Blockade of the renin-angiotensin system and renal tissue oxygenation as measured with BOLD-MRI in patients with type 2 diabetes

Menno Pruijm, Lucie Hofmann, Anne Zanchi, Marc Maillard, Valentina Forni, Marie Eve Muller, Grégoire Wuerzner, Bruno Vogt, Matthias Stuber, Michel Burnier

Research output: Contribution to journalArticle

Abstract

Aim: To assess whether blockade of the renin-angiotensin system (RAS), a recognized strategy to prevent the progression of diabetic nephropathy, affects renal tissue oxygenation in type 2 diabetes mellitus (T2DM) patients. Methods: Prospective randomized 2-way cross over study; T2DM patients with (micro)albuminuria and/or hypertension underwent blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) at baseline, after one month of enalapril (20mgqd), and after one month of candesartan (16mgqd). Each BOLD-MRI was performed before and after the administration of furosemide. The mean R2* (=1/T2*) values in the medulla and cortex were calculated, a low R2* indicating high tissue oxygenation. Results: Twelve patients (mean age: 60±11 years, eGFR: 62±22ml/min/1.73m2) completed the study. Neither chronic enalapril nor candesartan intake modified renal cortical or medullary R2* levels. Furosemide significantly decreased cortical and medullary R2* levels suggesting a transient increase in renal oxygenation. Medullary R2* levels correlated positively with urinary sodium excretion and systemic blood pressure, suggesting lower renal oxygenation at higher dietary sodium intake and blood pressure; cortical R2* levels correlated positively with glycemia and HbA1c. Conclusion: RAS blockade does not seem to increase renal tissue oxygenation in T2DM hypertensive patients. The response to furosemide and the association with 24. h urinary sodium excretion emphasize the crucial role of renal sodium handling as one of the main determinants of renal tissue oxygenation.

Original languageEnglish (US)
Pages (from-to)136-144
Number of pages9
JournalDiabetes Research and Clinical Practice
Volume99
Issue number2
DOIs
StatePublished - Feb 1 2013

Keywords

  • ACE-inhibitor
  • Angiotensin receptor blocker
  • BOLD-MRI
  • Furosemide
  • Hypertension
  • Renal

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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    Pruijm, M., Hofmann, L., Zanchi, A., Maillard, M., Forni, V., Muller, M. E., Wuerzner, G., Vogt, B., Stuber, M., & Burnier, M. (2013). Blockade of the renin-angiotensin system and renal tissue oxygenation as measured with BOLD-MRI in patients with type 2 diabetes. Diabetes Research and Clinical Practice, 99(2), 136-144. https://doi.org/10.1016/j.diabres.2012.11.004