated autophagy. However, the anti-apoptosis capacity of TSF was countered by the autophagy-lysosome inhibitor chloroquine. We found that TSF increased the nuclear translocation of TFEB in diabetic podocytes, and thus upregulated transcription of its several autophagic target genes. Pharmacological activation of TFEB by TSF accelerated the conversion of autophagosome to autolysosome and lysosomal biogenesis, further augmented autophagic flux. Conversely, TFEB knockdown negated the favorable effects of TSF on autophagy in AGEs-stimulated primary podocytes. CONCLUSIONS: These findings indicate TSF appears to attenuate podocyte apoptosis and promote autophagy in DN via the TFEB-mediated autophagy-lysosome system. Thus, TSF may be a therapeutic candidate for DN.

Efeitos do controle glicêmico obtido em curto prazo sobre a microalbuminúria e a filtração glomerular em pacientes diabéticos do tipo 2 com controle glicêmico precário / Efect of short term glycemic control on microalbuminuria and glomerular filtration rate in type 2 diabetic patients with poor glycemic control

INTRODUÇÃO: O controle intensivo da glicemia reduz significativamente o risco de desenvolvimento de complicações microvasculares, incluindo a nefropatia. OBJETIVOS: Foi avaliado o impacto do controle glicêmico, por meio do cálculo da glicemia média semanal (GMS) e variabilidade glicêmica (VG), sobre a pressão arterial (PA) nas 24 horas (MAPA), excreção urinária de albumina (EUA) e taxa de filtração glomerular (TFG). MÉTODOS: 53 pacientes com diabetes mellitus tipo 2 (DM2), dividida aleatoriamente em dois grupos para receber tratamento convencional ou intensivo. Esse último incluía visitas semanais para ajustes da medicação e aplicação de um plano educacional durante seis semanas. RESULTADOS: Observou-se controle glicêmico (GMS < 150 mg/dL e VG < 50) em 75% (n = 21) dos pacientes do grupo intervenção (GI) (n = 28) e em 24% (n = 6) do grupo convencional (GC) (n = 25) (p < 0,001). Dos 27 pacientes dos dois grupos que obtiveram controle glicêmico, 14 apresentavam inicialmente média da PA sistólica (PAS) > 120 mmHg e que se reduziu de 138,4 ± 10,1 para 127,8 ± 11,6 mmHg (p = 0,023) ao final das seis semanas. Foram observadas reduções da PAS e PA diastólica (PAD) na vigília e durante o sono, que não ocorreram no grupo (n = 17) sem controle glicêmico e PAS >120 mmHg. Inicialmente, 15 pacientes apresentavam TFG >120 mL/min, sendo que após seis semanas, apenas o subgrupo que alcançou controle glicêmico (n = 7) mostrou redução de 137,2 ± 16 para 122,2 ± 25,2 mL/min (p = 0,02). No inicio do estudo, outros quinze pacientes apresentavam microalbuminúria. Após seis semanas, independente de terem alcançado o controle glicêmico preconizado, observou-se redução da EUA de 63,0 ± 43,1 para 24,8 ± 19,5 mg/g de creatinina (p = 0,02). CONCLUSÃO: Assim, o controle glicêmico obtido em curto prazo resultou na redução da PA, da TFG e da EUA nos pacientes com DM2 que apresentavam alterações desses parâmetros, alterações benéficas no que se refere à proteção renal.

