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The Journal of the Royal Institute of Thailand Vol. 31 No. 2 Apr.-Jun. 2006 ‚√§À≈Õ¥‡≈◊ Õ¥ ‡Àµÿ ”§— ≠¢Õß°“√∑”≈“¬‰µ„πºŸâ ªÉ «¬‡∫“À«“π 492 Abstract Vascular Disease As a Crucial Determinant of Renal Disease Progression in Diabetes Mellitus Narisa Futrakul Department of Physiology, King Chulalongkorn Memorial Hospital Prasit Futrakul Fellow of the Academy of Science, The Royal Institute, Thailand Visith Sitprija Fellow of the Academy of Science, The Royal Institute, Thailand Two crucial issues relevant to the present therapeutic failure in preventing renal disease progression associated with type 2 diabetes mellitus are due to (1) lack of sensitive markers to early screen for diabetic nephropathy or diabetic vascular disease (2) ignorance of the crucial role of renal microvascular disease in inducing renal disease progression. With respect to the above view, the authors propose (1) a fractional excretion of magnesium to be the sensitive marker for early screening of diabetic nephropathy; (2) early biomarker for vascular disease reflected by circulating endothelial cells. In addition, a hemodynamic maladjustment secondary to glomerular endothelial dysfunction is a crucial determinant of renal disease progression. A therapeutic strategy aiming to correct the hemodynamic maladjustment with multidrug vasodilators can effectively restore renal function in both normoalbuminuric and albuminuric type 2 diabetic nephropathy. Key words : circulating endothelial cells, hemodynamic maladjustment, diabetic nephropathy °√≥’ ∑’Ë ‰¡à ‡«â π«√√§ „π°“√‡¢’ ¬πÀ√◊ Õæ‘ ¡æå Àπ— ß ◊ Õ‰∑¬ ¡’ °√≥’ ∑’Ë ‰¡à µâ Õ߇«â π«√√§ §◊ Õ Ò. ‰¡à ‡«â π«√√§√–À«à “ߧ”π”Àπâ “™◊Ë Õ°— ∫™◊Ë Õ ‡™à π π“ßÕ‘ π∑‘ √“ §“π∏’ Ú. ‰¡à ‡«â π«√√§√–À«à “ß∫√√¥“»— °¥‘Ï ¡≥»— °¥‘Ï ∞“π— π¥√»— °¥‘Ï °— ∫π“¡ À√◊ Õ√“™∑‘ ππ“¡ ‡™à π À¡à Õ¡√“‚™∑— ¬ À¡à Õ¡‡®â “‚«≤¬“°√ «√«√√≥ Û. ‰¡à ‡«â π«√√§√–À«à “ߧ”π”Àπâ “™◊Ë Õ∑’Ë ‡ªì πµ”·Àπà ßÀ√◊ ÕÕ“™’ æ°— ∫™◊Ë Õ ‡™à π »“ µ√“®“√¬å √Õß »¬“¡“ππ∑å Ù. ‰¡à ‡«â π«√√§√–À«à “ߧ”Àπâ “™◊Ë Õ∑’Ë · ¥ß∞“π–¢Õßπ‘ µ‘ ∫ÿ §§≈ Àπà «¬ß“π À√◊ Õ°≈ÿà ¡∫ÿ §§≈°— ∫™◊Ë Õ ‡™à π ¡Ÿ ≈π‘ ∏‘ “¬„®‰∑¬ ∫√‘ …— ∑‡ß‘ π∑ÿ πÀ≈— °∑√— æ¬å ¡À“ ¡ÿ ∑√ ®”°— ¥ ı. ‰¡à ‡«â π«√√§À≈— ߇§√◊Ë ÕßÀ¡“¬‰ª¬“≈πâ Õ¬ „π°√≥’ ∑’Ë ¡’ ‡§√◊Ë ÕßÀ¡“¬Õ◊Ë πµ“¡¡“ ‡™à π √∂‰ø‡∑’Ë ¬«®“°°√ÿ ߇∑æœ-‡™’ ¬ß„À¡à ˆ. ‰¡à ‡«â π«√√§∑—È ßÀπâ “·≈–À≈— ߇§√◊Ë ÕßÀ¡“¬¬— µ‘ ¿— ß§å ¬— µ‘ ¿“§ ‡™à π ›°√–‡©ß „™â ‡¢â “§Ÿà °— ∫§”°√–©— ∫ ‡ªì π °√–©— ∫°√–‡©ß. ¿“…“µ√–°Ÿ ≈‰∑¬-®’ π À≈— °‡°≥±å π’È ‡ªì π·π«„π°“√ªØ‘ ∫— µ‘ ·µà ∫“ߧ√—È ßÕ“®‡«â π«√√§À√◊ Õ‰¡à ‡«â π«√√§°Á ‰¥â ∑—È ßπ’È ¢÷È πÕ¬Ÿà °— ∫¥ÿ ≈¬æ‘ π‘ ®¢ÕߺŸâ ‡¢’ ¬π