Systemic and vascular inflammation is elevated in early IgA and type 1 diabetic nephropathies and relates to vascular disease risk factors and renal function

Abstract

Background. Inflammation is implicated in cardiovascular disease (CVD) and mortality in end-stage renal failure (ESRF). Its importance in early renal disease is yet to be defined. Methods. Serum levels of systemic and vascular inflammatory markers in early IgA nephropathy (IgAN) and control subjects were measured and related to renal function and vascular risk factors. A parallel study in type 1 diabetes mellitus subjects with (T1DM Nx) and without nephropathy (T1DM No Nx) was performed. Results. Fifty-one IgAN patients aged 46±2 years (mean±SEM), calculated creatinine clearance (CrCl) 88±5 ml/min, were compared with 51 matched control subjects. Forty-six T1DM Nx patients aged 40±2 years, CrCl 84±5 ml/min, and 73 T1DM No Nx patients aged 38±2 years were also compared. High sensitivity C-reactive protein (hsCRP) was elevated in IgAN, T1DM Nx and T1DM No Nx patients compared with controls [4.2±0.6 (PPPvs 1.6±0.3 mg/l]. Levels in T1DM Nx patients were higher than in T1DM No Nx patients (Pr = 0.47, P = 0.001; r = 0.40, PT = 2.45, PT = 7.83, PIgAN>T1DM No Nx vs controls: soluble vascular adhesion molecule-1 (sVCAM-1) 760±30 (P663±34 (P = 0.001)>601±21 (Pvs 536±15 ng/ml; soluble intracellular adhesion molecule-1 (sICAM-1) 320±8 (P313±13 (P307±8 (Pvs 244±6 ng/ml. sVCAM-1 levels were higher in T1DM Nx than in T1DM No Nx, Pr = 0.33, P = 0.017; r = 0.37; P = 0.017). sVCAM-1 was related to renal function in IgAN and T1DM Nx: serum cystatin C (r = 0.63, Pr = 0.425, P = 0.002), and urine protein:creatinine ratio in IgAN (r = 0.48; P = 0.001). Conclusions. Systemic and vascular markers of inflammation are increased in early renal disease and relate to renal dysfunction and cardiovascular risk factors. Inflammation may be a common process in various renal diseases and may link and accelerate renal dysfunction and CVD.