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

The chronic hyperglycemia in diabetes mellitus enhances the nonenzymic glycation of structural proteins possibly increasing the formation of highly reactive advanced glycation end products (AGE). These protein changes might be involved in tissue-damaging mechanisms leading to diabetic complications, including diabetic nephropathy. To simulate these events, an in vitro model, based on isolated human glomerular basement membrane (hGBM), has been developed. In this study we have investigated the extent of AGE formation and the binding changes induced by the nonenzymic glycation of hGBM. An enriched fraction of hGBM was isolated from normal human kidneys and glycated in vitro by incubation with glucose (500 mmol/l) at 37 degrees C for 10 days. The presence of AGE was investigated by two methods - spectrofluorescence and the diazonium salt reaction - both specific for this type of chemical entity. The binding capacity of glycated hGBM was tested by a 10-day incubation with human insulin, albumin, immunoglobulin G and fibrinogen. Higher relative spectrofluorescence values at 440 nm emission (20.0 +/- 2.0 vs. 12.5 +/- 5.0) and higher absorbance values at 492 nm (0.798 +/- 0.063 vs. 0.429 +/- 0.228) indicated the presence of increased levels of AGE in glycated vs. native hGBM. Insulin and the three proteins were bound to hGBM in increased amounts after its glycation (p less than 0.05). The results obtained in this in vitro model confirm that enhanced nonenzymic glycation of hGBM induces the formation of AGE and possibly, through these compounds, alters its physicochemical and binding properties. This reaction might contribute to the mechanisms eventually leading to diabetic nephropathy.
Nephron 1989
PMID:Nonenzymic glycation of isolated human glomerular basement membrane changes its physicochemical characteristics and binding properties. 273 62

The purpose of this investigation was to study in a group of diabetics with varying degrees of renal failure, the relationship of renal size to the degree of renal function. A literature search of the past 25 years has failed to document a precise relationship between structure and function in this setting. Patients were admitted, and sex, age, race, serum creatinine levels, renal size and mean blood pressure were ascertained. Patients with polycystic kidney disease were, obviously, excluded. The group consisted of 26 diabetics, divided into two groups based on previous (prior to onset of uremia) insulin and ketone status. Interestingly, there was no significant difference between groups with insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) as regards mean blood pressure (106.5 +/- 15.3 mm Hg vs. 108.9 +/- 17.64 mm Hg; t = 0.3607892, p = 0.9). Mean kidney length was inversely related to serum creatinine level (r = 0.3980, n = 26, p less than 0.05). There was no correlation between mean renal length and mean blood pressure (r = 0.189, p greater than 0.05). However, there was a significantly higher proportion of larger kidneys (11 cm or more) in the IDDM group than in the NIDDM group (Fischer's exact test; p less than 0.0001) which was related neither to age nor blood pressure. In this paper, we show an inverse correlation between kidney length and serum creatinine.(ABSTRACT TRUNCATED AT 250 WORDS)
Nephron 1989
PMID:Renal size and function in diabetic nephropathy. 273 65

Treatment with thiazide diuretics causes an impairment of the glucose metabolism. To study whether this is due to a direct effect on the endocrine pancreas, the effects of the thiazide hydroflumethiazide on the release of glucagon, insulin, and somatostatin from the isolated perfused pancreas of normal and alloxan diabetic dogs were examined. Hydroflumethiazide at concentrations ranging from 1 to 50 micrograms/mL stimulated the normal secretion of glucagon (P less than 0.001), insulin (P less than 0.001), and somatostatin (P less than 0.001) in a dose-dependent manner. The normal hormone responses evoked by 50 micrograms/mL of the thiazide were, however, modified by the prevailing glucose level: higher insulin (P less than 0.05) and somatostatin (P less than 0.05) and lower glucagon (P less than 0.05) were obtained at the high glucose concentration of 11 mmol/L rather than at the low glucose concentration of 1.3 mmol/L. In alloxan diabetes, insulin secretion was almost extinct and did not respond to hydroflumethiazide, whereas glucagon was dose-dependently stimulated (P less than 0.001). In addition, we looked at the effect of the loop diuretic, bumetanide. The infusion of bumetanide at doses ranging from 0.5 to 3 micrograms/mL did not alter the release of glucagon, insulin, and somatostatin in the presence of 5.5 mmol/L glucose. The results suggest that hydroflumethiazide possesses the ability to directly stimulate A cell secretion in the normal and alloxan diabetic pancreas. Whether this effect is of clinical importance for the diminution in glucose tolerance observed during thiazide therapy remains, however, uncertain.
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PMID:Effects of a thiazide diuretic (hydroflumethiazide) and a loop diuretic (bumetanide) on the endocrine pancreas: studies in vitro. 286 65

