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Am J Physiol Renal Physiol. 2017 Feb 1;312(2):F335-F342. doi: 10.1152/ajprenal.00438.2016. Epub 2016 Oct 12.

The relationship between urinary renin-angiotensin system markers, renal function, and blood pressure in adolescents with type 1 diabetes.

Author information

1
Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
2
Department of Pharmacology, University of Toronto, Toronto, Canada.
3
Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada.
4
Department of Paediatrics, Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, Canada, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) SickKids Multicenter Clinical Trial Center.
5
Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom.
6
University College Hospital, Heart Hospital and Great Ormond Street Hospital, London, United Kingdom.
7
WellChild Laboratory, Evelina Children's Hospital, St Thomas' Hospital, London, United Kingdom.
8
Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada; and.
9
Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
10
Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada; david.cherney@uhn.ca.

Abstract

The relationship between the renal renin-angiotensin aldosterone system (RAAS) and cardiorenal pathophysiology is unclear. Our aims were to assess 1) levels of urinary RAAS components and 2) the association between RAAS components and HbA1c, the urine albumin/creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and blood pressure (BP) in otherwise healthy adolescents with type 1 diabetes mellitus (TID) vs. healthy controls (HC). Urinary angiotensinogen and angtionsin-converting enzyme (ACE) 2 levels, activity of ACE and ACE2, BP, HbA1c, ACR, and eGFR were measured in 65 HC and 194 T1D from the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT). Urinary levels of all RAAS components were higher in T1D vs. HC (P < 0.0001). Higher HbA1c was associated with higher urinary angiotensinogen, ACE2, and higher activity of ACE and ACE2 (P < 0.0001, P = 0.0003, P = 0.003, and P = 0.007 respectively) in T1D. Higher ACR (within the normal range) was associated with higher urinary angiotensinogen (P < 0.0001) and ACE activity (P = 0.007), but not with urinary ACE2 activity or ACE2 levels. These observations were absent in HC. Urinary RAAS components were not associated with BP or eGFR in T1D or HC. Otherwise healthy adolescents with T1D exhibit higher levels of urinary RAAS components compared with HC. While levels of all urinary RAAS components correlate with HbA1c in T1D, only urinary angiotensinogen and ACE activity correlate with ACR, suggesting that these factors reflect an intermediary pathogenic link between hyperglycemia and albuminuria within the normal range.

KEYWORDS:

ACE; ACE2; hyperglycemia, albumin-to-creatinine ratio; type 1 diabetes

PMID:
27733369
DOI:
10.1152/ajprenal.00438.2016
[Indexed for MEDLINE]
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