Yesterday we discussed the critical role of angiotensin II and aldosterone in diabetic kidney damage that leads to dialysis. New science has broadened our understanding and it appears that the same same signaling is involved in kidney failure due to hypertension as well. As you can see from the diagram, both angiotensin II and aldosterone increase oxidant production, but so does the enzyme that makes bad cholesterol (HMG CoA Reductase) and cigarette smoke. The oxidants from all these factors activate the epidermal growth factor receptor (EGFR) which is critical in chronic kidney disease development from diabetes, hypertension, polycystic kidney disease, and other causes. EGFR is a growth factor receptor that is another master genetic metabolic switch involved in damage to the kidney and other organs. Blocking the effect of EGFR with a monoclonal antibody injection reduces organ damage from angiotensin II and these other factors. As you can see from the diagram, the green box interventions reduce EGFR activation or the downstream signaling. Combining these interventions in optimal medical therapy protects the kidney so that only one sixth as many people with diabetes go on to dialysis.
You can also see that metformin and empagliflozin impact this signaling further downsteam. The end result is that the kidney and other organs are protected from further damage from the factors in the red boxes. Inexpensive, proven generic medication and lifestyle measures give us the ability to limit kidney and other organ damage very precisely. Primary care teams can deliver that care even in rural outpatient settings.
Yup!