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Comparison of intrarenal renin‐angiotensin system activity in diabetic versus non‐diabetic patients with overt proteinuria
Author(s) -
Park Ji Hyeon,
Jang Hye Ryoun,
Lee JongHo,
Lee Jung Eun,
Huh Wooseong,
Lee KyuBeck,
Kwon YoungJoo,
Do Jun Young,
Kim Hye Young,
Kim YoonGoo
Publication year - 2015
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12383
Subject(s) - medicine , proteinuria , renin–angiotensin system , diabetes mellitus , urology , endocrinology , kidney , blood pressure
Aim The intrarenal renin‐angiotensin system ( RAS ) has been reported to be activated in chronic proteinuria patients. This study aimed to compare intrarenal RAS activity between diabetic nephropathy ( DN ) and non‐diabetic nephropathy ( NDN ) patients with overt proteinuria. Methods A multicenter, cross‐sectional study was conducted in 116 patients with overt proteinuria (urinary protein/creatinine ratio [u PCR ] > 1 mg/mg C r). To estimate intrarenal RAS activity we measured urinary excretion of angiotensinogen ( uAGT ) and renin (u R enin) in patients with DN ( n = 38) and NDN ( n = 78). Results Both natural logarithms of uAGT /urinary creatinine (ln[ uAGT / uCr ]) and u R enin (ln[ uRenin / uCr ]) levels were significantly higher in patients with DN compared with those with NDN (ln[ uAGT / uCr ]: 4.16 ± 1.13 in DN vs. 3.52 ± 1.21 in NDN , P = 0.007; ln[ uRenin / uCr ]: 5.66 ± 1.60 in DN vs. 4.29 ± 1.48 in NDN , P < 0.001), when estimated glomerular filtration rate ( eGFR ) and u PCR showed no significant difference between the two groups. In a subgroup analysis, according to amount of proteinuria, both uAGT and u R enin were higher in DN in patients with subnephrotic‐range proteinuria ( uPCR < 3.5 mg/mg C r). However, in patients with nephrotic‐range proteinuria ( uPCR ≥ 3.5 mg/mg C r), only u R enin was higher in DN compared to NDN . In a multiple regression analysis, diabetes showed independent association with u R enin. Conclusion Consistently elevated u R enin in DN , regardless of the amount of proteinuria, indicates that intrarenal RAS activity may be higher in DN compared to NDN in patients with overt proteinuria.