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2014 ; 99
(9
): 1140-5
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Intestinal regulation of urinary sodium excretion and the pathophysiology of
diabetic kidney disease: a focus on glucagon-like peptide 1 and dipeptidyl
peptidase 4
#MMPMID25085841
Vallon V
; Docherty NG
Exp Physiol
2014[Sep]; 99
(9
): 1140-5
PMID25085841
show ga
The tubular hypothesis of glomerular filtration and nephropathy in diabetes is a
pathophysiological concept that assigns a critical role to the tubular system,
including proximal tubular hyper-reabsorption and growth, which is relevant for
early glomerular hyperfiltration and later chronic kidney disease. Here we focus
on how harnessing the bioactivity of hormones released from the gut may
ameliorate the early effects of diabetes on the kidney in part by attenuating
proximal tubular hyper-reabsorption and growth. The endogenous tone of the
glucagon-like peptide 1 (GLP-1)/GLP-1 receptor (GLP-1R) system and its
pharmacological activation are nephroprotective in diabetes independent of
changes in blood glucose. This is associated with suppression of increases in
kidney weight and glomerular hyperfiltration, which may reflect, at least in
part, its inhibitory effects on tubular hyper-reabsorption and growth. Inhibition
of dipeptidyl peptidase 4 (DPP-4) is also nephroprotective independent of changes
in blood glucose and involves GLP-1/GLP-1R-dependent and -independent mechanisms.
The GLP-1R agonist exendin-4 induces natriuresis via activation of the GLP-1R. In
contrast, DPP4 inhibition increases circulating GLP-1, but drives a
GLP-1R-independent natriuretic response, implying a role for other DPP-4
substrates. The extent to which the intrarenal DPP-4/GLP-1 receptor system
contributes to all these changes remains to be established, as does the direct
impact of the system on renal inflammation.