Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To assess the cardiological status of patients with long-term lupus nephritis we evaluated 30 patients (mean age 43 +/- 11 years) with lupus nephritis lasting from at least 10 years (mean 15 +/- 5 years). At the time of cardiological evaluation the mean plasma creatinine was 132.6 +/- 11.1 mumol/l and in 28 patients lupus had been quiescent for at least 3 years. Fourteen patients (46.6%) showed one or more cardiac abnormalities: 10 had valvular lesions (1 verrucous endocarditis, 9 thickening and stiffness of one or more valves)--4 patients had regional myocardial akinesis as a consequence of a previous cardiac infarct (one had valvular abnormalities too). One patient had pulmonary hypertension probably secondary to pulmonary vasculitis. No patient had pericarditis. These cardiac abnormalities proved to be statistically correlated with the number of ARA criteria (p = 0.045), the number of lupus flares (p = 0.004), the serum levels of cholesterol (p = 0.04) and of triglycerides (p = 0.025) as well as the duration of hypercholesterolemia (p = 0.005) and of hypertriglyceridemia (p = 0.007). In conclusion, in patients with long-term lupus nephritis cardiac lesions are frequent. The main lesions are non-verrucous valvulopathy (probably a consequence of healing verrucous endocarditis) and cardiac infarct (caused by an accelerated atherosclerosis). On the contrary cardiac lesions caused by active lupus as pericarditis, myocarditis and verrucous endocarditis are rare.
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PMID:Cardiologic abnormalities in patients with long-term lupus nephritis. 769 32

The reactive vascular-injuring amino acid homocysteine was previously shown to be increased in plasma in diabetic patients with clinical signs of nephropathy. In this study, plasma homocysteine was measured in type 1 diabetic patients with normoalbuminuria (n = 22), microalbuminuria (n = 40) and proteinuria (n = 14) in order to investigate whether plasma homocysteine levels are increased already at the stage of incipient nephropathy, i.e. microalbuminuria. Furthermore, patients were characterized according to the degree of retinopathy. Plasma homocysteine in the whole population (n = 76) was related to B-Folate (r = 0.38, p < 0.01), S-Creatinine (r = 0.55, p < 0.001), S-Urea (r = 0.37, p < 0.01), U-Albumin (r = 0.46, p < 0.001), urinary N-acetyl-beta- glucosaminidase (r = 0.40, p < 0.001), systolic blood pressure (r = 0.36, p < 0.01) and diabetes duration (r = 0.44, p < 0.001). There were no differences in plasma homocysteine levels between patients with normoalbuminuria (8.0 +/- 1.7 mumol l-1; mean +/- SD) and those with microalbuminuria (9.1 +/- 3.4 mumol l-1). However, patients with clinical signs of nephropathy had higher plasma homocysteine levels (12.9 +/- 5.7 mumol l-1, p < 0.01) compared to the other two groups. There was no association between plasma homocysteine levels and different degrees of retinopathy. Thus, the present study does not show any relation between plasma homocysteine levels and early stages of diabetic nephropathy or retinopathy indicating that elevated concentrations of plasma homocysteine does not explain the increased risk for atherosclerosis observed in patients with microalbuminuria.
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PMID:Lack of association between plasma homocysteine levels and microangiopathy in type 1 diabetes mellitus. 770 67

Patients with advanced renal failure suffer from almost constant insulin resistance (IR) which is a major risk factor of atherosclerosis and very probably also of glomerulosclerosis. However, data on IR in kidney disease patients with mild-to-moderate kidney function decrease are lacking. A group of 52 patients with various kidney diseases and decreased kidney function of different degree but not with advanced renal failure was evaluated. Almost half of them suffered from IR though they did not differ from insulin-sensitive patients in age, sex, prevalence of various kidney diseases, hypertension, clearance of endogenous creatinine, serum creatinine, urea, uric acid, hippurate or pseudouridine concentrations. They did not differ in the prevalence and degree of metabolic acidosis or in the concentration of plasma and total and free magnesium in erythrocytes. They were just slightly more obese and their serum TG and VLDL concentrations were increased and HDL concentration decreased. It is concluded that IR and dyslipoproteinemia develop in the early stages of kidney diseases and could participate in kidney disease progression since the beginning of kidney disease. It is suggested that early treatment of these alterations could decrease the progression of kidney disease more effectively than their treatment in advanced stages.
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PMID:The prevalence of insulin resistance in kidney disease patients before the development of renal failure. 775 61

