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)

Type 2 diabetes is an ever-growing problem worldwide. Approximately 40% of the patients with type 2 diabetes will develop diabetic kidney disease. In the United States, diabetes has become the most common single cause of endstage renal disease defined by the need for dialysis or transplantation. Patients with type 2 diabetes and diabetic nephropathy have a dramatically increased cardiovascular risk. The Irbesartan Diabetic Nephropathy Trial was designed to determine whether the use of irbesartan or a calcium channel blocker would provide protection against the progression of nephropathy due to type 2 diabetes beyond that attributable to the lowering of blood pressure. In that study, 1715 hypertensive patients with nephropathy due to type 2 diabetes were randomly assigned to irbesartan 300 mg/day or amlodipine 10 mg/day, or placebo. All patients randomized in this trial had more than 900 mg of protein in their urine and serum creatinines between 1.0 mg/dl and 3.0 mg/dl. The target blood pressure was 135/85 mmHg or less in all groups. The primary outcome was time to a combined endpoint of doubling of their baseline serum creatinine concentration, the development of endstage renal disease, or death from any cause. The mean duration of follow-up was 2.6 years. Treatment with irbesartan was associated with a risk of the primary composite endpoint that was 20% lower than that in the placebo group ( P = 0.02) and 23% lower than that in the amlodipine group ( P = 0.006). The risk of doubling of the serum creatinine concentration was 33% lower in the irbesartan group than in the placebo group ( P = 0.003) and 37% lower in the irbesartan group than in the amlodipine group ( P < 0.001). Treatment with irbesartan was associated with a relative risk of endstage renal disease that was 23% lower than that in both other groups. These differences were not accounted for by differences in the blood pressures that were achieved. Proteinuria was reduced on average by 33% in the irbesartan group as compared with 6% in the amlodipine group and 10% in the placebo group. The angiotensin II receptor blocker irbesartan was shown to be effective in protecting against the progression of nephropathy due to type 2 diabetes. In a study done in patients with type 2 diabetes and early nephropathy as manifested by microalbuminuria, 590 hypertensive patients with type 2 diabetes and microalbuminuria were randomized to receive either irbesartan 150 mg/day or irbesartan 300 mg/day and followed for 2 years. The primary outcome in that trial was the time to the onset of diabetic nephropathy, defined by persistent albuminuria in overnight specimens, with a urinary albumin excretion rate that was more than 200 mg/min or at least 30% higher than the baseline level. The irbesartan 150 mg/day group demonstrated a 39% relative risk reduction versus the control group in the development of overt proteinuria. The irbesartan 300 mg/day group demonstrated a highly significant 70% risk reduction versus the control group ( P < 0.001). The albumin excretion rate was reduced in the two irbesartan groups throughout the study (-11% and -38% at 24 months compared with baseline in the irbesartan 150-mg and 300-mg groups, respectively). The albumin excretion rate remained unchanged in the control group. Irbesartan was demonstrated in the above study to be renoprotective, independent of its blood pressure-lowering effect, in patients with type 2 diabetes and microalbuminuria. Thus, irbesartan, an angiotensin receptor blocker, was demonstrated to be significantly renoprotective in patients with type 2 diabetes with either early nephropathy (microalbuminuria) or late nephropathy (proteinuria). The renoprotective effects of irbesartan were above and beyond the effects irbesartan had on systemic blood pressure. Patients with type 2 diabetes and either early or late diabetic nephropathy should be treated with the angiotensin II receptor blocker irbesartan.
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PMID:Treatment of diabetic nephropathy with angiotensin II receptor antagonist. 1458 37