INTRODUCTION: The intensive glucose control significantly reduces the risk of microvascular complications, including nephropaty. OBJECTIVES: We assess the impact of glycemic control through calculation of weekly mean glycemia (WMG) and glycemic variability (GV) on 24 hours ambulatory blood pressure (ABPM), urinary albumin excretion (UAE) and glomerular filtration rate (GFR). METHODS: 53 patients with type 2 diabetes mellitus (DM2) were randomly divided into two groups to receive conventional or intensive treatment, which included weekly visits for medication adjustments and implementation of an educational plan for six weeks. RESULTS: We observed glycemic control (WMG < 150 mg/dL and VG < 50) in 75% (n = 21) of the patients on the intervention treatment (IT) (n = 28), and in 24% (n = 6) of the ones on the conventional treatment (CT) (n = 25) (p < 0.001). Considering patients of the two groups, 14 out of the 27 patients who achieved glycemic control showed initial mean systolic blood pressure (SBP) > 120 mmHg which was reduced from 138.4 ± 10.1 to 127.8 ± 11.6 mmHg (p = 0.023) at the end of week six. Reductions in SBP and diastolic BP (DBP) during wakefulness and sleep did not occur in the group (n = 17) without glycemic control and with SBP > 120 mmHg. Initially, 15 patients had GFR > 120 mL/min, and after six weeks, only the subgroup that achieved glycemic control (n = 7) showed a reduction of 137.2 ± 16 to 122.2 ± 25.2 mL/min (p = 0.02). At the beginning of the study, another fifteen patients presented with microalbuminuria. After six weeks, regardless of whether they achieved glycemic control or not, there was reduction in UAE, from 63.0 ± 43.1 to 24.8 ± 19.5 mg/g creatinine (p = 0.02). CONCLUSION: Thus short term glycemic control resulted in reductions of BP, GFR and the UAE in patients with DM2, which are beneficial for renal protection.

Microalbuminuria y excreción urinaria de albúmina en la práctica clínica / Microalbuminuria and urinary albumin excretion in clinical practice

Background: Microalbuminuria is a new tool in the management of patients with diabetes mellitus or hypertension. Microalbuminuria is an easily measured biomarker in a urine sample. Urinary albumin to creatinine ratio in first morning urine sample correlates with 24 hours urinary albumin excretion, but it is easier to obtain, and can identify hypertensive or diabetic patients with high risk for cardiovascular events. Therapeutic interventions such as renin angiotensin system blockade have demonstrated their usefulness in reducing urinary albumin excretion in clinical studies. It would be advisable to incorporate urinary albumin to creatinine ratio to the routine clinical monitoring of patients with cardiovascular risk, such as those with hypertension and diabetes mellitus.

Efeito da perda de peso sobre a hemodinâmica renal em portadores da síndrome metabólica / Weight loss improves renal hemodynamics in patients with metabolic syndrome

OBJETIVO: No presente artigo, investigou-se o impacto da redução do peso corporal na excreção urinária de albumina e na depuração da creatinina em indivíduos obesos com síndrome metabólica. MÉTODOS: Trinta e cinco indivíduos foram submetidos à dieta hipocalórica por um período de 12 semanas, visando uma redução mínima de 5% do peso corporal. Os voluntários foram submetidos à avaliação metabólica (teste oral de tolerância à glicose, dosagens de lípides plasmáticos e ácido úrico) e à avaliação de parâmetros hemodinâmicos renais (depuração da creatinina e excreção urinária de albumina), antes (fase 1) e após 12 semanas de dieta hipocalórica (fase 2). RESULTADOS: Após o período de intervenção, os voluntários foram divididos em dois grupos: indivíduos que atingiram o alvo para redução de peso (respondedores: R, n = 14) e pacientes que não atingiram a meta para redução de peso (não-respondedores: NR, n = 21). Indivíduos do Grupo R apresentaram melhora do perfil lipídico, da redução da excreção urinária de albumina (mediana = 162.5 mg/24 horas, variação: 0,8 a 292 mg/24 horas, na fase 1 para 10,4 mg/24 horas, variação: 1,6 a 22,4 mg/24 horas, na fase 2), além de redução significante da depuração da creatinina (121,4 ± 66,5 mL/min. para 92,9 ± 35,6 mL/min., p = 0,001). No Grupo NR, não foram observadas diferenças estatisticamente significantes entre as fases 1 e 2 do estudo. CONCLUSÃO: A redução do peso corporal teve impacto positivo na hemodinâmica renal, reduzindo a excreção urinária de albumina e a hiperfiltração glomerular em indivíduos obesos com síndrome metabólica.

