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

Hypertension as well as hypotension can be harmful to a newly transplanted renal allograft. Elevated blood pressure is also a major risk factor for cardiovascular death, which is a frequent occurrence despite successful renal transplantation. Renal artery stenosis, immunosuppressive drugs, chronic rejection, retained native kidneys, and excessive extracellular fluid volume may all contribute to post-transplant hypertension. Antihypertensive agents are widely used in the management of post-transplant hypertension. Careful clinical judgement and knowledge of the pharmacology, pharmacodynamics, pharmacokinetics, adverse drug reaction profiles, potential contraindications, and drug-drug interactions of antihypertensive agents are important when therapy with antihypertensive drugs is initiated in renal transplant recipients. Since blood pressure elevation in any individual is determined by a large number of hormonal and neuronal systems, the effect of antihypertensive agents on the allograft should be considered a critical factor in the management of hypertension in renal transplant recipients. Most renal transplant recipients have other risk factors for premature cardiovascular death such as diabetes mellitus, hypercholesterolemia, insulin resistance, obesity, left ventricular hypertrophy and ischaemic heart disease. Initial antihypertensive therapy should be tailored individually according to the patient's risk factors. A realistic therapeutic goal for blood pressure management in the initial post-operative state is a systolic blood pressure <160 mm Hg and a diastolic blood pressure <90 mm Hg with lower pressure targets becoming applicable late post-transplantation.
 ...
PMID:A practical guide to the management of hypertension in renal transplant recipients. 1065 88

Renal artery stenosis (RAS) was searched for in a Type 2 diabetes population (n =208) with severe hypertension (SHT) and/or renal deficiency (RD) and/or severe macroangiopathy (MA), using arteriography and/or duplex colour scan (with confirmation by arteriography or magnetic resonance angiography). Thirty-four (16.3 %) cases had significant RAS >=70% (83% unilateral, 17% bilateral; 11.7% with total thrombosis). High significance (P<0.01) (34 RAS vs 174 subjects without RAS) was found for male predominance (sex ratio 0.8), smoking (47%), insulin requirement (65%), prevalence and severity of decreased renal function (65%), severe hypertension (53%), and prevalence of macroangiopathy (82%), especially in association with coronary heart disease (65%). RAS prevalence was low in subjects with only 1 (8%) diagnostic criterion and high when 2 (21%) or 3 (41%) signs were present, regardless of the criterion (HT/RD/MA). A high increase of RAS prevalence was found in males, smokers and patients with heart disease or macroalbuminuria when 2 or 3 diagnostic criteria were present (no increased prevalence for only 1 criterion). RAS screening should be performed in a Type 2 diabetic population with HT, RD, or MA by opacification of the renal arteries at the same time as arteriography for control of another vessel, or by duplex colour scan when 2 or 3 diagnostic criteria are present. This attitude allows a diagnostic score of 85 % of RAS in this Type 2 diabetic population.
Diabetes Metab 2000 Jul
PMID:Prevalence of renal artery stenosis in type 2 diabetes. 1092 79

Although diabetes is a classical risk factor for macroangiopathy, the prevalence of renal artery stenosis (RAS) in this type of pathology has not been clearly determined. More than 50% of RAS occur in diabetic patients (almost exclusively Type 2), whereas autopsy findings and the few clinical surveys reported indicate that the percentage of RAS within the diabetic population is close to 30%. RAS occur especially in elderly subjects with Type 2 diabetes and multiple vascular involvement, and bilateral stenoses are frequent. Diagnostic imaging of RAS can cause adverse effects in the diabetic patient if iodinated contrast media are used, especially in cases of renal insufficiency. The presence of this risk factor requires that iodinated radiological explorations be performed with due caution, or that another product be substituted as a contrast agent (CO(2) or gadolinium), or that an imaging technique without iodine be used (colour Doppler ultrasound, magnetic resonance angiography). The therapeutic management of RAS in the diabetic patient differs little from that employed for other atheromatous stenoses of the renal artery. Endovascular treatment of RAS is the technique of choice for most patients, whether diabetic or not. The existence of diabetes has little effect on therapeutic strategy, except in cases of renal insufficiency when the risk of iodine overload should limit the doses of contrast medium or require the partial or even total substitution of another agent (CO(2), gadolinium). As in the case of other RAS, the indications depend on the lesion and the clinical presentation. Similarly, the results are both clinical and anatomical, and the existence of diabetes has a limited impact on these different parameters.
Diabetes Metab 2000 Jul
PMID:Imaging and endovascular treatment of renal artery stenosis in the diabetic patient. 1092 80