Experience with renovascular reconstruction at the authors' institution over the past 16 years has been reviewed. A total of 76 patients underwent surgical intervention for renovascular disease during that time. This included 62 patients with atherosclerosis and 11 with fibromuscular hyperplasia. Indications for intervention were uncontrolled hypertension in 42 patients and to restore renal impairment in eight. The procedure was performed for both indications in 26 patients. Ten patients (13%) died in the perioperative interval, which correlated strongly with comorbidity. With the exception of one patient, all deaths occurred in the elderly (> 65 years). While an increased mortality rate (P < 0.05) was observed in those undergoing concomitant surgical procedures (20%) as opposed to those undergoing renovascular reconstruction alone (6%), this was not an independent risk factor. Both the short term and long term response of hypertension control to renovascular reconstruction were favourable, with age < 60 years, shorter duration of hypertension (< 5 years) and diagnosis of fibromuscular hyperplasia predictive of a better response. Renovascular reconstruction, while successful in stabilizing or even improving renal function in the short term, was poor at restoring function long term, especially in the subgroup of patients whose serum creatinine was > 200 mumol/l at the time of reconstruction.
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PMID:Short-term and long-term outcome following renovascular reconstruction. 778 Jul 10

It is a matter of concern that the elderly donor may have increased risks in the peri-operative period due to age-related changes in various organ. Nephrosclerosis, atherosclerosis and low GFR of an elderly kidney may portend a poor graft outcome. A retrospective analysis of our live related renal transplant program (from June 1989 to December 1993) revealed that 27 of the donors were above 60 years of age. 21 of the recipients have been followed up for more than 1 year. These patients were compared with a cohort of 25 patients (donor age < 45 years) with similar HLA match, immunosuppressive protocol, and follow-up period more than 1 year. Graft survival at 1 year was 86% and 88% in the recipients from elderly and younger donors respectively; 1 patient in the control group died of fulminant sepsis. Mean follow-up was 21.6 months in the study group and 22.8 months in the control group. Allograft function was evaluated by serum creatinine and differential GFR by Tc DTPA scan. Serum creatinine (mg%) was 1.3 +/- 0.2 and 1.4 +/- 0.2 in the study group and 1.3 +/- 0.3, 1.2 +/- 0.3 in the control group at 3 and 12 months respectively. Glomerular filtration rate (ml/min) was 36.5 +/- 11.6 and 43.7 +/- 12.4 in the recipients from elderly donors whereas those from the younger donors had GFR (ml/min) of 40.6 +/- 9.6 and 49.6 +/- 14.2 at 3 and 12 months respectively, GFR continued to improve in both groups with follow-up. There was no difference in incidence or severity of ATN In the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Should elderly donors be accepted in a live related renal transplant program? 786 13

A retrospective study is presented concerning 115 patients submitted to renal artery surgery from 1978 to 1990, and observed during 2 to 15 years. Included are 69 men and 46 women, aged 14 to 84 years (mean: 58.8 years). The underlying occlusive arterial disease was atherosclerosis in 87 patients, fibromuscular dysplasia in 21, and miscellaneous causes in 7 cases. One hundred and one patients (88%) were hypertensive. Some degree of impaired renal excretory function (serum creatinine level above 16 mg/l) was present in 30% (n = 42) of the patients, whereas 11 patients had severe renal insufficiency (creatinemia above 30 mg/l). Primary nephrectomy was performed in 11 patients as sole procedure and was associated with contralateral revascularization in another 9 patients. A variety of types of arterial reconstruction was performed, although more than half of the procedures were aortorenal bypass grafts. Bilateral procedures were performed in 19 cases. Simultaneous extrarenal operations included aortic reconstruction (n = 43), mesenteric arterial repair (n = 8), and carotid endarterectomy (n = 5). Operative mortality (9/115, 7.8%) varied considerably between the subgroups: 4% for group I (hypertension alone, n = 73), 15% for group II (renal impairment with or without hypertension, n = 34), and 12.5% for group III (acute renal failure, n = 8). There were 3 late non procedure-related in-hospital deaths. Preoperative renal insufficiency was the only independent predictive risk factor for operative death. The procedure was curative or led to improved blood pressure control in 79% (80/101) of hypertensive patients. The response rate was better for recent onset hypertension, compared to long-standing hypertension. Of the 42 azotemic patients, 78% had a benefit (improvement in 50%, stabilization in 28%) of renal revascularization. Associated longstanding hypertension had a negative prognostic value. Sequential clinical and functional follow-up evaluations are available on 99 of the 103 surviving patients. Cumulative 5-year survival is 87%. Cardiovascular causes account for most (11/15) of the late deaths.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Surgery for occlusive renal artery disease: immediate and long-term results. 790 Apr 83

