ABSTRACT
Background: Renal microvascular disease and reduction in peritubular capillary flow are generally observed in type 2 diabetic nephropathy (DN). Earlier therapeutic strategy with vasodilators has improved renal function in normo-albuminuric type 2 DN.Objective: Study the mechanism of vascular homeostasis in twenty patients associated with normo-albuminuric type 2 DN.Results: Angiogenic factors were observed in normo-albuminuric type 2 DN, where vascular endothelial growth factor (VEGF), was 420 + 341 vs. 428+291 pg/mL (normal), and vascular endothelial growth factor - receptor 1 (VEGF-R1) was 60+12 vs. 49+5 ng/mL (normal), which were not significantly different from the controls.Anti-angiogenic factors were observed in normo-albuminuric type 2 DN, where angiopoietin-2, was 2309+1125 vs. 1671+835 pg/mL (normal), and vascular endothelial growth factor - receptor 2 (VEGF-R2) was 5715+1400 vs.6126 + 1060 ng/mL (normal), which were not significantly different from the controls.Conclusion: The mechanism of vascular homeostasis was adequately functional in normo-albuminuric type 2 DN. This mechanism may explain the positive response to vasodilators and improved renal function in early stage oftype 2 DN following the vasodilator treatment.Keywords: Enhanced renal perfusion, normo-albuminuric type 2 diabetic nephropathy, vascular homeostasis,restoring renal function
ABSTRACT
Background: Vascular disease is unfortunately an asymptomatic process that is responsible for a variety of organ damages such as chronic kidney disease (CKD). Present therapeutic strategy in CKD which is usually initiated at the late stage of CKD fails to enhance renal perfusion or restore function.Objective: To summarize the mechanism of vascular homeostasis in different stages of CKD to explain the present therapeutic failure. Furthermore, the authors propose an innovative strategy to restore effectively renal perfusion and function in CKD.Results: Altered vascular homeostasis with impaired vascular repair is observed in late stage of CKD and would explain the present therapeutic failure. However, an adequate vascular repair is observed in early stage of CKD, which would provide an alternative innovative approach to restore renal function in this early stage under environment favorable for renal angiogenesis and regeneration.Conclusion: A restoration of renal perfusion and function can be accomplished in early stage of CKD with multidrug vasodilators.