Please use this identifier to cite or link to this item:
Title: The tubulointerstitium in progressive diabetic kidney disease: more than an aftermath of glomerular injury?
Austin Authors: Gilbert, Richard E;Cooper, Mark E
Affiliation: University of Melbourne, Department of Medicine, West Heidelberg, Victoria, 3081, Australia
Issue Date: 1-Nov-1999
Publication information: Kidney International; 56(5): 1627-37
Abstract: Although the glomerulus, particularly the mesangium, has been the focus of intense investigation in diabetes, tubulointerstitial injury is also a major feature of diabetic nephropathy and an important predictor of renal dysfunction. The renal tubule in diabetes is subject to both direct and indirect pathogenetic influences as a consequence of its position in the nephron and its resorptive function. On exposure to glucose, proximal tubular cells elaborate vasoactive hormones, including angiotensin II and injurious cytokines such as transforming growth factor-beta (TGF-beta), as well as extracellular matrix proteins. In turn, angiotensin II may further increase TGF-beta expression in both proximal tubular and interstitial cells, thus amplifying the stimulus to fibrogenesis in the renal tubulointerstitium. In addition to these mostly direct influences, the renal tubule, particularly its proximal segment, is exposed to glomerular effluent. In the diabetic state, this includes large quantities of advanced glycation end products and glucose and, at later stages in the evolution of diabetic nephropathy, protein, all of which are factors that may induce TGF-beta expression and fibrosis. Diabetic nephropathy should therefore be viewed as a disease affecting the entire nephron. Continued exploration into tubulointerstitial disease in addition to glomerular injury in diabetes may help provide further insights into the pathogenesis of diabetic nephropathy and additional targets for therapeutic intervention.
Gov't Doc #: 10571771
DOI: 10.1046/j.1523-1755.1999.00721.x
Type: Journal Article
Subjects: Angiotensin-Converting Enzyme Inhibitors.pharmacology
Diabetic Nephropathies.etiology
Kidney Glomerulus.pathology
Kidney Tubules.pathology
Appears in Collections:Journal articles

Show full item record

Page view(s)

checked on Nov 25, 2022

Google ScholarTM


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.