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J Am Soc Nephrol. 2016 Dec;27(12):3748-3757. Epub 2016 May 9.

Capillary Rarefaction Associates with Albuminuria: The Maastricht Study.

Author information

1
Department of Internal Medicine, Division of Nephrology and.
2
School of Nutrition and Translational Research in Metabolism.
3
Departments of Internal Medicine and.
4
Cardiovascular Research Institute Maastricht.
5
School for Public Health and Primary Care.
6
Department of Epidemiology, and.
7
Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands; and.
8
School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
9
Departments of Internal Medicine and cda.stehouwer@mumc.nl.

Abstract

Albuminuria may be a biomarker of generalized (i.e., microvascular and macrovascular) endothelial dysfunction. According to this concept, endothelial dysfunction of the renal microcirculation causes albuminuria by increasing glomerular capillary wall permeability and intraglomerular pressure, the latter eventually leading to glomerular capillary dropout (rarefaction) and further increases in intraglomerular pressure. However, direct evidence for an association between capillary rarefaction and albuminuria is lacking. Therefore, we examined the cross-sectional association between the recruitment of capillaries after arterial occlusion (capillary density during postocclusive peak reactive hyperemia) and during venous occlusion (venous congestion), as assessed with skin capillaroscopy, and albuminuria in 741 participants of the Maastricht Study, including 211 participants with type 2 diabetes. Overall, 57 participants had albuminuria, which was defined as a urinary albumin excretion ≥30 mg/24 h. After adjustment for potential confounders, participants in the lowest tertile of skin capillary recruitment during postocclusive peak reactive hyperemia had an odds ratio for albuminuria of 2.27 (95% confidence interval, 1.07 to 4.80) compared with those in the highest tertile. Similarly, a comparison between the lowest and the highest tertiles of capillary recruitment during venous congestion yielded an odds ratio of 2.89 (95% confidence interval, 1.27 to 6.61) for participants in the lowest tertile. In conclusion, lower capillary density of the skin microcirculation independently associated with albuminuria, providing direct support for a role of capillary rarefaction in the pathogenesis of albuminuria.

KEYWORDS:

chronic kidney disease; diabetic nephropathy; endothelium; microalbuminuria

PMID:
27160406
PMCID:
PMC5118486
DOI:
10.1681/ASN.2015111219
[Indexed for MEDLINE]
Free PMC Article

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