Apr 12, 2005

Tubular changes in early diabetic nephropathy

Advances in Chronic Kidney Disease
Merlin C ThomasM E Cooper


Far from being bystanders in diabetic nephropathy, changes in the proximal tubule are important for the development of progressive diabetic kidney disease. The proximal tubule is uniquely susceptible to a variety of metabolic and hemodynamic factors associated with diabetes. Renal function and prognosis correlate better with structural lesions in the tubuli and cortical interstitium than with classical glomerular changes of diabetic nephropathy. The proximal tubules show a variety of poorly characterized changes, which have led to the notion that tubular damage represents a "final common pathway" for proteinuric renal injury. However, tubular hypertrophy, reduced organic ion transport, and other tubular changes reviewed in this paper, are already apparent before the onset of proteinuria in diabetes. Indeed, increased tubuloglomerular feedback and defective uptake and lysosomal processing may independently contribute to hyperfiltration and urinary protein loss, respectively. This finding does not mean that glomerular or vascular dysfunction do not contribute to progressive nephropathy. However, although subdividing the nephron for the purposes of analysis and scientific discovery may be useful, the interactions between tubule, g...Continue Reading

  • References43
  • Citations94


  • References43
  • Citations94


Mentioned in this Paper

Metabolic Process, Cellular
Biochemical Pathway
Kidney Function Tests
Diabetic Nephropathy
De Toni-Debre-Fanconi Syndrome
Blood Vessel
Renal Glomerular Disease

About this Paper

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