OBJECTIVE: We investigated the impact of weight loss on urinary albumin excretion (UAE) and creatinine clearance in obese patients with metabolic syndrome. METHODS: Thirty-five obese patients undertook a 12-week calorie-restricted diet. The patients underwent a metabolic (oral glucose tolerance test, plasma lipids, and uric acid) and renal hemodynamic evaluations (creatinine clearance and urinary albumin excretion) before (phase 1), and after the 12-week diet (phase 2). RESULTS: After the dietary intervention, the subjects were divided into two groups: patients who achieved the target weight reduction (R: responders, n = 14), and patients who did not (NR: non-responders, n = 21). The patients in Group R showed an improvement in lipid profile, a decrease in UAE (median = 162.5 mg/24 hours, range: 0.8 to 292 mg/24 hours, at phase 1 versus 10.4 mg/24 hours, range: 1.6 to 22.4 mg/24 hours, at phase 2), and a significant reduction in creatinine clearance (121.4 ± 66.5 mL/min. in phase 1 to 92.9 ± 35.6 mL/min. at the end of phase 2, p = 0.001). In Group NR, no statistically significant differences were observed between phases 1 and 2. CONCLUSION: Body weight reduction has a positive impact on renal hemodynamics, decreasing urinary albumin excretion as well as glomerular hyperfiltration in obese patients with metabolic syndrome.

Beneficial effect of ubiquinol, the reduced form of coenzyme Q10, on cyclosporine nephrotoxicity

BACKGROUND: Cyclosporine (CyA) nephrotoxicity is partly due to some oxidative stress. Ubiquinol, the reduced form of coenzyme Q10 (rCoQ10), has recently gained attention for its anti-oxidative potential. The aim of this study is to evaluate the effect of rCoQ10 on a CyA nephrotoxic rat model. MATERIALS AND METHODS: Six-week-old male Wistar rats were divided into three groups (five animals each). Group 1 received a medium only. Group 2 received 30 mg/kg/day of CyA only. Group 3 received both the same dose of CyA and 600 mg/kg/day of rCoQ10. CyA and rCoQ10 were both given orally for four weeks. Systolic blood pressure (BP), daily urinary albumin secretion (u-Alb), serum creatinine (s-Cr) level, and super-oxide anion (SO) level in the renal tissue were measured and compared among those three groups. Immunohistochemistry using an antibody for the transforming growth factor-beta (TGF-beta) was also examined. RESULTS: BPs, u-Albs, s-Crs, and SO levels of groups 1, 2, and 3 were 114 ± 3, 132 ± 4, and 129 ± 5 mmHg, 2.6 ± 0.5, 42.1 ± 7.2, and 22.8 ± 3.4 micro-g/day, 1.1 ± 0.2, 1.7 ± 0.2, and 1.3 ± 0.2 mg/dl, and 224 ± 84, 1251 ± 138, and 512 ± 109 RLU/g kidney respectively. U-Albs, s-Crs, and SO levels were significantly ameliorated by rCoQ10. Micro-vacuolar changes and TGF-beta positive deposits in the proximal renal tubular cells of CyA group rats disappeared in those of CyA and rCoQ10 group rats. CONCLUSION: RCoQ10, an antioxidants, may have potential for preventing CyA nephrotoxicity.

