Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A new kit for radioimmunoassay of serum phospholipase A2 (PLA2) with monoclonal antibody (S-0932, Shionogi, Osaka, Japan) was used to examine PLA2 levels in patients with various diseases. Patients with acute pancreatitis showed significantly increased serum PLA2 levels. In patients with chronic pancreatitis, significant correlations were observed between the levels of factors evaluated by the secretin test and serum PLA2 levels. In patients with pancreatic cancer, serum PLA2 levels varied with disease severity. Serum PLA2 concentrations were within the normal range in patients with other malignant tumors, diabetes mellitus, and chronic liver diseases but were increased in patients with chronic renal failure. S-Sepharose column analysis of sera showed a small peak of pro-PLA2 and a large peak of PLA2 in sera from patients with severe acute pancreatitis, but a large peak of pro-PLA2 in healthy controls and patients with other diseases. On G-100 gel filtration, high-molecular-weight PLA2 immunoreactivity was detected in sera of patients with chronic renal failure, whereas a single peak of PLA2 immunoreactivity coinciding with that of standard PLA2 was detected in sera of patients with acute pancreatitis. These results suggest that (a) measurement of serum PLA2 is clinically useful for diagnosis and monitoring of pancreatitis, (b) active PLA2 in the circulation is dominant in severe acute pancreatitis, and (c) the kidney may be the main site of PLA2 degradation or excretion.
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PMID:Clinical usefulness of serum phospholipase A2 determination in patients with pancreatic diseases. 194 16

Several reports in animals, and sporadic case reports in humans, have suggested that kidneys with decreased nephron mass may be more susceptible to the development of focal-segmental glomerosclerosis. This prompted a reexamination of our previously reported group of pediatric donor-adult recipient renal transplant combinations. Data were analyzed from 31 adult recipients who had received renal transplants from cadaver pediatric donors (less than 6 years) with graft function for greater than 6 months and no evidence of chronic rejection. These were compared with a control group transplanted during the same period with adult donor kidneys. Immunosuppression consisted of azathioprine/prednisone or quadruple therapy in 16 and 15 patients respectively. End-stage renal disease (ESRD) was secondary to chronic glomerulonephritis (n = 9), diabetes mellitus (n = 6), polycystic kidney disease (n = 5), and miscellaneous causes (n = 11). Twenty patients had radiographic documentation of renal hypertrophy posttransplant. All patients had serial 24-hr urinalysis for protein and creatinine after transplantation during periods of stable renal function. Ten patients had renal biopsies performed at a mean time from transplant to biopsy of 10.4 +/- 1.6 months. Seven recipients had biopsies that revealed glomerulosclerosis at 13 +/- 6 months posttransplant. Protein excretion and serum creatinine in these patients were significantly higher than in control patients (1.6 +/- 0.37 vs. 0.49 +/- 0.15 g/24 hr and 1.96 +/- 0.11 vs. 1.64 +/- 0.09 mg%; P less than 0.03 and P less than 0.01, respectively). Only 3 of 25 control adult donor recipients developed proteinuria greater than 0.8 g/24 hr within 2 years of transplantation vs. 15/31 pediatric donor recipients. No correlations with the etiology of ESRD, age (greater than or less than 40 years), weight, sex, diabetes, hypertension, or the number of acute rejection episodes could be found. Our data suggest that adult recipients of pediatric donor renal transplants may be at greater risk for the development of glomerulosclerosis than those recipients receiving adult donor kidneys.
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PMID:The development of proteinuria and focal-segmental glomerulosclerosis in recipients of pediatric donor kidneys. 194 66

Simultaneous kidney-pancreas transplantation has emerged as a viable option for a select population of patients with type I diabetes mellitus and end stage renal disease. Nurses caring for this type of patient must be knowledgeable about the intricacies of the procedure. This article reviews indications for kidney-pancreas transplantation, selection criteria for both donors and recipients, organ procurement and transplant surgical procedures, potential postoperative complications, nursing considerations, and the impact this treatment modality has on the management of the patient with insulin-dependent diabetes mellitus.
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PMID:Simultaneous kidney-pancreas transplantation. 195 86

In the patient with diabetes mellitus the onset of intermittent and then persistent proteinuria signals the development of established nephropathy. This heralds an extremely poor prognosis and mortality in this group has been estimated to be 80 to 100 times greater than that of an age-matched normal population. The excess mortality and its associated morbidity exists for both insulin-dependent and non-insulin-dependent patients who develop proteinuria. The final cause of death is often cardiovascular, such as myocardial infarction or a cerebrovascular accident, rather than end stage renal failure with death from uraemia. Strict and aggressive control of blood pressure during this stage is the only therapy that has been shown to slow the decline in glomerular filtration. To date, there have been no studies large enough to establish if this can produce the desired effect of reducing the excess mortality in this group. The newer antihypertensive agents may have a specific role but this also remains to be shown conclusively; their major advantage may be related to their fewer side-effects especially on cardiovascular risk factors in this highly susceptible group.
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PMID:Hypertension and prognosis in established diabetic nephropathy. 195 24

End-stage renal disease is a major cause of morbidity and mortality in the U.S. population and a significant contributor to national health-care expenditures. In recent years, a growing body of literature has accumulated from studies in animals and humans to suggest that dietary protein restriction can significantly retard the progression of chronic renal insufficiency. This article reviews the relevant literature and outlines the questions that remain for future investigation.
Diabetes Care 1991 Sep
PMID:Low-protein diets in renal disease. 195 77

