Albuminuria And Renal Structure In Niddm

Although the principal endpoint in evaluating the influence of an antihypertensive agent on renal function in diabetes is its ability to alter the progression of the disease, it is clear that abnormally elevated albuminuria is also associated with progressive renal injury [132]. Nevertheless, many of the short-term trials that have been performed in DM2 subjects only document a reduction in albuminuria in the absence of a change in glomerular filtration rate. Long-term studies in both DM1 and DM2 subjects suggest that the severity of proteinuria also correlates with the rate of progression of renal disease [4, 6, 133]. Nonetheless, studies involving renal structural assessment are warranted to more accurately determine the response to antihypertensive agents. Fioretto et al have investigated the underlying renal pathology which occurs in DM2 patients with various stages of nephropathy [134]. There appears to be a marked variation in the degree of glomerulosclerosis and tubulointerstitial fibrosis in this population with only about one third having the typical histology of diabetic nephropathy. Recently it has been demonstrated in a small study that the ACEI, perindopril, can attenuate the development of renal injury and in particular tubulointerstitial expansion [135, 136]. The utility of detailed histomorphometric studies in this content remain to be validated and this morphological approach may be more relevant for research purposes, particularly if they incorporate studies to delineate the importance of various cellular and molecular processes implicated in progressive diabetes related renal injury.

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