El pentosán polisulfato de sodio previene las alteraciones morfológicas renales y la albuminuria en ratas con diabetes tipo 1 / Pentosan polysulfate sodium prevents kidney morphological changes and albuminuria in rats with type 1 diabetes

Se ha reportado una disminución de los valores de glicosaminoglicanos (GAG) en el riñón y otros órganos en modelos experimentales de diabetes y en humanos. La administración a largo plazo de heparina y otros GAG previene las alteraciones morfológicas y funcionales del riñón en ratas diabéticas. Evaluamos el efecto del pentosán polisulfato de sodio (PPSNa), un mucopolis acárido semisintético similar a los GAG y de baja actividad anticoagulante, sobre la función renal y los cambios estructurales en ratas diabéticas. La diabetes fue inducida a ratas Sprague Dawley mediante la administración i.v. de estreptozotocina (STZ). Los animales fueron distribuidos al azar en tres grupos (C = control, STZ y STZ + PPSNa = pretratados con 15 mg/kg/día de PPSNa s.c.). Después de 3 meses se tomaron muestras de sangre y de orina de 24 horas; los animales fueron sacrificados y los riñones extraídos mediante microdisección para el análisis morfométrico. Los animales del grupo STZ presentaron un incremento importante de la excreción de albúmina en orina (C = 0,26 ±0,03 frente a STZ = 7,75 ± 1,8 mg/24 h), que fue parcialmente revertido por el pretratamiento con PPSN a (3,7 ± 0,7 mg/24 h),sin afectar al control metabólico, HbA1c(C = 3,6 ± 1,7; STZ = 8,82± 0,47; STZ + PPSNa = 8,63 ± 0,54). En las micrografías electrónicas se observan las lesiones renales típicas descritas en la diabetes experimental (grupo STZ). La administración de PPSNa previene el engrosamiento de la membrana basal tubular y la pérdida de la citoarquitectura inducida por la diabetes. Nuestros resultados demuestran que la administración de PPSNa previene parcialmente el daño renal en este modelo experimental y sugieren un potencial uso terapéutico de este compuesto (AU)

Decreased levels of glycosaminoglycans (GAG) have been observed in kidney and other organs, in human and animal models of diabetes. Long term administration of heparins and other glycosaminoglycans have demonstrated a beneficial effect on morphological and functional renal abnormalitiesin diabetic rats. We assessed the effect of sodium pentosen polysulfate (SPP), a semi-synthetic glycosaminoglycan with low anticoagulant activity, on renal involvement in streptozotocin diabetic rats. Diabetes was induced in male Sprague Dawley rats by i.v. administration of streptozotocin (STZ).Animals were randomly allocated in three groups: C = control, STZ and STZ + SPP = pretreated with SPP (15 mg/kg, s.c.).After three months of follow-up, blood and 24 h-urine samples were obtained and then the animals were sacrificed and the kidney microdissected for morphometric analysis. Urinaryalbumin excretion was markedly increased in untreated diabetic rats (C = 0.26 ± 0.03 vs. STZ = 7.75 ± 1.8 mg/24 h) andSPP treatment partially prevented the albumin rise (3.7 ± 0.7mg/24 h), without affecting the metabolic control HbA1c(C = 3.6 ± 1.7; STZ = 8.82 ± 0.47; STZ + SPP = 8.63 ± 0.54). Electron microscope observation revealed typical renal lesions described in experimental diabetes (STZ group). SPP administration prevent the tubular basement membrane thickening and the lost of cytoarchitecture induced by experimental diabetes. Our data demonstrated that long-term administration of SPP have a favorable effect on morphological and functional abnormalities in kidney of diabetic rats and suggests a potential therapeutic use for this compound (AU)

Eficacia del Enalapril en pacientes monorrenos con dieta normoproteica y sin ella / Efficacy of Enalapril in patients with single kidney and with or without normoprotein diet