Percutaneous transluminal renal angioplasty (PTRA) has a beneficial effect on renal function in some, but not all, patients with atheromatous renal artery stenosis. Our aim is to identify factors influencing clinical success after PTRA in this group of patients. Seventy-three patients undergoing PTRA were studied; 14 patients were excluded from final analysis because of restenosis. All patients had chronic renal failure secondary to vascular nephropathy and renal artery stenosis. The diagnosis of renal artery stenosis was based on carbon dioxide digital angiography showing greater than 60% luminal narrowing. The rate of renal failure progression was assessed by the slope of the regression line of serum creatinine versus time. At least three consecutive creatinine measurements before and after angioplasty were required for study entry. Response to PTRA was made by comparison of the slope before and after PTRA. The association of age, serum creatinine level, proteinuria, renal size, pre-PTRA slope value, diabetes, ischemic heart disease, peripheral vascular disease, and cerebrovascular disease with response to PTRA was assessed by multiple regression analysis, with changes in slope values as the dependent variable. Renal function improved in 34 of 59 patients (57.6%). Mean follow-up was 627 +/- 284 (SD) days. The slope of the reciprocal serum creatinine plot before PTRA was significantly associated with a favorable change in progression rate after PTRA (beta = -0.012; P = 0.004). A scatter plot showed a statistically significant inverse correlation between pre-PTRA slope values and post-PTRA slope changes (r = -0.46; P = 0.000). Rapidly progressive renal failure is associated with a favorable response on renal failure progression after PTRA in patients with vascular nephropathy and renal artery stenosis.
 ...
PMID:Rapid decline in renal function reflects reversibility and predicts the outcome after angioplasty in renal artery stenosis. 1177 3

The prevalence of RAAS in non-insulin-dependent diabetic patients ranges from 17 to 44%. The prevalence increases exponentially in the presence of several risk factors such as severe arterial hypertension, severe renal insufficiency, macroangiopathy, smoking, and insulin requirement. In diabetic patients, RAAS should be investigated in patients with severe arterial hypertension, repeated pulmonary oedemas, and renal insufficiency without any clear etiology associated with a mild proteinuria and/or with a renal insufficiency secondary to the administration of angiotensin converting enzyme inhibitors or angiotensin II receptors antagonists. Asymmetrical size of the kidneys should also prompt the physician with a suspicion of RAAS. There are several specific criteria, that may confirm the suspicion of a RAAS. Renal arteriography is still the goal standard for diagnosing renal artery stenosis.
Diabetes Metab 2002 Jun
PMID:[How and when to search for a renal artery atheromatous stenosis in diabetic patients?]. 1214 7

This retrospective study aimed to use captopril renography (CR) for predicting the benefits of captopril treatment in hypertensive patients with diabetic nephropathy. CR was utilized in 60 hypertensive patients with diabetic nephropathy for detecting the probability of renovascular hypertension (RVH) and predicting the benefits of renal artery revascularization or captopril treatment. Ten of the 60 patients showed a high probability of RVH with marked changes of the renogram curve after an oral intake of 50-mg captopril compared to baseline findings. All of the 10 patients confirmed significant main renal artery stenosis in all of them, bilaterally in four patients and unilaterally in the remaining six patients by renal angiographic findings. After successful revascularization, blood pressure was well controlled and renal function was preserved in all of the 10 patients. The other 50 patients showed a low or intermediate probability of RVH with normal findings or unchanged on CR after 50-mg captopril. Then, captopril alone or combination treatment started and continued on 50 patients. After monitoring for at least 6 months, blood pressure was well controlled and renal function was preserved in all the 50 patients on captopril treatment. We conclude that CR should be considered as the standard diagnostic criteria of RVH and may be helpful in predicting the beneficial impact of captopril treatment in hypertensive patients with diabetic nephropathy.
J Diabetes Complications
PMID:Usefulness of captopril renography to predict the benefits of renal artery revascularization or captopril treatment in hypertensive patients with diabetic nephropathy. 1220 78

Atherosclerotic renovascular disease (ARVD) is common in the general population, and its prevalence increases with age. Parallel studies show it is also common in patients with diabetes. The widespread use of angiotensin converting enzyme inhibitors and angiotensin receptor antagonists for heart and kidney disease might therefore expose arteriopathic diabetic patients to potential harm if they had critical renal artery stenosis. This review looks at the natural history of ARVD in the diabetic and non-diabetic populations: while it is common, it only rarely leads to renal failure. Hence intervention to revascularize ischaemic kidney son the basis of radiological appearances alone may subject some patients to unnecessary therapy. Although untested by randomized trial, a policy of watchful waiting may be the simplest strategy for most diabetic patients with suspected ARVD, reserving angiography and angioplasty (usually backed up by a stent) for those with an abrupt decline in renal function and no other cause for renal deterioration. Future clinical trials may better define subgroups of patients who will truly benefit from renal revascularization.
 ...
PMID:The impact of atherosclerotic renovascular disease on diabetic renal failure. 1242 24