Diabetic nephropathy is the common cause of end stage renal disease in diabetes mellitus. But other glomerular pathologies have been also described in diabetic patients. We described 3 cases with diabetes mellitus and other glomerular diseases. Case I: A 59-year-old male patient with type 2 diabetes mellitus for 4 years was evaluated for generalized edema. Physical examination showed pretibial edema and no diabetic retinopathy. The cause of nephrotic syndrome was membranoproliferative glomerulonephritis. Conservative therapy could not control the severe proteinuria and renal dysfunction. With corticosteroid and cyclophosphamide therapy partial remission was obtained. Case II: A 46-year-old diabetic woman was evaluated for severe proteinuria. Diabetic retinopathy was not found on her funduscopic examination. Mesangioproliferative glomerulonephritis was found on renal biopsy. Proteinuria did not regress with conservative therapy and corticosteroid and cyclophosphamide. Case III: A 48-year-old male patient with diabetes mellitus type 2 for 2 years was admitted to the hospital because of nephrotic syndrome and weakness. At another hospital his diagnosis with biopsy showed minimal change disease. He was treated with corticosteroid since 3 months. His renal biopsy was reevaluated and found amyloid deposition but not diabetic nephropathy or minimal change disease. In diabetic patients, nondiabetic nephropathy is not uncommon and it was reported as common as about 30%. In addition to therapy for diabetes mellitus these patients can need specific therapy.
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PMID:Other glomerular pathologies in three patients with diabetes mellitus. 1528 4

Proteinuria is a known risk factor for both renal disease progression and cardiovascular morbidity and mortality in hypertensive populations. African Americans are among the highest risk groups for development of renal disease in the setting of hypertension and suffer a disproportionate burden of end-stage renal disease attributed to hypertension. Population-based studies indicate that African Americans have higher rates of albuminuria compared to non-African Americans in part due to higher rates of hypertension and diabetes in African Americans as compared to non-Hispanic whites for example. The African American Study of Kidney Disease and Hypertension (AASK) Trial was a prospective long-term clinical trial that examined the effect of aggressive blood pressure lowering versus usual blood pressure lowering in three different classes of antihypertensives on renal outcomes in approximately 1200 African Americans with hypertensive nephrosclerosis. Two thirds of trial participants had < 300 mg protein, and one third had > or = 300 mg of protein in a 24-hour urine specimen at baseline. Those with > 300 mg protein excretion compared to those with < 300 mg protein excretion at baseline had more rapid decline in renal function and ESRD events. Moreover, lower levels of proteinuria than previously thought may be important for identifying those at higher risk for kidney disease progression. The AASK cohort study, a follow-up to the trial, is now underway. The longer term follow-up will provide new insights into proteinuria and other risk factors for progression of kidney disease in hypertensive nephrosclerosis.
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PMID:Proteinuria and hypertensive nephrosclerosis in African Americans. 1548 98

The association between cigarette consumption and prevalence of mild proteinuria (30-99 mg/dl of albumin) was analyzed in 11,569 male and 4,715 female workers aged 18-67 yr recruited from an occupational population. Proteinuria was found in 274 (2.4%) of the total male workers and in 50 (1.1%) of the total females. Stepwise logistic regression analyses showed that sex, suspected diabetes mellitus, blood pressure (BP) and Brinkman Index (BI) levels (0, 1-199, 200-499, 500-799, 800-) were significantly related to proteinuria, and that the odds ratio of each BI level for proteinuria was 1.11 (C.I.: 1.01-1.67). In the subjects aged 50 yr or older, after excluding those suspected of having hypertension and/or diabetes mellitus, the odds ratio reached 1.37 (C.I.: 1.15-1.63), with the gender difference then no longer significant. The odds ratio for proteinuria was calculated as 5.44 (C.I.: 2.27-13.0) in male and female smokers having a BI of 500 or above and normal-high BP (130-139/85-89 mmHg) in comparison with nonsmokers having normal BP (<130/85 mmHg). These results suggest that heavy cigarette consumption represented by a BI of 500 or above is a risk factor of proteinuria even in healthy Japanese workers, particularly in those aged 50 yr or older and having normal-high BP.
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PMID:Association between cigarette consumption and proteinuria in healthy Japanese men and women from an occupational population. 1549 53

