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J Korean Med Sci. 2017 May;32(5):782-788. doi: 10.3346/jkms.2017.32.5.782.

Changes in Urinary Angiotensinogen Associated with Deterioration of Kidney Function in Patients with Type 2 Diabetes Mellitus.

Lee MJ1,2, Kim SS1,2, Kim IJ1,3, Song SH1,2, Kim EH1,2, Seo JY1,2, Kim JH1,2, Kim S1,2, Jeon YK1,2, Kim BH1,2, Kim YK4.

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Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Kim Yong Ki Internal Medicine Clinic, Busan, Korea.


Urinary angiotensinogen (AGT) is potentially a specific biomarker for the status of the intrarenal renin-angiotensin system (RAS) in patients with diabetes mellitus. We explored whether changes in urinary AGT excretion levels were associated with the deterioration of kidney function in type 2 diabetes patients with preserved kidney function. Urinary baseline AGT levels were measured in 118 type 2 diabetic patients who were not taking RAS blockers and who had estimated glomerular filtration rates (eGFRs) ≥ 60 mL/min/1.73 m². A total of 91 patients were followed-up for 52 months. Changes in urinary levels of AGT (ΔAGT) were calculated by subtracting urinary AGT/creatinine (Cr) at baseline from urinary AGT/Cr after 1 year. ΔAGT was significantly inversely correlated with annual eGFR change (β = -0.29, P = 0.006; β = -0.37, P = 0.001 after adjusting for clinical factors). RAS blockers were prescribed in 36.3% of patients (n = 33) during follow-up. The ΔAGT values were lower in the RAS blockers users than in the non-RAS blockers users, but the differences were not statistically significant (7.37 ± 75.88 vs. 22.55 ± 57.45 μg/g Cr, P = 0.081). The ΔAGT values remained significantly correlated with the annual rate of eGFR change (β = -0.41, P = 0.001) in the patients who did not use RAS blockers, but no such correlation was evident in the patients who did. ΔAGT is inversely correlated with annual changes in eGFR in type 2 diabetes patients with preserved kidney function, particularly in RAS blocker-naïve patients.


Angiotensinogen; Diabetic Kidney Disease; Renin-Angiotensin System; Type 2 Diabetes Mellitus

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