In an effort to identify preoperative and perioperative factors impacting outcome in repair of juxtarenal abdominal aortic aneurysm (JRAAA), hospital records and CT scans (for calcification, intraluminal thrombus, and aortic diameter) of all patients undergoing JRAAA repair over the past 10 years were reviewed. The 87 men and 25 women had a mean age of 72, and a mean maximal aortic diameter of 6.2 cm. Renal artery stenosis (RAS) and iliac disease were present in 13 (11%) and 40 patients (35%), respectively. Comorbidities included coronary artery disease (n = 49, 44%), COPD (n = 28, 25%), diabetes mellitus (n = 10, 9%), and preoperative renal insufficiency (PRI; Cr >1.4 mg/dL; n = 14, 12%). A midline incision was used in most of the patients (n = 98, 88%). The proximal aortic clamp was placed in the supraceliac (SC) position in 92 (82%) patients, and directly above one or both renal arteries in 20 (18%) patients. The overall mortality was 6% (n = 7). Cardiac complications occurred in 26 patients (23%); pulmonary, in 22 (20%); renal, in 14 (12%); and gastrointestinal, in 10 (9%). No patient experienced mesenteric ischemia. Mean elevation in creatinine was greater in patients with PRI (1.8 mg/dL vs. 0.13 mg/dL, p = 0.04). Mean blood loss (EBL) was 2701 +/- 189 cc, and mean LOS was 16.1 +/- 1.7 days. Age >70 was associated with increased length of stay (LOS) (12.1 days vs. 18.6 days, p = 0.05) and higher mortality (0 vs. 10%, p = 0.02); otherwise there were no significant relationships between pre- and perioperative parameters and any of the measured outcomes including death, postoperative RI, and LOS. Preferential SC clamping may substantially reduce complications of JRAAA repair (such as mesenteric and renal ischemia) related to proximal cuff disease, but cannot overcome the deleterious affects of advanced age and PRI.
 ...
PMID:Optimal operative strategies in repair of juxtarenal abdominal aortic aneurysms. 1252

Recognition of coincidence of cerebral vascular disease is of importance in patients with coronary artery disease. One hundred and seventy-three patients who underwent coronary angiography were also studied by angiography of subclavian arteries and abdominal aorta. The majority of the patients (128/173; 74%) were men. Risk factors of hypertension, diabetes, and hypercholesterolemia were present in a high percentage of patients. Disease of the proximal part of the vertebral artery was seen in 41.6% (72/173). Presence of vertebral artery disease was significantly correlated with diabetes (p = 0.02), renal artery stenosis (p = 0.003), coronary artery disease (p = 0.05), and iliac artery disease (p = 0.05). The proximal part of the vertebral artery was found to be affected in a high percentage (41.6%) of patients undergoing coronary angiography.
 ...
PMID:Disease of proximal part of vertebral artery in patients with coronary artery disease. 1267 96

Predictors of restenosis after stent angioplasty of ostial renal artery stenosis (RAS) and long-term technical success, particularly the influence of gold coating, are unknown. During a 4-year period (1996-2000), we treated 156 consecutive patients with 219 ostial RAS of > or = 70% diameter stenosis. Gold-coated stents were used in 29% of RAS (n = 64); the vessel diameter ranged from 3 to 9 mm. The restenosis rate was 11.4% at 12 months, 12.2% for gold-coated stents and 11.1% for noncoated stents. Restenosis rates were 16% for < or = 4 mm, 17% for 5 mm, 10% for 6 mm, and 0% for > or = 7 mm (P < or = 0.05). In a backward stepwise logistic regression analysis including gold coating, vessel diameter, gender, diabetes, smoking status, as well as lesion diameter stenosis before and after stenting, vessel diameter was found the only independent predictor of restenosis (odds ratio = 0.57; 95% CI = 0.35-0.93; P = 0.02, for an increase in vessel diameter of 1 mm). Gold coating was not a significant predictor (odds ratio = 1.09; 95% CI = 0.39-3.03; P = 0.87). Seven major (4.5%) complications occurred. There were no procedural fatalities. The restenosis rate after stent angioplasty of ostial RAS is influenced by the vessel diameter but not by gold coating.
 ...
PMID:Gold coating and restenosis after primary stenting of ostial renal artery stenosis. 1292 94


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>