Blood glucose in relation to blood pressure control asrisk factors in the progression of renaldamage in type 2 diabetes

摘要

One of the central functions of the kidney is to excrete low molecular weight, water-soluble, plasma, waste products into the urine, whereas macromolecules, the size of albumin and larger, are retained. The flow of the glomerular filtrate is thought to follow an extracellular route, passing through the endothelial fenestrae, then across the glomerular basement membrane (GBM) and finally through the slit diaphragm between the foot processes of podocytes. It has been recently hypothesized that microalbuminuria leading to proteinuria and to end stage renal disease (ESRD) is mainly due to an altered glomerular filtration barrier at podocyte level. The "conditio sine qua non" for the development of diabetic ESRD is hyperglycemia. However, hypertension is also an important antecedent of such complication in diabetes mellitus. Both hyperglycemia and hypertension appear to cause podocyte damage by overproduction of and extracellular release of oxygen radical species.