This month's Nature Review Nephrology dedicated an entire journal to the Concept of Diabetic Nephropathy.
There are many articles that are in the journal but a few highlights are worth mentioning.
1. The potential role of epigenetic mechanisms in diabetic nephropathy is intriguing. Epigenetics interact with genetic information and alter genetic expression and perhaps even cause human diseases. The Epigenetics concept is growing and even human behavior can change the epigenome. These epigenomes are sort of turn on and off switches of the genes.
The mention a concept of metabolic memory of renal cells and epigenomics in diabetes is new. The question of whether transient hyperglycemia ( leading to a memory of that in the renal cells) due to glycosolated end products or AGE, can induce epigenetic modifications of gene expression by affecting the methylation of particular parts of the genome is what is discussed in one of the articles. Metobolic memory is referred to as if the cells have seen prior hyperglycemia, they keep that memory and can later on return via epigenetic mechanism to lead to diabetic disease!
2. Another article discusses the concept of nuclear hormone receptors in diabetes. Multiple nuclear hormone receptors have been linked with changes and leading to diabetic nephropahty in rat models. Some of the ones mentioned are PPARY, estrogen receptor, Vitamin D receptor, hepatocyte nuclear factor 4, farnesoid receptor, liver X receptor, and estrogen related receptors. All of these receptors in some shape of form have been linked to either renal fibrosis, proteinuria, mesangial expansion, lipid accumulation or macrophage infiltration( different stages of diabetic nephropathy)
3. The concept of RAGE or receptor of advanced glycalation endproducts is reviewed in one of the chapters.
RAGE is not only dominant player in diabetes but there have been papers regarding lupus, amyloidosis, ischemic renal injury as well. A simple way to conceptualize is the stimulus is likely elevated glucose that leads to activation of RAGE on the glomerular cells that leads to podocyte apoptosis and increase permeability; increased reactive oxygen species and increased TGF-B and fibrosis; increased CCL2 and hence increased inflammation via attraction of inflammatory cells and mesangial expansion. All these phenomenon leading to increase damage and repair leading to the pathology we see in Diabetic Nephropathy.
- ► 2017 (37)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- ► 2011 (370)
- IN THE NEWS: Three trials SHOCK the NEPHROLOGY WOR...
- IN THE NEWS:- Angiotensin-receptor blockade and r...
- CONSULT ROUNDS: Hypocomplementemia!
- IN THE NEWS ---> Stem Cells and Kidney Damage
- Answer to Immunology Quiz 2
- Rituximab for induction?
- TOPIC DISCUSSION: Phosphorous containing foods
- Panel Reactive Antibody? how do you calculate?
- Topic Discussion: MYH9 Nephropathies
- Pediatrics Grand rounds continue
- CLINICAL CASE 18, ANSWER and SUMMARY
- New blogs of interest
- Topic Discussion: Primary vs Secondary Membranous
- CLINICAL CASE 17, ANSWER AND SUMMARY
- TOPIC DISCUSSION: Amylase in the urine?? Hmm!!
- Gurudakshina in Nephrology
- Are you aware of MICA antibodies?
- ISBP Conference Sept 2010
- Innovative Nephrology teaching tools!
- Kamal Shah's Blog: An Indian CKD registry now exis...
- CLINICAL CASE 16 , ANSWER and SUMMARY
- IN THE NEWS- Proteinuria and Avastin
- CONSULT ROUNDS: Dialysis Membrane Reactions- Type ...
- IN THE NEWS ---> New treatments for cystic diseas...
- Immunology Quiz 1 Answers
- Rituximab induced lung injury
- TOPIC DISCUSSION: DIABETIC NEPHROPATHY!!
- B cell signature and Tolerance
- Nephrology World on Intragraft gene expression
- Kidney Transplant as an Outpatient Procedure
- IN THE NEWS ---> Detective Nephron strikes again!...
- IN THE NEWS --->NephrologyonDemand
- CONSULT ROUNDS: ANURIC RENAL FAILURE
- CONSULT ROUNDS: Hydronephrosis without evidence on...
- Journal Club: B regulatory cells
- CLINICAL CASE 15 , ANSWER and SUMMARY
- ▼ June (36)