Mahapatra Himansu Sekhar, Kumar Adarsh, Kulshreshtha Bindu, Chitkara Anubhuti, Kumari Anamika
Department of Nephrology, ABVIMS, Dr. R.M.L. Hospital, New Delhi, India.
Department of Endocrinology, ABVIMS, Dr. R.M.L. Hospital, New Delhi, India.
Indian J Nephrol. 2021 Jul-Aug;31(4):341-348. doi: 10.4103/ijn.IJN_67_20. Epub 2021 Jan 27.
Urinary angiotensinogen (UAGT) is supposed to be a marker of activation of the intrarenal renin- angiotensin system (RAS) system in early diabetic nnephropathy (EDN). Vitamin D has been studied as a negative regulator of the circulating and tissue RAS activity, so its supplementation may prevent the progression of diabetic nephropathy (DN). This study was planned to assess the RAS activation and effect of vitamin D supplementation in EDN progression by estimating the UAGT level.
A total of 103 EDN subjects were randomized in two groups to receive either cholecalciferol (54) or matching placebo (49) in a double-blind manner. All were subjected to routine investigations, urinary albumin-to-creatinine ratio (UACR), UAGT, vitamin D, and intact parathyroid hormone (iPTH) at the 0 and 6 months. A total 40 healthy controls were also included for assessment of the same investigations at 0 month.
Significant reduction of UACR, UAGT, and iPTH level were corroborated with an increase in 25(OH) vitamin D level from 0 to 6 months (all four < 0.001). After 6 months, the median [interquartile range (IQR)] of UAGT and UACR levels was significantly lower in the cholecalciferol group as compared to placebo group (p < 0.001 and = 0.04, respectively). The median UAGT level was significantly higher in patients with EDN (cholecalciferol & placebo Group) than control group at 0 month (p = 0.001).
Significantly higher UAGT levels in EDN supports the role of intrarenal RAS activation. A significant decrease in UAGT level in the cholecalciferol group supports the beneficial role of vitamin D supplementation in the progression of EDN.
尿血管紧张素原（UAGT）被认为是早期糖尿病肾病（EDN）中肾内肾素-血管紧张素系统（RAS）激活的标志物。维生素D已被研究作为循环和组织RAS活性的负调节剂，因此补充维生素D可能预防糖尿病肾病（DN）的进展。本研究旨在通过评估UAGT水平来评估RAS激活及补充维生素D对EDN进展的影响。
总共103名EDN受试者被随机分为两组，以双盲方式分别接受胆钙化醇（54例）或匹配的安慰剂（49例）。在0个月和6个月时，所有受试者均接受常规检查、尿白蛋白与肌酐比值（UACR）、UAGT、维生素D和完整甲状旁腺激素（iPTH）检测。还纳入了40名健康对照者，在0个月时进行相同检查以作评估。
从0个月到6个月，UACR、UAGT和iPTH水平显著降低，同时25（OH）维生素D水平升高（所有四项均P<0.001）。6个月后，胆钙化醇组的UAGT和UACR水平中位数[四分位间距（IQR）]显著低于安慰剂组（分别为P<0.001和P=0.04）。在0个月时，EDN患者（胆钙化醇组和安慰剂组）的UAGT水平中位数显著高于对照组（P=0.001）。
EDN中UAGT水平显著升高支持肾内RAS激活的作用。胆钙化醇组UAGT水平显著降低支持补充维生素D对EDN进展的有益作用。
