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Diabetic nephropathies --- Physiopathology.

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This dissertation by Stephanie Franzén explores the role of hypoxia in the development of diabetic nephropathy, a leading cause of end-stage renal disease in diabetes patients. The research investigates the temporal relationship between intrarenal hypoxia and kidney disease progression, emphasizing the potential involvement of endothelin receptor signaling. Utilizing experimental models, the study examines various mouse strains to identify those with disease progression patterns similar to humans. The work further adapts electron paramagnetic resonance (EPR) oximetry to measure kidney oxygenation, revealing early onset of hypoxia prior to albuminuria. Key findings suggest that endothelin receptor type A contributes to hypoxia, while type B stimulation improves oxygenation, indicating potential therapeutic targets. The intended audience includes medical researchers and healthcare professionals focused on nephrology and diabetes.

Diabetic nephropathies. --- Anoxemia.

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Kidneys --- Diabetic nephropathies. --- Hypertension. --- Diseases --- Risk factors.

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Diabetes Mellitus --- Diabetes --- Diabetic Nephropathies --- Diabetic Retinopathy --- Diabetic nephropathies --- Diabetic retinopathy --- Complications

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At the present time, about 30% of diabetic type II patients are suffering for chronic renal insufficiency but the problem is often underrecognized or neglected in clinical practice. The use of antidiabetics drugs is quite limited due to poor product’s elimination. This may lead to side effects like lactic acidosis with Metformine or hypoglycemia with Sulfonylureas. More the renal disease is advanced less is the choice for medication. Metformine by example is not allowed for patients with a GFR less than 60 ml/min; other drugs will need to have their doses reevaluated. It seems like new drugs like the dipeptidyl-peptides 4 inhibitors are best choices but we have to remain carefully as we don’t have sufficient experience to use them widely A l’heure actuelle, environ 30% des patients diabétiques de type 2 développent une insuffisance rénale chronique, mais ce problème est souvent méconnu ou négligé dans la pratique clinique. L’utilisation des médicaments antidiabétiques est assez limitée à cause d’une mauvaise élimination du produit qui entraîne l’apparition d’effets secondaires comme une acidose lactique dans le cas de la Metformine ou encore une hypoglycémie dans le cas des Sulfamidés hypoglycémiants. Au plus l’atteinte rénale est sévère, au plus le choix se restreint. C’est le cas de la Metformine qui est formellement contre-indiquées à partir d’un débit de filtration glomérulaire inférieur à 60 ml/min, d’autres subiront un ajustement de doses. Il semble aussi que les nouveaux médicaments tels que les inhibiteurs de la dipeptidyl peptidase-4 soient prometteurs mais il faut tout de même rester prudent car « nouveau » veut aussi dire moins de recul quant à leur utilisation

Diabetes Mellitus --- Renal Insufficiency, Chronic --- Diabetic Nephropathies --- Prescription Drugs