Albuminuria and hypertension: the chicken or the egg?
Albuminuria and hypertension: the chicken or the egg?
复制标题
蛋白尿和高血压：先有鸡还是先有蛋？
DOI：
10.1038/hr.2014.135
复制
发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Nakanishi T
中科院分区：
文献类型：
--
作者：
Nagasawa Y;Hasuike Y;Nanami M;Kuragano T;Nakanishi T
白蛋白尿是高血压的孵化卵传统上，白蛋白尿被归因于高血压：在鸡或蛋的情况下，白蛋白尿似乎是高血压“孵化”的产物（图1）。高血压促进内皮细胞的剪切应激和氧化应激。这些受损的内皮细胞失去了覆盖其窗孔的糖萼（图2）;因此，它们不能阻止白蛋白穿过基底膜。因此，白蛋白尿是由于内皮细胞损伤，而大量蛋白尿是由于足细胞或足突损伤。由于血管拉伤，近髓肾元通常面临以强烈高血压为特征的疾病。白蛋白尿是压力相关性肾单位损伤的指标。2一些疾病，以及高血压，也以类似的方式引起蛋白尿。3，4糖尿病是一种众所周知的蛋白尿诱导剂。5在糖尿病背景下，由氧化应激6诱导的乙酰肝素酶表达增加减少了内皮表面层;这种现象可以解释糖尿病肾病中观察到的白蛋白尿。蛋白多糖上的负电荷糖链介导肾小球内皮细胞的选择性渗透特性。1高浓度的葡萄糖增加功能障碍的内皮型一氧化氮合酶和活性氧的表达，而高剂量的游离脂肪酸不增加氧化应激。7
ALBUMINURIA AS THE HATCHED EGG OF HYPERTENSION Classically, albuminuria has been attributed to hypertension: in a chicken or egg scenario, albuminuria appears to be the product that ‘hatches’ from hypertension (Figure 1). Hypertension promotes shearing stress and oxidative stress in endothelial cells. These injured endothelial cells lose the glycocalyx that covers their fenestrae (Figure 2); therefore, they cannot prevent albumin from moving through the basal membrane. 1 Accordingly, albuminuria is attributed to endothelial cell injury, whereas macroproteinuria is attributed to either injured podocytes or their foot processes. The juxtamedullary nephrons often face conditions characterized by intense hypertension due to vessel strain. Albuminuria has served as an indicator of pressure-associated injury to nephrons. 2Several disease conditions, as well as hypertension, also cause proteinuria in a similar manner. 3, 4 Diabetes mellitus is a well-known inducer of albuminuria. 5 The endothelial surface layer is diminished by the increased expression of heparanase, which is induced by oxidative stress 6 in the setting of diabetes mellitus; this phenomenon may explain the albuminuria observed in diabetic nephropathy. The negatively charged sugar chains attached to proteoglycans mediate the permselective properties of glomerular endothelial cells. 1 High concentrations of glucose increase the expression of both dysfunctional endothelial nitric oxide synthase and reactive oxygen species, whereas high doses of free fatty acids do not increase oxidative stress. 7