Issue 3, 2010 September 2010 Welcome to the third issue of Kidney and Blood Pressure Research Digest (KBPR Digest) in 2010. We would like to draw your attention to articles of outstanding importance in the field of nephrology and hypertension, presenting short summaries of these articles to the scientific community in the form of KBPR Digest. KBPR Digest provides readers from all over the world with a free and concise overview on interesting topics which are part of the current issue of Kidney and Blood Pressure Research. We hope that you will be inspired to get to know more about the articles which are presented below. Professor Thomas Quaschning, MD, PHD On behalf of the Editorial Board of Kidney and Blood Pressure Research mail@thomas-quaschning.de   Digest of issue 3/2010 Issue 3/2010 of Kidney and Blood Pressure Research covers a wide spectrum of clinical and preclinical topics. It contains a study which explores gender-related determinants of atherosclerosis after kidney transplantation as well as a comparative analysis of renoprotective effects of angiotensin-II receptor blockers in early stage diabetic nephropathy. A third manuscript evaluates the suppressive effect of eplerenone on the expression of vascular endothelial growth factor in the kidney. Cardiovascular disease caused by atherosclerosis remains a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). The high risk of patients with ESRD including those after kidney transplantation is on one hand caused by the increased prevalence of traditional cardiovascular risk factors already detected in the general population: higher age, smoking, hypertension, diabetes mellitus, obesity and dyslipidemia. On the other hand, several factors associated with renal disease could have unique effects on the initiation and acceleration of atherosclerosis. One of the recently discussed newer biomarkers indicating increased cardiovascular risk is asymmetric dimethyl L-arginine (ADMA). In contrast, the soluble receptor for advanced glycation end products (sRAGE) has been recognized as a potential protective factor. Therefore, Pitha and coworkers (Kidney Blood Press Res 2010;33:227-234) evaluated ADMA, sRAGE and common risk factors including lipid parameters in 92 male and 47 female patients with ESRD undergoing their first cadaveric renal transplantation. Furthermore, preclinical atherosclerosis was measured by ultrasound using the Belcaro score. The prevalence of atherosclerotic changes was approximately 70% in men and women. In logistic regression, age, history of smoking, presence of diabetes mellitus, and plasma triglycerides were the strongest independent predictors for advanced atherosclerosis in the whole group. In unadjusted analyses, advanced atherosclerosis was also associated with sRAGE in men and with the atherogenic index of plasma in women. Apart from traditional cardiovascular risk factors such as age, smoking and diabetes mellitus, plasma triglycerides were found to be strong and independent predictors of advanced atherosclerosis in men and women with ESRD undergoing renal transplantation and treated frequently with antihypertensive and hypolipemic drugs. Based on these results, sRAGE deserves attention as a potential newer risk factor for atherosclerosis. Microalbuminuria is a well-established risk marker for cardiovascular and renal morbidity and mortality in diabetic patients. An increase in urinary albumin excretion (UAE) is associated with greater cardiovascular and renal risk in diabetes mellitus. Albumin resorption in the proximal tubules is disturbed in the early stage of diabetic nephropathy. Angiotensin II receptor blockers (ARB) have been shown to restore albumin reabsorption via amelioration of megalin expression in the proximal tubules in early-stage diabetes. The aim of the study presented by a group of Japanese scientists (Kidney Blood Press Res 2010;33:213-220) was to determine whether various ARBs differentially affect UAE and markers of tubulointerstitial damage such as urinary liver-type fatty acid-binding protein (L-FABP) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels in early-stage diabetic nephropathy patients with microalbuminuria. Therefore, 68 patients with microalbuminuric diabetic nephropathy were randomly allocated to 1 of 4 treatment groups: losartan 100 mg/day, candesartan 12 mg/day, olmesartan 40 mg/day, or telmisartan 80 mg/day. Treatment was continued for 12 months. UAE, L-FABP and 8-OHdG excretion, serum creatinine, and 24-hour creatinine clearance (Ccr) were measured at baseline and after 6 and 12 months. The authors showed that serum creatinine and 24-hour Ccr were not affected during the experimental period in any of the groups. Systolic and diastolic blood pressures, UAE, urinary L-FABP and 8-OHdG excretion were significantly reduced after 6 and 12 months compared with baseline in any of the groups. Decrease in LFABP and 8-OHdG was significantly greater on telmisartan treatment than in the other 3 groups after 12 months. The authors conclude that ARBs exhibit renoprotection via reduction of UAE and reduction of tubulointerstitial damage. Interestingly, in the present setting, telmisartan appeared to be superior to other ARBs. Further studies will be necessary to rule out whether differences are due to non-equivalent doses or whether there are distinct advantages of one or the other ARB in the treatment of diabetic nephropathy. It is well accepted that high dietary salt intake accelerates both hypertension and target organ damage. Furthermore, there is compelling evidence that increased salt intake results in marked damage to renal tissue via the mineralcorticoid receptor. It was previously shown that eplerenone attenuates sustained elevated systolic blood pressure in Dahl salt-sensitive (SS) rats. In the present study, Eatman and coworkers (Kidney Blood Press Res 2010;33:167-173) investigated the role of eplerenone on vascular endothelial growth factor (VEGF) expression. They hypothesized that eplerenone treatment may trigger a mechanism that relies on the downregulation of VEGF. To verify this hypothesis, Dahl SS rats were fed a high salt (8% NaCl) diet for 3 weeks and then switched to normal salt (0.3% NaCl) diet with or without treatment with eplerenone (100 mg/kg/day), enalapril (30 mg/kg/day) and their combination for an additional 3 weeks. In addition to reducing blood pressure, eplerenone inhibited glomerulosclerosis and suppressed the expression of VEGF and endothelial nitric oxide synthase mRNA as well as protein levels. In contrast, enalapril alone did not effect VEGF levels. Based on these findings, the authors conclude that VEGF stimulation of endothelial nitric oxide synthase plays a significant role in the eplerenone-induced reversal of the renal and vascular damages caused by high dietary salt intake. Consequently, the present investigations suggest that blockade of aldosterone might offer beneficial effects in the treatment of kidney disease. For submission of articles or sign-ups to ToC Alerts, please go to the journal's homepage © S. Karger AG - Medical and Scientific Publishers Allschwilerstrasse 10, P.O. Box, CH-4009 Basel (Switzerland) Tel. +41 61 306 1200, Fax +41 61 306 1234, publications@karger.com. Please read the Karger Privacy Policy. 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