El paciente monorreno, sin dieta normoproteica,puede presentar microalbuminuriaanormal con eventual desarrollo de glomerulosclerosis.Objetivo. Evaluar la eficacia del Enalapril parareducir la microalbuminuria patológica en pacientesmonorrenos con dieta normoproteica y sin ella.Población, material y métodos. Estudiamos 49 pacientesmonorrenos, edad (media) 11 años, eutróficos,con función renal normal y consentimiento médicoaprobado. Criterios de exclusión: uropatías,hipertensión arterial, enfermedades oncológicas, tratamientoscon drogas nefrotóxicas, proteinuriaortostática. La población se clasificó en dos grupos:Grupo A: con dieta normoproteica (0,8-1,2 g/kg/díapara sexo y edad). Grupo B: con dieta libre.A los pacientes con microalbuminuria anormal seles administró Enalapril (intervalo de dosis: 0,1 mg/kg/día a 0,3 mg/kg/día).Resultados. Grupo A: 21 pacientes, 2 con microalbuminuriapatológica. Aumento promedio del tamañorenal: 14% (DE 8 por ciento). Riesgo de presentarmicroalbuminuria patológica: 9 porc ciento.Grupo B: 28 pacientes, 11 con microalbuminuriaanormal. Riesgo de presentar microalbuminuriaanormal: 40 por ciento. Aumento promedio del tamaño renal:33,8 (DE 6,1 por ciento). RR: 4,125(IC 1-16) (p: 0,01).NND: 3. Media de microalbuminuria pre-Enalapril50,20 μg/minuto y post-Enalapril 11,5 μg/minuto.Dosis media de Enalapril: 0,2 mg/kg/día.Coeficiente de correlación entre microalbuminuriay aumento del tamaño renal: 0,75; y entre ingestaproteica y aumento del tamaño renal: 0,72.Tiempo (medio) de aparición de la microalbuminuriaanormal: 81 meses (DE 7 meses).Conclusión. El Enalapril junto con la dieta normoproteicaen pacientes monorrenos disminuyen elriesgo de desarrollar microalbuminuria anormal

Uso de olmesartán en la prevención o retraso de la nefropatía diabética: algunas consideraciones / Olmesartan for the prevention or delay of diabetic nephropathy: some considerations

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Nefroprotección y riesgo vascular: prevención del daño renal en la hipertensión arterial / Nephroprotection and vascular risk: prevention of renal damage in hypertension

La prevalencia de disfunción renal es elevada en la población general, y mucho más entre los pacientes con hipertensión arterial. Ello comporta un elevado riesgo no sólo de evolucionar a insuficiencia renal terminal, sino de presentar una mayor morbimortalidad cardiovascular. Las guías clínicas de enfermedad renal crónica recomiendan un control ambicioso de la presión arterial (< 130/80mmHg o más bajo en caso de proteinuria) y la utilización de fármacos contra el sistema renina-angiotensina (SRA). Sin embargo, la evidencia de estas recomendaciones parece escasa para aquellos pacientes hipertensos que no sean diabéticos o no tengan proteinuria. Este artículo revisa dicha controversia y concluye con recomendaciones para la mejor preservación renal en los pacientes hipertensos(AU)

Kidney dysfunction is highly prevalent in the general population and even more so among patients with hypertension, leading to a high risk not only of progression to end-stage renal insufficiency but also of greater cardiovascular morbidity and mortality. Clinical guidelines for chronic kidney disease recommend ambitious blood pressure control (< 130/80mmHg or lower if there is proteinuria) and the use of renin-angiotensin system blockers. However, the evidence for these recommendations in patients with hypertension without diabetes or proteinuria is scarce. The present article reviews this controversy and concludes with recommendations for better renal preservation in patients with hypertension(AU)

Daño renal en pacientes con síndrome metabólico que consultan en atención primaria / Renal damage in primary care patients with metabolic syndrome