Urinary excretion of glycosaminoglycans (GAGS) and sialic acid (SA), as well as the activity of two renal enzymes related to glycoprotein metabolism, N-acetyl-beta-D-glucosaminidase (NAG) and beta-galactosidase (GAL), and two others unrelated to glycosaminoglycans and glycoprotein metabolism, gamma-glutamyltranspeptidase (gamma-Gt) and angiotensin-I-converting enzyme (ACE), were evaluated in 40 insulin-dependent diabetic patients with normal range albuminuria, 21 patients with mesangial glomerulonephritis, and 30 control subjects. Diabetic and glomerulonephritic patients excreted a significantly higher amount of GAGS and SA, and showed greater NAG and GAL activities; gamma-Gt and ACE levels were within normal ranges. No correlation could be demonstrated between diabetes duration and GAGS, SA, NAG and GAL findings. Moreover, no correspondence between degree of metabolic control, as reflected by glycosylated hemoglobin (HbA1a-c) and GAGS, SA, NAG and GAL emerged.
Nephron 1986
PMID:Urinary glycosaminoglycans, sialic acid and lysosomal enzymes increase in nonalbuminuric diabetic patients. 287 16

End-stage renal failure is a severe and relatively frequent complication of insulin-dependent diabetes, also representing the only growing cause of uremia requiring replacement therapy in Western countries. Five principal pathogenic factors are to be considered: genetic, immunologic, hemorheologic, biochemic, and hemodynamic; of these, nonenzymatic glycosylation of proteins and glomerular hyperfiltration appear to be most important. In the last few years, a better understanding of the natural history of type I diabetes has been gained, with particular significance attributed to the stage of the disease defined as incipient diabetic nephropathy which is characterized by microalbuminuria. However, advances in pathophysiologic notions have not always been followed by corresponding results in the prevention and therapy of diabetic nephropathy; possible reasons for this are briefly discussed. In spite of these uncertainties, the importance of achieving the best possible correction of glycemic homeostasis and of albeit initial elevations in the arterial pressure appears to be well established.
Nephron 1988
PMID:Physiopathology and clinical aspects of diabetic nephropathy. 306 62

Heavy reversible proteinuria induced by antihypertensive treatment with low doses of captopril has recently been reported by our group in psoriatic patients. To ascertain whether an increased permeability of the glomerular basal membrane of psoriatics can lead to an enhanced urinary excretion of albumin independently from the presence or absence of coexisting diabetes or hypertension, the latter parameter was measured in 39 patients affected by diffuse psoriasis. A high prevalence of microalbuminuria was observed in diabetic and hypertensive psoriatics. Moreover, a direct correlation was found between the diastolic blood pressure (BP) values and the urinary excretion of albumin in the entire group of psoriatics, thus suggesting systemic hypertension as one of the factors responsible for proteinuria in these patients. However, more than 50% of normotensive psoriatics showed an enhanced excretion of albumin. Since microalbuminuria has been indicated as a reliable index to predict the development of renal impairment, the finding of an enhanced albumin loss in psoriatics represents a further risk factor in these patients, who are particularly susceptible to experience cardiovascular complications.
Nephron 1988
PMID:High prevalence of microproteinuria, an early index of renal impairment, in patients with diffuse psoriasis. 328 Oct 46