Proteinuria is a sign of abnormal excretion of protein by the kidney but is a nonspecific term including any or all proteins excreted. In contrast, albuminuria specifically refers to an abnormal excretion rate of albumin. Microalbuminuria refers to an abnormally increased excretion rate of albumin in the urine in the range of 30-299 mg/g creatinine. It is a marker of endothelial dysfunction and increased risk for cardiovascular morbidity and mortality especially, but not exclusively, in high-risk populations such as diabetics and hypertensives. Testing for microalbuminuria is now made easy by in-office dipstick tests (semiquantitative) and widely available laboratory testing (quantitative). Physicians should screen all diabetics for albuminuria and strongly consider screening hypertensives to identify those at higher risk for cardiovascular disease. Appropriate intervention, including use of drugs that block the renin-angiotensin-aldosterone system, may be appropriate in such cases as suggested by the American Diabetes Association and the Seventh Report of Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
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PMID:Microalbuminuria: definition, detection, and clinical significance. 1553 4

Renin angiotensin system inhibitor therapy is seldom offered to individuals who have diabetes and advanced chronic kidney disease because of safety concerns. In this post hoc, secondary analysis of the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial, angiotensin antagonism risk/benefit profile was assessed in 1513 individuals with type 2 diabetes and overt nephropathy. Incidence of ESRD, hospitalizations for heart failure, withdrawals for adverse events, and proteinuria during losartan or conventional treatment were compared within three tertiles of baseline serum creatinine concentration (highest, 2.1 to 3.6 mg/dl; middle, 1.6 to 2.0 mg/dl; lowest, 0.9 to 1.6 mg/dl). Losartan decreased the risk of ESRD by 24.6, 26.3, and 35.3% in highest, middle, and lowest tertiles, respectively. For every 100 patients with serum creatinine >2.0, 1.6 to 2.0, or <1.6 mg/dl, respectively, 4 yr of losartan therapy was estimated to save 18.9, 8.4, and 2.9 ESRD events and US$1,502,855, US$1,021,770, and US$528,591 costs for renal replacement therapy. Losartan also decreased the hospitalizations for heart failure by 50.2 and 45.1, in the highest and middle tertile, respectively. Withdrawals for adverse events other than heart failure were comparable between tertiles and treatment groups. Proteinuria decreased more on losartan than on placebo in all tertiles (highest, 24 versus -8%; middle, 16 versus -8%; lowest, 15 versus -10%). In proteinuric individuals with type 2 diabetes, losartan therapy reduced ESRD and hospitalizations for heart failure and was well tolerated at all levels of renal function. Angiotensin II antagonism is a suitable and well-tolerated treatment for individuals with type 2 diabetes even with GFR levels approaching renal replacement therapy.
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PMID:Continuum of renoprotection with losartan at all stages of type 2 diabetic nephropathy: a post hoc analysis of the RENAAL trial results. 1557 15

The American College of Rheumatology renal criteria require re-evaluation to incorporate recent advances in the classification of glomerulonephritidies. Renal biopsy is now common and safely performed by experienced nephrologists in community as well as academic settings. The optimal criterion is renal histopathology findings of an immune complex mediated glomerulonephritis as interpreted by an experienced pathologist employing accepted criteria. Renal biopsies should be analysed by routine histopathology, immunofluorescent and electron microscopy. Rating of activity and chronicity should be noted. Secondary criteria for patients unable to undergo renal biopsy includes a combination of findings. These include proteinuria, hypocomplementemia, elevated anti-dsDNA antibodies and an active urine sediment. Proteinuria is a nonspecific finding and, most importantly, can be associated with a number of comorbidities including diabetes, hypertension and atherosclerotic disease. Persistent proteinuria > 0.5 g per day or a spot protein to creatine ratio of > 0.5 should be accompanied by an additional feature supporting active lupus such as positive serologies (hypocomplementemia and/or elevated anti-dsDNA antibodies) and/or active urinary sediment. Similarly, active urinary sediment should be accompanied by the additional criterion of proteinuria to meet renal criteria. Decline in renal function is not a reliable criterion given the numerous medications, comorbidities and other clinical circumstances which may result in this feature.
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PMID:Review of ACR renal criteria in systemic lupus erythematosus. 1558 Sep 82

