Primary kidney growth and its consequences at the onset of diabetes mellitus |
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Authors: | J. Satriano V. Vallon |
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Affiliation: | (1) Department of Medicine, Division of Nephrology-Hypertension, The Veterans Administration San Diego Healthcare System, University of California, San Diego, CA, U.S.A.;(2) Department of Pharmacology, University of San Diego, San Diego, CA, U.S.A. |
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Abstract: | Summary. Diabetes mellitus is a primary contributor to progressive kidney dysfunction leading to end-stage renal disease (ESRD). In the early phase of diabetes, prior to the onset of further complications, both kidney size and glomerular filtration rate (GFR) increase. Glomerular hyperfiltration is considered a risk factor for downstream complications and progression to ESRD. Abnormalities in vascular control have been purported to account for the glomerular hyperfiltration in early diabetes. In this review we discuss a tubulo-centric concept in which tubular growth and subsequent hyper-reabsorption contribute to the onset of glomerular hyperfiltration that demarks the early stage of diabetes. Kidney growth, in this concept, is no longer relegated to a compensatory response to hyperfiltration, but rather plays a primary and active role in its genesis and progression. As such, components of kidney growth, such as the polyamines, may provide a means of early detection of diabetic kidney dysfunction and more effective therapeutic intervention. |
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Keywords: | : Type-1 diabetes – Hyperfiltration – Tubuloglomerular feedback – Kidney – Polyamines – Hypertrophy |
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