Ten autopsied cases of uremia (none with diabetes mellitus) who had been treated with hemodialysis were studied histopathologically. Hyaline replacement of islets of Langerhans was found in 6 out of 10 cases, while such a change was observed in only 1 of 15 control non hemodialzyed controls. These 6 cases had received hemodialysis therapy for a duration of more than 2 years and 10 months. The hyaline material in the islets of Langerhans was confirmed as the presence of amyloid by electron microscopy. Clinically, urinary glucose was present in 1 out of 3 patients and the blood glucose level was moderately elevated in 2 other cases. Therefore, it should be emphasized that care should be taken about glucose tolerance in uremic patients receiving chronic hemodialysis.
Nephron 1987
PMID:The islets of Langerhans in uremic patients receiving chronic hemodialysis. 329 21

We reviewed the recommendations and outcomes for all patients with diabetes mellitus and end-stage renal disease referred to the Medical Center Hospital of Vermont from 1971 through December 1983. During this period, we recommended transplantation in 53 of 73 patients evaluated. Thirty-two transplants were performed in 30 patients. Of the 30 patients, 10 had clinical vascular disease prior to transplantation, i.e., claudication, amputation, active angina, myocardial infarction, or stroke. Seven of the 10 had only claudication or amputation. These 10 patients showed a clear excess in graft failure and mortality. One- and 2-year graft survival was 37 and 13%; patient survival was 48 and 24%. By comparison, the 20 patients without evident vascular disease had 1- and 2-year graft survival rates of 83 and 75% and patient survival rates of 85% at both 1 and 2 years. The incidence of cardiovascular death in the group with vascular disease was 45% at 1 year and 63% at 2 years, as compared with none in the group without vascular disease. The high graft loss and mortality in this group after transplantation should be a major consideration when therapeutic alternatives are considered in diabetics with end-stage renal disease.
Nephron 1986
PMID:Renal transplantation in diabetes mellitus. Influence of preexisting vascular disease on outcome. 351 20

Cerebrovascular accidents, often secondary to severe atherosclerotic disease, are very common in uremic patients on long-term hemodialysis. The aim of the present study is to assess asymptomatic carotid artery atherosclerotic disease (CAAD) in hemodialyzed normotensive and hypertensive patients in comparison with age-matched controls, by the use of Doppler ultrasound flow velocity wave form analysis (FVWFA), recorded from the common carotid artery. This study was performed on 47 subjects divided into four groups: 10 young and 10 middle-aged normals were considered in groups I and II, respectively, 5 young uremic normotensive, 6 young uremic hypertensive and 16 middle-aged uremic normotensive patients in groups III, IV and V, respectively. All the examined patients were nonsmokers, without diabetes or cardiopathy. The five wave form dimensions most capable of separating different degrees of atherosclerotic disease were determined on every common carotid tracing and used in a single best fit discriminant equation; the resultant discriminant score (DS) classified each carotid tracing and consequently every group's range. DS of groups I and III were not different, but significantly higher compared to the other three groups; besides DS was statistically not different in groups II, IV and V. In conclusion, FVWFA did not detect a different degree of CAAD between normotensive dialyzed patients and age-matched normals, whereas the blood pressure pharmacological control did not affect the velocity findings of advanced CAAD in young uremic hypertensive patients.
Nephron 1986
PMID:Carotid artery atherosclerotic disease assessed by flow velocity wave form analysis in hemodialyzed normotensive and hypertensive patients. 353 16

An unusual case of diabetes secondary to acute pancreatitis in a boy with end-stage renal failure receiving continuous ambulatory peritoneal dialysis (CAPD) is described. A hyperglycaemic, hyperosmolar pre-coma developed, aggravated by associated hypercalcaemia. The glucose content of the dialysis fluid contributed to the hyperglycaemia, which settled as the pancreatitis resolved and lower glucose concentration dialysis fluid was used. Our experience suggests that pancreatic dysfunction should be considered where significant hyperglycaemia occurs during peritoneal dialysis.
Nephron 1986
PMID:Non-ketotic hyperosmolar diabetic pre-coma due to pancreatitis in a boy on continuous ambulatory peritoneal dialysis. 354 Jun 93


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