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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The strong association between anemia and cardiovascular complications among patients with end-stage renal disease suggests that anemia during chronic renal insufficiency (CRI) may also have important consequences. We performed a retrospective cohort study to identify factors associated with severe anemia (hematocrit [Hct] < 30%) and examine anemia management practices in CRI. The CRI cohort was composed of 604 adult patients with elevated serum creatinine levels. There was a direct correlation between predicted glomerular filtration rate and Hct (r = 0.49) and an inverse correlation between serum creatinine level and Hct (r = -0.37). Anemia was noted early in CRI; 45% of patients with serum creatinine levels of 2 mg/dL or less had an Hct less than 36%, and 8% had an Hct less than 30%. During the course of the study, mean Hct decreased from 35.1% +/- 5.6% to 31.8% +/- 5.6%. Iron studies were obtained in only 19% of patients, and among these, the prevalence of iron deficiency (transferrin saturation < 20%) was 54%. Only 30% and 26% of patients were administered recombinant human erythropoietin (rHuEPO) and iron, respectively. Multivariate analyses showed that diabetes as the cause of renal disease, greater serum creatinine level, and having a single nephrology visit were associated with greater odds for the presence of anemia. A lower Hct and having a single nephrology visit were associated with greater odds for rHuEPO use. These results show that anemia begins early in the course of CRI, and management of anemia is suboptimal, even among patients under the care of nephrologists. Educational programs to optimize anemia management among patients with CRI are needed.
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PMID:Anemia: an early complication of chronic renal insufficiency. 1157 84

Pseudomembranous colitis usually presents with diarrhea in a clinical setting of recent antibiotic use. It is uncommon to see it as a cause of obstipation and colonic pseudo-obstruction. We report an unusual case of an elderly woman with hypertension, congestive heart failure, chronic obstructive pulmonary disease, chronic renal insufficiency, and diabetes mellitus, who was admitted with fever, abdominal pain, and distension without diarrhea. She presented with decreased stool frequency and obstipation. She did not respond to conservative management. Colonoscopy revealed a picture of pseudomembranous colitis, and Clostridium difficile toxin was positive. She responded well to metronidazole therapy.
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PMID:Pseudomembranous colitis without diarrhea presenting clinically as acute intestinal pseudo-obstruction. 1157 68

Emphysematous pyelonephritis in renal transplant allograft occurs rarely. This is a case report on a 55-year-old man who had renal transplantation in 1983 and developed post-transplant diabetes mellitus in 1984. This patient suffered from fever and right low abdominal pain and was subsequently diagnosed as emphysematous pyelonephritis by computerized tomography. He was successfully treated with percutaneous drainage, percutaneous nephrostomy and parenteral antibiotics. Although the management of emphysematous pyelonephritis has been a subject of controversy, we recommend consideration of renal preservation in patients with few risk factors, especially in those patients presenting with chronic renal insufficiency, solitary kidney and transplant allograft.
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PMID:Emphysematous pyelonephritis in a renal allograft: successful treatment with percutaneous drainage and nephrostomy. 1167 65

Cyclooxygenase-2 (COX-2) selective inhibitors are now extensively used for their anti-inflammatory and analgesic efficacy. Several large controlled trials provide evidence to support the proposition that they cause fewer major gastro-intestinal side effects and less toxicity than routine nonsteroidal anti-inflammatory drugs (NSAIDs). In view of the documented different localizations of the cyclooxygenase-1 and COX-2 enzymes in the kidney, it was initially hoped that COX-2 inhibitors would be associated with fewer renal side effects than other NSAIDs. This has not been borne out by subsequent studies. Like other NSAIDs, COX-2 inhibitors can cause salt and water retention, leading to edema and worsening hypertension. They can also cause acute declines in renal function and glomerular filtration rate. These events are, however, uncommon in large rheumatology populations and infrequently lead to discontinuation of the medications. Judicious use of COX-2 inhibitors in high-risk patients (such as those with chronic renal insufficiency, diabetes or congestive heart failure) will lead to a decreased incidence of adverse renal events.
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PMID:COX-2 inhibitors and the kidney. 1169 50