The metabolic changes which accompany hyperglycemia in a person with diabetes are thought to cause renal hyperperfusion and intraglomerular hypertension, especially in the person with a predisposition to essential hypertension. Intraglomerular hypertension causing deposition of protein in the mesangium leads to glomerulosclerosis and renal failure. Screening for microalbuminuria can predict which type I diabetic patients will develop nephropathy. The decline in renal function in established diabetic nephropathy can be slowed with aggressive treatment of hypertension. The use of ACE inhibitors may also decrease intraglomerular hypertension. Whether similar treatment in the person with preclinical diabetic nephropathy would delay or prevent the onset of diabetic nephropathy is being investigated. Restricted protein intake, anti-platelet and rheolitic drugs may have a role in the treatment of established diabetic nephropathy. In end stage renal failure, renal transplantation is the treatment of choice. When transplantation cannot be performed, chronic ambulatory peritoneal dialysis is preferable to hemodialysis.
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PMID:Diabetic nephropathy: changing concepts of pathogenesis and treatment. 200 Aug 93

Recent studies emphasize the adverse effects of endocrine disorders on bone mass. Successful surgery for hyperparathyroidism results in an increase in bone mass, although impact on future fracture rates in these patients is unknown. The etiology of reduced bone mass in diabetes is still unclear, and the adverse effects of thyroxine replacement treatment on bone mass need to be carefully balanced against beneficial effects on hypercholesterolemia. Musculoskeletal problems in chronic renal failure are common, but investigations into their pathogenesis are complicated by the coexistence of renal endocrine failure and beta 2-microglobulin-related amyloid deposition in long-term dialysis patients. An improved definition of dialysis arthropathy is needed. The type of dialysis membrane does not appear to be important in the pathogenesis of this condition.
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PMID:Endocrine disorders. 204 39

Prospectively collected data on the incidence of treated hypertensive end-stage renal disease (HT-ESRD) were analyzed to investigate whether the higher rate of HT-ESRD in blacks compared with whites is due to differences in putative ESRD risk factors. The overall age-adjusted relative risks of HT-ESRD for black compared with white residents in the Maryland Regional ESRD Registry (Network 31) Catchment Area were 7.4 (95% confidence interval, 5.9 to 9.4) and 9.9 (95% confidence interval, 7.4 to 13.1) for men and women, respectively. In a population level analysis, race-specific HT-ESRD incidence rates in the black and white populations of 13 regions in Network 31 were related to the prevalence of putative ESRD risk factors in those populations. The latter were estimated from the 1981-1982 Maryland Statewide Household Hypertension Survey. Black populations had a 5.6-fold (95% confidence interval, 3.9 to 8.1) higher unadjusted incidence of HT-ESRD than white populations. The HT-ESRD incidence in a population was also directly related to that population's prevalence of hypertension, severe hypertension, and diabetes mellitus and inversely related to measures of socioeconomic status and mean age at diagnosis of hypertension. When adjusted simultaneously for age, prevalence of hypertension, severe hypertension, diabetes, and level of education, the risk of HT-ESRD was still 4.5 (95% confidence interval, 3.2 to 6.2) times higher for black compared with white populations. Our findings failed to support the hypothesis that race-related differences in the prevalence, severity, or age at onset of hypertension, in the prevalence of diabetes or in socioeconomic status, explain the well-recognized black-white differences in the HT-ESRD incidence.
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PMID:Does racial variation in risk factors explain black-white differences in the incidence of hypertensive end-stage renal disease? 206 76

Investigation of renal biopsy specimens from 488 patients with diabetic glomerulosclerosis (DGS) of varying severity revealed the following: 1) The severity of DGS increases with the duration of the diabetes. 2) As the severity of DGS increases, it is complicated with increasing frequency by exudative changes, which correspond in detail to hyperperfusion lesions described in the literature. 3) As the severity of DGS increases, the severity of arteriolosclerosis and the incidence of nephrotic syndrome increase significantly. 4) The 5- and 10-year renal survival rates are highest for those diabetic patients in whom the tubules and renal cortical interstitium are of normal appearance. These survival rates are diminished if any of the following are present at the time of biopsy: a) interstitial fibrosis; b) hyperperfusion lesions; c) nephrotic syndrome; d) elevation of the serum creatinine concentration to more than 1.3 mg%. 5) No significant correlation was found between renal survival rate and age, sex, or type of diabetes. 6) The inflammation of the renal interstitium seen in diabetes does not differ from that seen in chronic glomerulonephritis. Monocytes, macrophages, T lymphocytes, fibroblasts and fibrocytes play the major role in this inflammation. This inflammatory process is considered to represent not pyelonephritis, but rather an auto-immune process. In other words, it is proposed that the diabetic kidney fails not only as a result of non-specific glomerular lesions (hyperperfusion lesions) but also because of non-specific tubulointerstitial changes, whereas diabetic glomerulosclerosis alone does not lead to chronic renal failure.
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PMID:The pathogenesis of chronic renal failure in diabetic nephropathy. Investigation of 488 cases of diabetic glomerulosclerosis. 206 8

We carried out a retrospective survey to assess prevalence and type of diabetes in three Italian Renal Units located respectively in the North (Tradate, Varese), in the Middle (Latina) and in the South (Reggio Calabria) of Italy. The prevalence of diabetes among patients accepted for RRT was 10.5% (60/659). 40 patients (66.7%) were non-insulin dependent and only 6 patients were insulin-dependent. A similar pattern was observed among the 289 patients referred to the Renal Unit of Reggio Calabria during 1972-1987 for evaluation of Chronic Renal Failure. Our data suggest that among the Italian diabetic patients treated by dialysis and transplantation insulin-dependent diabetes is uncommon. This finding could be explained by the low incidence of insulin-dependent diabetes in Italy.
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PMID:[Prevalence of insulin-dependent and non-insulin-dependent diabetes among Italian patients on replacement therapy. Preliminary survey at 3 dialysis centers]. 208 Apr 47


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