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)

Several factors are involved in the persistence of endocrine alterations after renal transplantation, among which the following are to be mentioned: (1) duration of chronic uraemia before renal transplantation; (2) residual function of the patients' native kidneys; (3) quality of function of the renal graft; (4) modulation of secretion, transport, and degradation of hormones, and/or (5) altered target organ responsiveness to hormones induced by immunosuppressive drugs (glucocorticoids, azathioprine, cyclosporin A) or altered internal environment. In kidney transplant patients the following endocrine abnormalities are to be mentioned: dissociation of the physiological relationship between aldosterone synthesis and function of the renin-angiotensin system, abnormal volumetric regulation of arginine vasopressin secretion, suppressed responsiveness of cortisol secretion to stimulatory manoeuvres, persistent secondary hyperparathyroidism, relative deficiency of insulin (induced by glucocorticoid therapy), with consequent carbohydrate intolerance or even diabetes mellitus, suppressed response of gastrin and pancreatic hormone secretion to a test meal, and reduced responsiveness of atrial natriuretic peptide secretion to central hypervolaemia. Episodes of acute graft rejection are characterized by endocrine alterations similar to those seen in patients with acute or chronic renal failure.
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PMID:Endocrine alterations in kidney transplant patients. 219 17

Diabetic renal microangiopathy accounts for enormous morbidity and mortality, particularly in patients who develop diabetes in childhood or early youth; in the last few years its pathogenesis has been therefore extensively studied, aiming to prevent renal complications or at least of slowing down its progression toward uremia. Though not always in accordance with theoretical expectations, the results of clinical trials have nevertheless widened our therapeutic possibilities; in fact, besides the attainment of an optimal metabolic control, other possible interventions include a careful correction of albeit minimal elevations in arterial pressure; the interference with intrarenal hemodynamic parameters; the correction of insulin-independent metabolic pathways, abnormally activated in the diabetic, such as non enzymatic glycation and polyol pathway; the treatment of endothelial and platelet alterations; the improvement of the rheologic properties of blood.
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PMID:[Current approach in the prevention and treatment of diabetic nephropathy]. 219 15

Limb salvage in patients with end-stage renal disease (ESRD) is complicated by the diffuse, obstructive, calcific arteriopathy that makes anastomotic technique especially critical. Furthermore, decreased resistance to infection and impaired wound healing produced by host-factor deficiencies such as diabetes mellitus, hypoalbuminemia, uremia, and immunosuppression produce additional obstacles to successful limb salvage. This report summarizes our experience with distal arterial bypass procedures in these patients. A total of 32 bypass procedures were performed for limb salvage in 24 patients (17 diabetic) during a period of 5 years. The operative mortality rate was 6%. During the same period, 635 infrainguinal bypass procedures were performed by the in situ technique in patients without ESRD. Primary bypass patency was comparable in both groups at 24 months (92% vs 90%). In the group with ESRD, overall limb salvage was 83% at 2 years. Life-table analysis of bypass patency and limb salvage was thought not to be appropriate in the population with ESRD beyond 2 years because of the increased mortality rate (38%; 9/24) during this interval. It is important that limb salvage was achieved in diabetic patients with ESRD in the presence of extensive foot gangrene or ischemic ulceration. Revascularization should be considered strongly for limb salvage in all patients in this difficult population.
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PMID:Results of infrainguinal bypass for limb salvage in patients with end-stage renal disease. 221 87

Renal dysfunction and hypertension are closely associated. Hypertension causes approximately 25% of end-stage renal disease (ESRD) and develops in virtually every patient with advanced renal insufficiency from any cause. Although normalization of blood pressure can reduce mortality from uremia and ameliorate the progression of renal impairment in patients with established renal insufficiency from hypertension and diabetes, antihypertensive therapy alone is not totally effective in preventing progressive compromise of renal function--especially in blacks and diabetics, who are at high risk for developing ESRD. Of particular promise is the rapidly increasing understanding of the intrarenal autocrine and paracrine functions of angiotensin II produced locally by a tissue renin-angiotensin system. Consistent and convincing experimental data have demonstrated that angiotensin II plays many roles in the control of renal function and the kidney's response to injury. The intrarenal effects of angiotensin II include: 1) increase in the efferent arteriolar tone, resulting in increased glomerular capillary pressure, 2) promotion of mesangial cell contraction, 3) stimulation of proximal tubular Na+ reabsorption, and 4) possible growth hormone effects leading to hypertrophy or hyperplasia of vascular smooth muscle. Because of their favorable intrarenal hemodynamic effects (particularly reduction of glomerular capillary pressure), ACE inhibitors may provide a renal protective effect in addition to their systemic antihypertensive effects. Clinical trials evaluating the effect of ACE inhibition on the progression of renal insufficiency in hypertensives and diabetics are currently under way. Favorable results could lead to a significant decrease in the morbidity and mortality associated with hypertension.
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PMID:Renal protective effects of angiotensin converting enzyme inhibitors. 226 Nov 45

Successful pancreas transplantation can result in the longterm normalization of glucose metabolism. Since most pancreas recipients already have severe diabetic complications, and the observation period after transplantation is rather short, an assessment of the effect of complete glucose normalization on these diabetic changes is problematic. It has, however, been shown that the development of diabetic nephropathy can be prevented, peripheral microcirculation improved, and autonomic and peripheral neuropathy and retinopathy stabilized. These positive effects are, possibly, in part due to the elimination of uremia, since most patients receive both a pancreas and a kidney. The aim must be to perform pancreas transplantation in an early stage of diabetes, even though remarkable improvements have also been reported in terminal stages of the disease, and the quality of life of these patients has been significantly improved.
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PMID:[Pancreas transplantation in Type I diabetic patients]. 227 7

