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2015 ; 2015
(ä): 539787
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Elevated Urinary Connective Tissue Growth Factor in Diabetic Nephropathy Is
Caused by Local Production and Tubular Dysfunction
#MMPMID26171399
Gerritsen KG
; Leeuwis JW
; Koeners MP
; Bakker SJ
; van Oeveren W
; Aten J
; Tarnow L
; Rossing P
; Wetzels JF
; Joles JA
; Kok RJ
; Goldschmeding R
; Nguyen TQ
J Diabetes Res
2015[]; 2015
(ä): 539787
PMID26171399
show ga
Connective tissue growth factor (CTGF; CCN2) plays a role in the development of
diabetic nephropathy (DN). Urinary CTGF (uCTGF) is elevated in DN patients and
has been proposed as a biomarker for disease progression, but it is unknown which
pathophysiological factors contribute to elevated uCTGF. We studied renal
handling of CTGF by infusion of recombinant CTGF in diabetic mice. In addition,
uCTGF was measured in type 1 DN patients and compared with glomerular and tubular
dysfunction and damage markers. In diabetic mice, uCTGF was increased and
fractional excretion (FE) of recombinant CTGF was substantially elevated
indicating reduced tubular reabsorption. FE of recombinant CTGF correlated with
excretion of endogenous CTGF. CTGF mRNA was mainly localized in glomeruli and
medullary tubules. Comparison of FE of endogenous and recombinant CTGF indicated
that 60% of uCTGF had a direct renal source, while 40% originated from plasma
CTGF. In DN patients, uCTGF was independently associated with markers of proximal
and distal tubular dysfunction and damage. In conclusion, uCTGF in DN is elevated
as a result of both increased local production and reduced reabsorption due to
tubular dysfunction. We submit that uCTGF is a biomarker reflecting both
glomerular and tubulointerstitial hallmarks of diabetic kidney disease.