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Query: UMLS:C0011849 (diabetes)
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Glomerular hyperfiltration is one of the factors held responsible for the development of diabetic nephropathy. A supranormal glomerular filtration rate (GFR) can be found in diabetic patients even when they are well controlled. Infusion of low-dose dopamine demonstrates that glomerular hyperfiltration in well-controlled insulin-dependent diabetic patients is not based on a predominant vasodilatation of the efferent arteriole. In the present study this is confirmed, since the dopamine-induced rise in GFR of control subjects (13.5% +/- 2.2) did not differ from that of patients with insulin-dependent diabetes mellitus (10.8% +/- 2.1). In animal studies it has been demonstrated that the increased GFR in diabetes mellitus is caused by a predominant decrease in resistance of the afferent arteriole. Protein loading and infusion of amino acids also increase GFR by dilatation of the afferent arteriole. Thus, protein loading or amino acid infusion may be used to test the existence of afferent vasodilatation. The present study investigates the effect of amino acid infusion on GFR of control subjects and insulin-dependent diabetic subjects. The amino acid-induced rise in GFR tended to be lower in the diabetic patients (6.9% +/- 2.8) compared with controls (13.2% +/- 2.7). Percentage amino acid-induced change in GFR appeared to decline with increasing baseline GFR in the diabetic subjects (r = -0.83; P less than 0.001). In controls, no such relationship was established (r = -0.22; n.s.). Our results suggest the existence of afferent vasodilatation in diabetic patients with a high GFR. The cause of this vasodilatation warrants further study.
Nephrol Dial Transplant 1987
PMID:Renal reserve filtration capacity in patients with type 1 (insulin-dependent) diabetes mellitus. 312 51

Diabetic nephropathy, a rarely listed cause of end-stage renal failure (ESRF) among patients starting renal replacement therapy (RRT) in the early seventies, has progressively gained in importance and become one of the major reasons for the continuous growth of the patient population on RRT in most European countries. Amongst new patients commencing RRT in 1985, the acceptance rate varied between 3 and 12 per million population for type I diabetes mellitus and between one and four per million population for type II diabetes mellitus. Nordic countries, particularly Sweden and Finland, had the highest acceptance rate of young patients with type I diabetes mellitus whose median ages were 38-42 years. In most central and southern European countries the median age of patients with type I diabetes mellitus varied between 50 and 58 years. The high number of young patients with type I diabetes mellitus and ESRF in Nordic countries point to a different natural history of this disease. It cannot be excluded, however, that the higher median age in other countries might result from doctors mistakenly diagnosing type I disease in patients with type II disease who need insulin treatment. Patients with type II diabetes mellitus had a similar age distribution at start of RRT throughout Europe and their median ages clustered around 60 years in most countries. The contribution of haemodialysis, peritoneal dialysis and renal transplantation was analysed for diabetic compared to non-diabetic ESRF. Despite large geographical differences in the proportional use of methods of treatment, a general trend to apply CAPD more frequently in diabetic as compared to non-diabetic patients was observed, and this was true for countries with both predominant haemodialysis and predominant transplant programmes. Transplantation without prior dialysis was performed in 17% of Swedish and 30% of Norwegian patients with type I diabetes mellitus. In order to better explain the mortality of patients with diabetic ESRF, the proportional distribution of causes of death was analysed. Myocardial ischaemia and infarction was confirmed to be the leading cause of death in patients with diabetes mellitus on RRT. The coronary death rate was estimated to be 10 times greater in young patients with type I diabetes mellitus as compared to their non-diabetic counterparts. Other cardiovascular as well as infectious causes were recorded in a similar proportion of deaths in diabetics as in non-diabetics. Cancer deaths, however, appeared to be definitely less frequent in patients on RRT due to diabetic nephropathy.
Nephrol Dial Transplant 1988
PMID:Renal replacement therapy in patients with diabetic nephropathy, 1980-1985. Report from the European Dialysis and Transplant Association Registry. 314 13

The demography of renal replacement therapy for 1985 and 1986 is presented, based on returns of individual patient questionnaires to the EDTA Registry, supplemented by some data from the centre questionnaire. Patient questionnaires for 1985 were received from 83% of known centres and for 1986 from 79% of known centres in 33 countries. Of 244,497 individually registered patients, 116,892 were known to be alive on defined forms of renal replacement therapy on 31 December 1985 and 121,755 on 31 December 1986. Countries covered by the EDTA Registry include one-third of the world's population on renal replacement therapy. Individual countries exemplify different strategies with variable proportional contributions from home haemodialysis, CAPD and transplantation, and varying levels of achievement in numbers of patients on treatment. Trends in patient populations demonstrate that standard risk patients (aged under 55 and non-diabetic) are mostly receiving treatment in countries with advanced programmes, whereas the growth in numbers of new patients is due largely to increase in the acceptance of high-risk patients (aged over 55 or with diabetes mellitus). These trends have implications for the future; predictions must take account of the variable mixture of standard and high-risk patients, the different results achieved in these categories and the rates at which the mixture between them is changing.
Nephrol Dial Transplant 1988
PMID:Demography of dialysis and transplantation in Europe in 1985 and 1986: trends over the previous decade. Report from the European Dialysis and Transplant Association Registry. 314 12

In a retrospective study, causes of death and the cardiovascular risk conferred by established risk factors were analysed in 200 diabetic and 200 matched non-diabetic uraemic patients admitted for haemodialysis. Total and cardiovascular mortality was considerably higher in diabetics, both type I (4.8-fold) and type II (3.0-fold). Fifty-eight per cent of deaths in diabetics, but only 38 per cent of deaths in non-diabetics were due to cardiovascular causes; myocardial infarction and stroke accounted for less than 15 per cent of deaths, the majority being due to sudden death. Cardiovascular death in diabetes was predicted by both history of hypertension and by cardiomegaly, but to a much lesser extent by clinical evidence of macroangiopathy. The results are compatible with an important role of non-coronary cardiomyopathic mechanisms of cardiovascular death in dialysed diabetics.
Proc Eur Dial Transplant Assoc Eur Ren Assoc 1985
PMID:Cardiovascular risk factors and cardiovascular death in haemodialysed diabetic patients. 399

