IntroductionSubclinical Diabetic Kidney Disease (subDKD) is a clinically silent stage of kidney disease secondary to diabetes mellitus (DM), being a public health problem worldwide. The pathogenic mechanism involves hyperglycemia-induced tubulointerstitial injury associated with dysfunction of tubular protein reabsorption and proteinuria, even without any clinical signs like impaired glomerular function. Interestingly, angiotensin receptor blockers (ARBs), known as type 1 angiotensin II receptor (AT1R) antagonists, are effective against proteinuria in many kidney diseases, suggesting the potential involvement of the Renin-Angiotensin System. Herein, we studied the potential renoprotective effects of ARB on the pathogenesis of subDKD.MethodsFor that, we developed streptozotocin (STZ)-induced type 1 DM [with normal levels of glomerular flow rate] in male Wistar rats, which were daily treated with 30 mg/kg/day losartan, a well-known ARB, via gavage for 6 consecutive weeks starting after induction of diabetes. Four experimental groups were generated: 1) CONT, normoglycemic rat; 2) ARB, normoglycemic rat treated with losartan; 3) subDKD, diabetic rat; 4) subDKD+ARB, diabetic rat treated with losartan.ResultsComparing with the CONT group, the subDKD group presented: 1) impaired tubular reabsorption of Na+ and Cl-; 2) proteinuria associated with dysfunction in cortical albumin endocytosis; 3) increased levels of urinary lactate dehydrogenase and γ-glutamyltransferase, markers of kidney and proximal tubule epithelial cell injuries, respectively; 4) increased kidney injury score and tubulointerstitial injury; 5) increased cortical type 1 collagen deposition. Interestingly, the ARB treatment ameliorated all parameters observed in diabetic rats (subDKD+ARB group). No significant changes were observed in the ARB group.DiscussionAltogether, our findings indicated that ARB promotes renoprotective effects by attenuating AT1R-associated tubular damage and proteinuria of tubular origin observed in subDKD.
Angiotensin receptor blocker ameliorates the development of tubulointerstitial injury and fibrosis associated with tubular proteinuria observed in subclinical diabetic kidney disease
Diogo B. Peruchetti