The use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor antagonists, or aldosterone antagonists can have important beneficial effects on the progression of renal disease associated with glomerular and interstitial fibrosis, especially if the adverse side effects (eg, hyperkalemia) can be minimized. Because it appears that chronic renal insufficiency and proteinuria may well be cardiovascular risk factors, it is exciting to note that recent large scale epidemiologic studies (Heart Outcomes and Prevention Evaluation [HOPE]) have shown both cardioprotective and renoprotective effects of ACE inhibition. It appears paradoxic that such renoprotective effects are clearly evident in diabetes mellitus in which the plasma renin activity may be suppressed. Even in this setting, it appears that there is activation of the renal angiotensin system(s), and inhibitions of these intrarenal systems are involved in the renoprotective effects of these agents. Recent studies have identified nearly all of the components needed to generate angiotensin II in the renal luminal compartment, and suggest that there may be a direct effect through AT(1) receptors on NaCl transport in the distal nephron. The possibility that the components of this intraluminal renin-angiotensin system may be acutely regulated by variations in dietary salt intake provides an opportunity to better understand the normal maintenance of salt balance. Whether or not inhibition of these pathways is involved in the renoprotective effects of ACE inhibitors and angiotensin receptor antagonists is an important issue to be addressed.
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PMID:Prevention, protection, and the intrarenal renin-angiotensin systems. 1170 7

Chronic renal insufficiency is characterized by specific abnormalities in lipoprotein metabolism, affecting both apolipoprotein A (apo A)- and apo B-containing lipoproteins. To evaluate the effects of fluvastatin, a synthetic 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, on renal dyslipoproteinemia, we performed a randomized, double-blind, placebo-controlled, two-way, period cross-over study. Study patients were administered fluvastatin, 40 mg/d, or placebo during 8 weeks in randomized order. Forty-five nonnephrotic patients (28 men, 17 women) without diabetes with moderate to advanced chronic renal insufficiency participated in the study. Their mean age was 56.4 +/- 11.0 years. Glomerular filtration rate ranged from 12 to 44 mL/min/1.73 m2 of body surface area (mean, 27.5 +/- 10.5 mL/min/1.73 m2). Fluvastatin treatment resulted in significant reductions in the primary outcome variables low-density lipoprotein cholesterol (LDL-C; -26%; P < 0.001), apo B (-21%; P < 0.001), and lipoprotein B complex (Lp-Bc) (-14%; P < 0.01). There were statistically significant differences between fluvastatin and placebo treatment for the secondary outcome variables total cholesterol (-19%), triglycerides (TGs; -13%), VLDL-C (-13%), apo E (-13%), and Lp-B (-22%). There was no treatment effect on high-density lipoprotein cholesterol or lipoprotein(a). Fluvastatin treatment was well tolerated, with no serious adverse events during the study. In conclusion, fluvastatin treatment was well tolerated in patients with moderately advanced renal insufficiency and led to a significant reduction in cholesterol-rich, but to a lesser extent in TG-rich, apo B-containing lipoproteins. It remains to be clarified whether these positive changes in lipoprotein profile also will result in attenuation of the atherosclerotic process in these patients, as well as beneficially affect the progression of chronic renal failure.
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PMID:Fluvastatin improves lipid abnormalities in patients with moderate to advanced chronic renal insufficiency. 1177 4