Introducción. Estudiar en condiciones de práctica clínica real el daño renal, la prevalencia y grado de control de los factores de riesgo cardiovascular en pacientes con síndrome metabólico atendidos en atención primaria. Material y método. Estudio observacional realizado a pacientes con síndrome metabólico (criterios ATP III). Realizado en centros de atención primaria de la Región de Murcia y Asturias. Se incluyó a 485 pacientes. Los datos recogidos fueron edad, sexo, índice de masa corporal (IMC), presión arterial, presión de pulso, glucosa, hemoglobina glucosilada, perfil lipídico, factores de riesgo cardiovascular, tratamiento, componentes de síndrome metabólico y datos de afectación renal. Resultados. De los 458 pacientes, el filtrado glomerular es < 90ml/min en 375 (77,5%). La microalbuminuria ha sido positiva en 94 pacientes (22%). Las cifras medias de presión arterial fueron 143,6±16,0mm de Hg para la sistólica y 82,8±10,2mm de Hg para la diastólica. El LDL colesterol (LDLc) medio fue de 129,88±36,77mg/dl y la hemoglobina glucosilada, de 6,47±1,45g/dl. El fármaco más utilizado para el control de la diabetes fue la metformina en el 33,6% de los diabéticos. Respecto a la hipertensión arterial (HTA) los fármacos más utilizados fueron los bloqueantes del sistema renina angiotensina en el 41,1% de los hipertensos y para el control lipídico fueron las estatinas en el 63,1% de los dislipidémicos. Conclusiones. Se detecta afectación renal en un alto porcentaje de los pacientes. Es necesario lograr un alto grado de control de los factores de riesgo cardiovascular en estos pacientes (AU)

Introduction: To study, under routine clinical practice conditions, renal damage, prevalence and control of cardiovascular risk factors in patients with metabolic syndrome treated in Primary Care centres in Spain. Material and methods: An observational study in patients with metabolic syndrome (ATP III criteria) was conducted in Primary Care Centres in Murcia and Asturias. A total of 485 patients were included. The data collected were: age, sex, body mass index, blood pressure, pulse pressure, glucose, glycosylated haemoglobin, lipid profile, cardiovascular risk factors, treatment, components of metabolic syndrome and data on renal involvement. Results: Of the 485 patients, 375 (77.5%) had a glomerular filtration rate of < 90 ml/min. Microalbuminuria was positive in 94 patients (22%). The means of blood pressure were 143.6±16.0 mmHg for systolic, and 82.8±10.2 mmHg for diastolic. The mean LDL cholesterol was 129.88±36.97 mg/dL and for glycosylated haemoglobin it was 6.47±1.45 g/dL. The drug most used for the control of the diabetes was metformin in 33.6% of the diabetics. With respect to hypertension the drugs more used were the renin-angiotensin system blockers in 41.1% of the hypertensive patients. Statins were used for lipid control in 63.1% of the patients. Conclusions: Renal damage was detected in a high percentage of the patients. An increased level of control of cardiovascular risk factors is required in these patients (AU)

Papel da dieta como fator de risco e progressão da nefropatia diabética / The role of the diet as a risk factor for the development and progression of diabetic nephropathy

A nefropatia diabética (ND) acomete até 40 por cento dos pacientes com diabetes melito (DM) tipo 1 e tipo 2, sendo a principal causa de insuficiênca renal crônica naqueles pacientes que ingressam em programa de tratamento de substituição renal. A dieta parece ter um papel importante no desenvolvimento da doença. Existem evidências de que não apenas a quantidade mas o tipo de proteína ingerida também está associado à ND. Poucos estudos analisaram o papel dos lipídeos da dieta na ND. Dietas hipoprotéicas têm sido úteis em modificar de forma favorável a evolução da ND, desacelerando a perda de função renal em pacientes DM tipo 1 e ND. Existem poucos estudos em pacientes com DM tipo 2, porém estudos a curto prazo sugerem que esta dieta reduz a albuminúria. Entretanto, o seu uso a longo prazo é comprometido pela dificuldade de aderência à restrição protéica e pela sua segurança nutricional não estar ainda estabelecida. Resultados promissores são observados quando comparadas diferentes fontes de ingestão de proteína animal sobre a função renal e perfil lipídico sérico de pacientes com ND, podendo estas intervenções representar uma alternativa à dieta hipoprotéica no manejo dietoterápico nestes pacientes, ao atuar sobre os fatores de risco cardiovasculares e na função endotelial.