J Korean Diabetes.  2013 Mar;14(1):15-18.

Pathophysiology of Diabetic Nephropathy

• Kim MK

Abstract

Diabetic nephropathy is the leading cause of end stage renal disease in the world including Korea. The accumulation of extracellular matrix with thickening of the glomerular and tubular basement membranes is the key feature of diabetic nephropathy. Hyperglycemia and hemodynamic factors such as hypertension are involved in the development and progression of diabetic nephropathy through multiple mechanisms and interactions with various cytokines and growth factors. In this report, the pathophysiology of diabetic nephropathy is reviewed.

Keyword

Diabetic nephropathies; Pathology; Physiology

MeSH Terms

Basement Membrane
Cytokines
Diabetic Nephropathies
Extracellular Matrix
Hemodynamics
Hyperglycemia
Hypertension
Intercellular Signaling Peptides and Proteins
Kidney Failure, Chronic
Korea
Cytokines
Intercellular Signaling Peptides and Proteins

Reference

1. SKorean Diabetes Association, Korea Centers for Disease Control and Prevention. Diabetes fact sheet in Korea 2012. Seoul: Korean Diabetes Association/Korea Centers for Disease Control and Prevention;2012.

2. SAmerican Diabetes Association. Standards of medical care in diabetes-2013. Diabetes Care. 2013; 36(Suppl 1):S11–66.

3. SESRD Registry Committee, Korean Society of Nephrology. Current Renal Replacement Therapy in Korea -Insan Memorial Dialysis Registry, 2010. Korean J Nephrol. 2011; 30:531–57.

4. SDronavalli S, Duka I, Bakris GL. The pathogenesis of diabetic nephropathy. Nat Clin Pract Endocrinol Metab. 2008; 4:444–52.

5. SGnudi L, Thomas SM, Viberti G. Mechanical forces in diabetic kidney disease: a trigger for impaired glucose metabolism. J Am Soc Nephrol. 2007; 18:2226–32.

6. SBrownlee M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes. 2005; 54:1615–25.

7. SWolf G. New insights into the pathophysiology of diabetic nephropathy: from haemodynamics to molecular pathology. Eur J Clin Invest. 2004; 34:785–96.

8. SOsterby R, Gundersen HJ, Horlyck A, Kroustrup JP, Nyberg G, Westberg G. Diabetic glomerulopathy. Structural characteristics of the early and advanced stages. Diabetes. 1983; 32(Suppl 2):79–82.

9. SGnudi L. Cellular and molecular mechanisms of diabetic glomerulopathy. Nephrol Dial Transplant. 2012; 27:2642–49.

10. SDoublier S, Salvidio G, Lupia E, Ruotsalainen V, Verzola D, Deferrari G, Camussi G. Nephrin expression is reduced in human diabetic nephropathy: evidence for a distinct role for glycated albumin and angiotensin II. Diabetes. 2003; 52:1023–30.

11. SWolf G, Ziyadeh FN. Cellular and molecular mechanisms of proteinuria in diabetic nephropathy. Nephron Physiol. 2007; 106:26–31.

12. SRuilope LM. Angiotensin receptor blockers: RAAS blockade and renoprotection. Curr Med Res Opin. 2008; 24:1285–93.

13. SOsei SY, Price DA, Laffel LM, Lansang MC, Hollenberg NK. Effect of angiotensin II antagonist eprosartan on hyperglycemia-induced activation of intrarenal renin-angiotensin system in healthy humans. Hypertension. 2000; 36:122–6.

14. SOsei SY, Price DA, Fisher ND, Porter L, Laffel LM, Hollenberg NK. Hyperglycemia and angiotensin-mediated control of the renal circulation in healthy humans. Hypertension. 1999; 33:559–64.

15. SBrewster UC, Perazella MA. The renin-angiotensin-aldosterone system and the kidney: effects on kidney disease. Am J Med. 2004; 116:263–72.

16. SBrownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature. 2001; 414:813–20.

17. SKunisaki M, Bursell SE, Umeda F, Nawata H, King GL. Normalization of diacylglycerol-protein kinase C activation by vitamin E in aorta of diabetic rats and cultured rat smooth muscle cells exposed to elevated glucose levels. Diabetes. 1994; 43:1372–7.

18. SSuzuki D, Miyata T, Saotome N, Horie K, Inagi R, Yasuda Y, Uchida K, Izuhara Y, Yagame M, Sakai H, Kurokawa K. Immunohistochemical evidence for an increased oxidative stress and carbonyl modification of proteins in diabetic glomerular lesions. J Am Soc Nephrol. 1999; 10:822–32.

19. SWada J, Makino H. Inflammation and the pathogenesis of diabetic nephropathy. Clin Sci (Lond). 2013; 124:139–52.

20. SAdler S. Diabetic nephropathy: Linking histology, cell biology, and genetics. Kidney Int. 2004; 66:2095–106.

21. SMooyaart AL, Valk EJ, van Es LA, Bruijn JA, de Heer E, Freedman BI, Dekkers OM, Baelde HJ. Genetic associations in diabetic nephropathy: a meta-analysis. Diabetologia. 2011; 54:544–53.