SLIDE 1
Glycocalyx Loss—
Podocyte and Kidney Injury Induces Albuminuria
Nat Rev Nephrol 2015;11:667-676
Atherosclerotic Lesions Develop After Glycocalyx Loss
Nat Rev Nephrol 2015;11:667-676
Glycocalyx Loss Podocyte and Kidney Injury Induces Albuminuria Nat - - PowerPoint PPT Presentation
Glycocalyx Loss Podocyte and Kidney Injury Induces Albuminuria Nat - - PowerPoint PPT Presentation
Glycocalyx Loss Podocyte and Kidney Injury Induces Albuminuria Nat Rev Nephrol 2015;11:667-676 Atherosclerotic Lesions Develop After Glycocalyx Loss Nat Rev Nephrol 2015;11:667-676 Mechanism of Glycocalyx Degradation Nat Rev Nephrol
SLIDE 2
SLIDE 3
Mechanism of Glycocalyx Degradation
Nat Rev Nephrol 2015;11:667-676
SLIDE 4
Glycocalyx Thickness is Lower in Children with Type 1 Diabetes
J Pediatr 2014;164:584-589
SLIDE 5
So what is albuminuria?
An elevated urinary albumin excretion is a marker
- f endothelial dysfunction; it symbolizes the kidney’s way
- f translating the existence of vascular damage.
SLIDE 6
Prevalence of Albuminuria in the General Population
Low-Normal Albuminuria
0-10mg/24h 75%
Macroalbuminuria
>300 mg/24h 0.7%
Microalbuminuria
30-300 mg/24h 7.2%
High-Normal Albuminuria
11-29 mg/24h 16.6%
N = 40,856
J Int Med 2001;249:519-526
SLIDE 7
The Significance of Albuminuria
- Results from injury to systemic and glomerular
circulation (loss of glycocalyx)
- When increased, associated with progressive
decline in renal function
- Predicts new onset diabetes risk
- When increased, associated with greater risk of
cardiovascular, cerebrovascular, and peripheral vascular disease
N Engl J Med 2000;342:145-153; Am J Kidney Dis 2000;36:646-661; Am J Kidney Dis 2000;35(4suppl1):S97-S105
SLIDE 8
Albuminuria Predicts Chronic Kidney Disease in the Non-Diabetes General Population
>300 30 - 300 15 – 29 0 - 14
Incidence of Stage 3 CKD (%)
70 60 50 40 30 20 10
Albuminuria (mg/day)
9 13 22 58
Kidney Int 2004;66(suppl 92):1-4
Stage 3 CKD = creatinine clearance < 60 mL/min
SLIDE 9
Albuminuria Predicts New Onset Diabetes Risk in General Population
>300 30 - 300 15 – 29 0 - 14
New Onset Diabetes (%)
14 12 10 8 6 4 2
Albuminuria (mg/24h) 2.2 4.3 7.9 11.8
Diabetes Care 2005;28:2525-2530
SLIDE 10
Albuminuria Predicts Cardiovascular Death in General Population
>300 30 - 300 15 – 29 0 - 14
CV death (% per 1000 patients)
35 30 25 20 15 10 5
Albuminuria (mg/24h)
3.5 4.5 11.2 29.1
Circulation 2002;106:1777-1782
SLIDE 11
Increased All-Cause Morality when the Albumin Creatinine Ratio is > 5
Kidney Int 2011;79:1341-1352
↓
SLIDE 12
Lancet Diabetes Endocrinol 2015;3:514-525
eGFR and UACR: CVD, Stroke, and CHF Risks
↓ ↓
HR: 1.0 eGFR 95 mL/min HR: 1.0 UACR 5 mg/g creatinine
Hyperfiltration