The aim of the present study is to describe the prevalence of proteinuria in a series of type 2 diabetic patients registered and followed up in the diabetes clinic of a primary health care center (PHCC) in Abha city, southern Saudi Arabia and to relate the proteinuria to some clinical manifestations. The study involved the files of 208 diabetic patients (118 females and 90 males). They were chosen from 475 files of diabetic patients receiving care in the PHC center of Shamasan in Abha City. The selection for this study was based on the fulfillment of certain criteria: type 2 diabetic patients, registered for at least 12 months and visited the clinic for at least once during that period. For each patient the age, sex, family history, diabetes duration, body mass index, the last readings of fasting blood sugar, total cholesterol level, systolic and diastolic blood pressure were used. Proteinuria was considered whenever the last and any of the preceding 3 urine analysis revealed it by the dipstick test provided the patient was not suffering on the day of the test from fever, urinary tract infections, other renal diseases or congestive heart failure. Further, the last recorded subjective evaluation of the treating physician concerning diet, drug and appointment compliance as poor or good was used. The mean age is 56.2+/-8.8 years. The mean duration of diabetes was 9.6+/-4.7 years, while the fasting blood sugar shows a considerably high mean of 218.0+/-72.0 mg/dl. The total cholesterol level on the other hand showed a slight high average of 233.7+/-55.2 mg/dl. The mean systolic and diastolic blood pressure were within normal ranges (136.4+/-18.9mmHg and 87.5+/-10.8mmHg) respectively. The results of the three different types of compliance as scored by the treating physician. The poor scores dominate with 74%, 82.7% and 78.4% of patients' diet, drug and appointment compliances. Proteinuria is present in more than half of the patients (54.3%). The outcome of the logistic regression model for proteinuria showed that the significant factors were the poor glycemic control with an odds ratio (OR) of 3.13, diabetes duration (OR= 1.08 for every year) and diastolic blood pressure (OR= 6.11). The overall model prediction was 72.12%. Diabetic patients treated in the PHC level should be regularly monitored for microalbuminuria and not gross proteinuria to prevent progression to overt nephropathy which will eventually lead to ESRD. The risk increases with poorly controlled and hypertensive patients.
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PMID:Significance of proteinuria in type 2 diabetic patients treated at a primary health care center in Abha City, Saudi Arabia. 1558 31

Rates of end-stage renal disease in the Aboriginal community have been increasing over the past two decades, particularly in the northern and more remote areas of Australia, and especially in disadvantaged communities. Proteinuria predicts the rate of loss of renal function and is common in young adults and virtually universal in those over 50 years old. Cumulative independent risk factors include low birthweight, recurrent skin infections, adult obesity, diabetes or its precursors, smoking, excessive alcohol intake and a family history of renal disease. A plausible theory is that intrauterine malnutrition permanently reduces total nephron numbers, which are then overworked in adulthood by the metabolic stresses of obesity (from excess alcohol and poor diet), blood pressure and infections, while starved of blood supply through smoking. Although renal disease is often only detected when already established, there are great rewards for active medical intervention. Control of blood pressure (preferentially using angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor blockers (AIIRB) in combination) can often stop or even reverse kidney damage, despite ongoing poor diabetic control. Adequately funded kidney health programmes with active Aboriginal Health Worker involvement are enormously cost-effective: tight blood pressure control at least halves the rate of disease progression, and every year of dialysis deferred for one patient could fund the appointment of two more health workers. Addressing the underlying social causes for this epidemic is critical.
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PMID:Antecedents of renal disease in Aborigines. 1560

The urinalysis dates back 6000 years. Information has evolved from tasting it for sugar to computer assisted assessment for the presence of cells and casts. The urine gives valuable information about kidney function in general and the glomeruli in particular. Findings can lead to a diagnosis of various medical conditions, most notable being diabetes mellitus. Proteinuria has many implications, including the presence of systemic disease and the progression of an underlying renal condition.
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PMID:The urinalysis--inexpensive and informative. 1568 10


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