28 patients treated by programmed hemodialysis (PH) were followed up from 1985 to 1991. All the patients were over 60 years old. 16 patients died within month 1-60 since PH initiation. Overall PH duration for the whole group reached 24.6 +/- 3.58 months. Pretreatment urea and creatinine in plasma of senile patients were significantly lower than in young patients not resulting, though, in uremia reduction. The findings show that it is not valid to consider creatinine a determinant for starting hemodialysis in senile patients. Despite multimorbidity, more rapid progression of atherosclerosis and complicated establishment of the vascular approach, senile patients successfully adapt to PH regimen, need less numerous weekly PH hours. By anemia manifestations, incidence of hyperparathyroidism and polyneuropathy, senile patients did not differ much from their younger counterparts.
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PMID:[Programmed hemodialysis in middle and old age]. 794 Mar 70

Available data fail to define the prevalence of ischemic nephropathy or the association of critical renovascular disease (RVD) with renal function in the atherosclerotic population. The data do suggest, however, that critical RVD is prevalent and that the prevalence increases with age, increasing serum creatinine and clinical atherosclerosis at extrarenal sites. Furthermore, our preliminary data suggest that critical RVD may be either the cause or an important superimposed accelerant of renal insufficiency in a larger portion of the atherosclerotic population with renal insufficiency than previously recognized. In this latter group, critical RVD as a cause of renal insufficiency appears to be rapidly progressive and may contribute to end-stage renal disease with increasing frequency. Conclusive definition of the importance of ischemic nephropathy as a contributor to progressive renal insufficiency and end-stage renal disease will require population-based studies that estimate the prevalence of ischemic nephropathy and the natural history of the disease. Presently, renal duplex sonography appears to be the screening test of choice to define critical RVD for such population-based studies.
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PMID:Prevalence of ischemic nephropathy in the atherosclerotic population. 794 19

Increased plasma activity of plasminogen activator inhibitor 1 (PAI-1) is considered as a risk factor for thrombosis associated with atherosclerosis by reduction of fibrinolysis. Since nephropathic patients with non-insulin-dependent diabetes mellitus (NIDDM) are a cardiovascular high-risk group, which has yielded only controversial results as to the regulation of PAI-1, we compared 19 overt nephropathic NIDDM patients (mean age 63 years, serum creatinine 1.9 mg/dl, proteinuria 4.2 g/day) to 17 nondiabetic nephropathic patients with various causes of renal insufficiency (mean age 63 years, serum creatinine 2.8 mg/dl, proteinuria 3.9 g/day). We found normal PAI-1 levels for patients with diabetic nephropathy and significantly elevated PAI-1 levels within the upper normal range for nondiabetic nephropathic patients. Common risk factors in both groups were very high levels of fibrinogen, lipoprotein(a), serum cholesterol, and LDL cholesterol.
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PMID:Plasminogen activator inhibitor 1 activity and lipoprotein(a) in nephropathic patients with non-insulin-dependent diabetes mellitus versus patients with nondiabetic nephropathy. 795 56

The association of apolipoprotein E (apo E) genetic polymorphism, particularly apo E2, with renal failure (plasma creatinine > or = 1.4 mg/dl, and urinary albumin excretion index > or = 300 mg/g.creatinine and/or persistent proteinuria) was investigated in 57 non-insulin-dependent diabetic (NIDDM) patients. Apo E2 allele frequency was significantly higher in diabetic patients with renal failure (9.6%) than in diabetic patients without renal failure (3.2%) and in the general Japanese population (3.7%). This finding suggests that apo E2 is associated with renal failure in NIDDM. In addition, to elucidate the association of apo E2 with lipid abnormalities, plasma lipid and lipoprotein levels were compared among the apo E2 (E2/2 and E3/2) and E3/3 groups of NIDDM with renal failure (n = 27) and the apo E2 (E3/2) and E3/3 groups of NIDDM with normoalbuminuria (n = 34). In diabetic patients, the apo E2 group with renal failure had significantly higher levels of plasma total cholesterol (T-chol), very-low-density lipoprotein (VLDL)-chol, triglyceride (TG), VLDL-TG and apo E than the apo E3/3 group with renal failure, and had significantly higher levels of plasma T-chol, VLDL-chol, TG and VLDL-TG than the apo E2 and E3/3 groups with normoalbuminuria. Furthermore, the apo E2 group with renal failure had significantly higher ratios of VLDL-(chol/TG) and VLDL-chol/TG (an index of remnants in plasma) than the apo E3/3 group with renal failure and the apo E2 and E3/3 groups with normoalbuminuria. These results suggest that apo E2 leads to the accumulation of TG-rich lipoprotein and remnants in plasma. It is concluded that apo E2 is associated with renal insufficiency in NIDDM and that apo E2 may be a factor that aggravates lipid abnormalities in NIDDM with renal failure.
Atherosclerosis 1994 Jun
PMID:Apolipoprotein E2, renal failure and lipid abnormalities in non-insulin-dependent diabetes mellitus. 798 Jun 94


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