The hypercoagulable state in patients with diabetes mellitus, glomerular diseases and pregnancy induced hypertension was studied by using new methods. The research items included platelet function, coagulation, anti-coagulation system, fibrinolysis and TEG examination. The results showed that there was a hypercoagulable state in patients with diabetes mellitus, pregnancy induced hypertension and glomerular diseases, especially in those with uremia and nephrotic syndrome.
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PMID:[Clinical research of hypercoagulation in patients with diabetes mellitus, glomerular diseases and pregnancy induced hypertension]. 228 69

In patients with insulin-dependent diabetes, antihypertensive treatment has a beneficial effect on the rate of progression toward uremia of overt diabetic nephropathy (albumin excretion rate [AER] greater than 300 mg/24 hour). The influence of hypertension on the progression of "incipient" nephropathy (AER ranging between 30 and 300 mg/24 hours) is not well defined, particularly in patients with noninsulin-dependent diabetes. In this study, 21 patients with noninsulin-dependent diabetes and hypertension (11 with normoalbuminuria and 10 with microalbuminuria), who were comparable for age, duration of diabetes and hypertension, were treated with indapamide, 2.5 mg once daily, and followed up for 24 months. Blood pressure, glomerular filtration rate (GFR), albumin excretion rate and subclass 4 of urinary immunoglobulin G (IgG4) were indicated. In normoalbuminuric patients, blood pressure was significantly reduced, whereas AER, IgG4 and GFR did not show any variation throughout the study. In microalbuminuric patients, blood pressure, AER and IgG4 were significantly reduced, and GFR remained unchanged. In patients with noninsulin-dependent diabetes, antihypertensive treatment, which is begun during incipient diabetic nephropathy, may have a beneficial effect on the progression of the disease, although a long-term follow-up study is needed to confirm this.
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PMID:Efficacy of antihypertensive treatment with indapamide in patients with noninsulin-dependent diabetes and persistent microalbuminuria. 233 Sep 7

We have followed a group of 18 uremic patients through living-related donor renal transplantation (RTX) using pattern-reversal VEPs. Recordings were made prior to and 10 weeks after surgery at high, medium and low spatial frequencies. Prior to RTX, mean latency of the P100 component of the VEP was 107 msec. Individual values did not correlate with blood urea nitrogen or creatinine. Patients requiring hemodialysis did not differ from non-dialyzed patients. Ten weeks after RTX P100 latencies were significantly shortened while N75 latencies were unchanged. Several diabetic patients exhibited the appearance of previously unrecorded wave forms. P100 latency increased significantly with increasing spatial frequency before and after transplantation. Diabetic patients demonstrated a consistent increase in P100 amplitude while non-diabetic patients demonstrated a consistent decrease in P100 amplitude after RTX. The data indicate that renal transplantation has beneficial effects on the central nervous system of uremic patients not seen with chronic hemodialysis and that these effects may be quantitatively measured using the VEP. The data further suggest that electrophysiological effects of uremia and diabetes may be additive, but reversible after RTX. Alterations in the uremic and diabetic VEP may be related to retinal or more proximal central nervous system structures.
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PMID:Visual evoked potential changes following renal transplantation. 243 74

Glycosylated and carbamylated haemoglobin were determined in patients with uraemia and/or diabetes mellitus. Glycosylated haemoglobin measured by ion-exchange chromatography (HbA1, HbA1c, HbA1a + b) was elevated in non-diabetic uraemic patients, while colorimetrically determined glycosylated haemoglobin was similar to controls. Patients with diabetes mellitus and normal renal function had similar glycosylated haemoglobin concentrations to those with renal failure. Both methods showed an excellent correlation, independent of renal function, in patients with diabetes mellitus. The HbA1c component was more influenced by diabetes and the HbA1a + b component was relatively more dependent on renal function. Carbamylated haemoglobin was detected in all subjects, but was grossly elevated in uraemia. Carbamylated haemoglobin significantly correlated with renal function and chromatographically determined glycosylated haemoglobin. Data from this study strongly suggests that the apparent elevation of chromatographically determined glycosylated haemoglobin in uraemia is due to the increased formation of carbamylated haemoglobin. However, in patients with diabetes mellitus, independent of renal function, both the chromatographic and colorimetric methods of determining glycosylated haemoglobin are equally valuable and reliable. The non-enzymatic formation of carbamylated haemoglobin in uraemia has several similarities to glycosylated haemoglobin in patients with diabetes mellitus. Carbamylated haemoglobin may have a clinical role as a marker of uraemia and may also have a pathophysiological relevance.
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PMID:Glycosylated and carbamylated haemoglobin in uraemia. 249 61

Serum fructosamines and glycosylated haemoglobin have been examined in groups of patients with (n = 27) and without (n = 39) diabetes mellitus and chronic renal failure, or undergoing renal replacement therapy. Elevated values of fructosamines were found in nondiabetic haemodialysis patients as compared to the other non-diabetic patients. The relationship between fructosamines and glycosylated haemoglobin appeared to be attenuated by uraemia. Successful pancreatic transplantation returned fructosamine and glycosylated haemoglobin values to normal.
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PMID:Fructosamines in uraemia and renal replacement therapy. 251 86


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