In adults, advanced glycation end products (AGEs) rise slowly in tissues and circulation during aging, and accumulate at an accelerated rate both in diabetes and chronic renal insufficiency (CRI). We aimed to investigate the pattern of AGE accumulation in children/adolescents with CRI and on renal replacement therapy by dialysis and transplantation. Concentrations of fluorescent AGEs, carboxymethyllysine (CML) and lipofuscin-like substance (LFLS, a marker of lipid peroxidation) were followed. Data were obtained from 11 CRI patients on conservative treatment (age 12.6+/-1.7 years, serum creatinine: 205.7+/-17.5 micromol/l), ten patients on renal replacement therapy with dialysis (13.6+/-1.7 years, 698.2+/-48.9 micromol/l) and nine patients after kidney transplantation (15.9+/-1.1 years, 115.9+/-12.0 micromol/l) and comparison made with the data from 28 healthy controls (11.8+/-8.2 years, 44.1+/-8.2 micromol/l). In controls, an age-dependent rise of fluorescent AGE and CML levels was observed. In the CRI group, fluorescent AGEs [0.38+/-0.03x105 arbitrary units (AU)] and CML (369+/-26 ng/ml) concentrations were doubled compared with controls (0.16+/-0.03x105 AU and 189+/-42 ng/ml, respectively) and even higher levels were revealed in dialyzed patients (0.80+/-0.05x105 AU; 650+/-94 ng/ml). Successful kidney transplantation significantly reduced but did not normalize fluorescent AGE levels (0.39+/-0.03 x105 AU), while the decline in CML levels (550+/-47 ng/ml) was insignificant. Plasma LFLS was elevated in CRI (19.6+/- 1.7 AU) and was even higher in dialyzed children (32.0+/-5.3 AU) compared with healthy controls (7.1+/- 1.4 AU). Kidney transplantation did not normalize LFLS levels (20.3+/-5.3 AU), pointing to persistently enhanced lipid peroxidation. Our study provides the first data on enhanced fluorescent AGEs and CML levels in children/adolescents with CRI and on dialysis. Successful renal transplantation decreased but did not normalize AGE levels, probably because of still-impaired renal function with enhanced oxidative stress, as well as the influence of immunosuppressive therapy.
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PMID:Plasma levels of advanced glycation end products in children with renal disease. 1179 10

This article includes a review of hypertension, nephrolithiasis and cystic diseases of the kidney, all quite common diagnoses. These days, as concerns are growing, some are considering diabetes mellitus to be a national epidemic. Thus, our entire article focuses on the diabetic renal disease. The current approach to the diagnosis and treatment of acute renal failure and chronic renal insufficiency is discussed, including treatment modalities such as dialysis and transplantation. This article is not at all intended to be a comprehensive review of each topic included, but rather it is an attempt to make the reader more familiar with the fascinating and continuously evolving field of nephrology.
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PMID:Updates in nephrology. A summary of common diagnoses encountered in the clinical practice. 1180 65

The authors report a case of an acute toxic cholestatic reaction to clarithromycin, proven by liver biopsy, in a patient with comorbid diseases, prior exposure to erythromycin and ultimate death. No autopsy was performed. A 59-year-old woman with diabetes mellitus and chronic renal insufficiency received clarithromycin 500 mg twice daily for 3 days for acute maxillary sinusitis and then developed a rash and jaundice. She was hospitalized 11 days after stopping clarithromycin. Progressive cholestatic jaundice accompanied by oligo-anuric renal failure requiring hemodialysis ensued. Liver biopsy showed pure bilirubinostasis without parenchymal inflammation. On the 22nd hospital day, after clinical deterioration, she died from an apparent cardiopulmonary death. This is the first report in the literature of a fatality associated with a short-term, low (1 g) daily dose of drug-induced pure cholestasis, an entity not previously identified with severe drug-induced hepatotoxicity.
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PMID:Progressive cholestatic liver disease associated with clarithromycin treatment. 1204 57

As many as 6.2 million Americans may have chronic renal insufficiency (CRI), an insidious disease that can arise as a result of diabetes, hypertensive nephrosclerosis, chronic glomerulonephritis, and many other disorders. CRI usually progresses over time to end-stage renal disease, when patients require either dialysis or kidney transplantation in order to survive. With this population identified, primary care physicians, nephrologists, and payers have an opportunity to prevent or at least slow the progression of renal disease. The Renal Anemia Management Period (RAMP) may help raise awareness of the need for early diagnosis and aggressive treatment of anemia, one of the leading causes of morbidity in CRI patients. Such treatment has the potential to prevent or control the development of significant morbidity and mortality.
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PMID:Management of chronic renal insufficiency: a call for a proactive approach. 1209 66


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