Under common practice, the conventional diagnostic marker such as microalbuminuria determination does not recognized early stage of diabetic kidney disease （normoalbuminuria, chronic kidney disease stage 1, 2）; due ...Under common practice, the conventional diagnostic marker such as microalbuminuria determination does not recognized early stage of diabetic kidney disease （normoalbuminuria, chronic kidney disease stage 1, 2）; due to the insensitiveness of the available marker. Treat-ment at later stage （microalbuminuria） simply slows the renal disease progression, but is rather diffcult to restore the renal perfusion. Intrarenal hemodynamic study in these patients revealed an impaired renal per-fusion and abnormally elevated renal arteriolar resis-tances. Treatment with vasodilators such as angiotensin converting enzyme inhibitor and angiotensin receptor blocker fails to correct the renal ischemia. Recent study on vascular homeostasis revealed a defective mecha-nism associated with an impaired nitric oxide production which would explain the therapeutic resistance to va-sodilator treatment in microalbuminuric diabetic kidney disease. This study implies that the appropriate thera-peutic strategy should be implemented at earlier stage before the appearance of microalbuminuria.展开更多
基金Supported by Thailand Research-Fund,Bhumirajanagarindra Kidney Institute and National Research Council Fund of Thailand
文摘Under common practice, the conventional diagnostic marker such as microalbuminuria determination does not recognized early stage of diabetic kidney disease （normoalbuminuria, chronic kidney disease stage 1, 2）; due to the insensitiveness of the available marker. Treat-ment at later stage （microalbuminuria） simply slows the renal disease progression, but is rather diffcult to restore the renal perfusion. Intrarenal hemodynamic study in these patients revealed an impaired renal per-fusion and abnormally elevated renal arteriolar resis-tances. Treatment with vasodilators such as angiotensin converting enzyme inhibitor and angiotensin receptor blocker fails to correct the renal ischemia. Recent study on vascular homeostasis revealed a defective mecha-nism associated with an impaired nitric oxide production which would explain the therapeutic resistance to va-sodilator treatment in microalbuminuric diabetic kidney disease. This study implies that the appropriate thera-peutic strategy should be implemented at earlier stage before the appearance of microalbuminuria.
