**Section 1**

**Systemic and Local Intrarenal Renin-Angiotensin-Aldosterone System in the Development of Diabetic Nephropathy** 

**1** 

*Brazil* 

Dulce Elena Casarini et al.\*

**Up-Regulation of Renin-Angiotensin System in** 

The growing worldwide epidemic of metabolic syndrome and other chronic degenerative diseases continues to expand, with a rapid decrease in the age at which they are being diagnosed (Guarnieri et al.; 2010; Hsueh & Wyne, 2011). Metabolic syndrome is a multifactorial disorder, strongly influenced by several lifestyle factors, with symptoms clustering on abnormalities that include obesity, hypertension, dyslipidemia, glucose intolerance and insulin resistance (Guarnieri et al.; 2010; Tanaka et al.; 2006). The syndrome is also referred to as "Diabesity" highlighting the incidence of diabetes mellitus (DM) in combination with obesity as a result of changes in human behavior (Astrup & Finer, 2000; Farag & Gaballa,

Obesity is considered an independent predictor of the development of hypertension and it has been estimated that about half of individuals with essential hypertension are considered insulin resistant (Hall et al.; 2010; Kotsis et al.; 2010). Likewise, insulin resistance and hyperinsulinemia increase the risk of hypertension, and it usually accompanies DM, early in type 2 (DM2) and delayed in type 1 (DM1). Moreover, among patients being treated for hypertension, the risk of new-onset diabetes is doubled in those with uncontrolled blood pressure (BP) (Gress et al.; 2000; Gupta et al.; 2008; Izzo et al.; 2009). Although effective antihypertensive agents are available, achieving adequate BP control remains difficult in

It is widely known that individuals with DM and/or hypertension are prone to develop a broad range of long term complications, including cardiovascular disease and nephropathy (Farag & Gaballa, 2011; Guarnieri et al.; 2010; Houston et al.; 2005; Handelsman, 2011; Tanaka et al.; 2006), and it has already been shown that several modifiable risk factors are associated with poor renal and cardiovascular outcome, including BP, plasma glucose and lipid concentrations, smoking, and body weight (Miao et al.; 2011). It is important to

Danielle Yuri Arita1, Tatiana Sousa Cunha1,2, Fernanda Aparecida Ronchi1, Danielle Sanches Aragão1,

*3Department of Physiological Sciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil*

Rodolfo Mattar Rosa1, Nadia Sousa Cunha Bertoncello1 and Fernanda Klein Marcondes3 *1Department of Medicine, Nephrology Division, Federal University of São Paulo, São Paulo, Brazil 2Science and Technology Institute, Federal University of São Paulo, São José dos Campos, Brazil* 

hypertensive patients, particularly in the context of concomitant diabetes.

**1. Introduction** 

2011; Hu, 2011).

 \*

**Diabetes and Hypertension: Implications on** 

**the Development of Diabetic Nephropathy** 

*Department of Medicine, Federal University of São Paulo, São Paulo* 