Twenty-four hour urine specimens of 67 diabetic children aged 1-17 years without any renal manifestations were examined by SDS-polyacrylamide gel electrophoresis (SDS-PAGE). The excretion of high molecular weight, i.e. glomerular proteins was compared to that of low molecular weight, i.e. tubular proteins corresponding to more or less than 68,000 daltons. The glomerulo-tubular protein ratio (GTPR) obtained was significantly lower in diabetic patients compared with 30 healthy children of the same age and showed a linear decrease with longer duration of diabetes.
Proc Eur Dial Transplant Assoc Eur Ren Assoc 1985
PMID:Low molecular weight proteinuria in diabetic children--a marker of early diabetic nephropathy? 399 56

To evaluate the role of renal haemodynamic factors in the pathophysiology of diabetic nephropathy, we determined by radionuclear techniques glomerular filtration rate (GFR) and renal plasma flow (RPF) in 18 patients affected by insulin dependent diabetes mellitus (IDDM) in good metabolic control, with normal blood pressure and plasma creatinine. GFR and RPF measured in the same patients after ten months correlated with proteinuria and duration of diabetes. Our finding of a significant correlation between the decline of RPF and duration of diabetes may support the haemodynamic hypothesis of progression of diabetic nephropathy.
Proc Eur Dial Transplant Assoc Eur Ren Assoc 1985
PMID:Radionuclear determination of glomerular filtration rate and renal plasma flow to detect early decrease of renal function in insulin dependent diabetes. 399 57

The effect of continuous subcutaneous insulin infusion on renal function was studied in 12 patients with insulin-dependent diabetes mellitus. Serum creatinine was less than 110 mumol/L in all patients. Total urinary protein excretion was less than 250 mg/24 hr in seven patients (group I) and exceeded 0.5 g/24 hr in five (group II). Initial glomerular filtration rate was higher in group I compared with group II: 136.0 +/- 8.5 ml/min versus 103.2 +/- 4.6 ml/min (mean +/- SEM; p less than 0.02). After one to three months pump therapy glomerular filtration rate decreased in both groups. It remained stable during 32-36 months in group I (126.3 +/- 6.1, and 127.9 +/- 7.7 ml/min, respectively) but deteriorated in group II (98.6 +/- 4.4, and 60.0 +/- 6.8 ml/min, respectively; p less than 0.01 compared with group I). These results indicate that strict blood glucose control with continuous subcutaneous insulin infusion does not prevent deterioration of renal function in type I diabetic patients with clinical proteinuria. This suggests that other factors than metabolic control are involved in the course of diabetic nephropathy.
Proc Eur Dial Transplant Assoc Eur Ren Assoc 1985
PMID:The effect of continuous subcutaneous insulin infusion on renal function in type I diabetic patients with and without proteinuria. 399 67

The first study compared two groups on dialysis: 25 patients with diabetes mellitus and 25 matched non-diabetic patients, in relation to the presence of signs of hyperparathyroidism, to assess the reported low incidence of hyperparathyroidism in these patients. The diabetic group showed significantly lower values of PTH, Alk phosphatase, percentage of patients requiring vitamin D treatment, and less evidence of hyperparathyroidism on X-ray and in bone histomorphometry. In the second study 16 patients with chronic renal failure due to diabetic nephropathy were compared to 27 patients with the same degree of renal failure of other origin, the diabetic nephropathy group showed no increase in PTH, with falling creatinine clearance. Despite this low PTH, the phosphaturia was higher in the diabetic nephropathy group (Tm PO4/C Cr: 1.94 +/- 0.43 vs 2.5 +/- 0.68). In conclusion, patients with diabetes mellitus are less prone to develop hyperparathyroidism in progressive renal failure. This could be due to a relative increase in phosphaturia during declining function.
Proc Eur Dial Transplant Assoc Eur Ren Assoc 1985
PMID:Low incidence of hyperparathyroidism in diabetic renal failure. 399 89

A patient with diabetes mellitus and acute renal failure requiring hemodialysis developed Candida sepsis which was effectively treated with the oral antifungal drug, ketoconazole. Plasma drug levels during hemodialysis suggested that ketoconazole was not dialyzed, but that its pharmacokinetics, specifically gastrointestinal absorption, may be altered in renal failure.
Clin Exp Dial Apheresis 1983
PMID:Ketoconazole treatment of fungal infection in acute renal failure. 632 71

Plasma prednisolone concentrations were measured in 26 renal transplant (RT) patients and five control subjects. A linear relationship was found between prednisolone dosage in mg/kg and area under the plasma concentration time curve in seven stable RT patients (r = 0.98) and in all subjects (n = 19) with estimated prednisolone clearance rates (CLp) between 0.075 and 0.11 L/kg/hr (r = 0.96). The greatest deviation from this occurred in five patients having reduced CLp with prolonged prednisolone half life (t1/2p) and in one having increased CLp while taking phenytoin. Three of the five with reduced clearance had steroid induced diabetes and one a Cushingoid appearance. There was some correlation between peak plasma prednisolone and dosage (r = 0.77) in all subjects, but none between creatinine clearance and t1/2p or CLp.
Proc Eur Dial Transplant Assoc 1983
PMID:Plasma prednisolone concentrations and kinetics in renal transplant patients. 634 52


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