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

Imbalances in renal vasodilatory and vasoconstrictive mechanisms are responsible for the renal haemodynamic changes observed in Type 1 diabetes mellitus. Animal experiments have shown that noradrenaline (NA) infusion increases the intraglomerular pressure by predominantly efferent arteriolar vasoconstriction. The relationships between ambient plasma NA levels and renal haemodynamics were studied in 18 healthy control subjects (group C); in 17 normoalbuminuric diabetic patients (group D1) (albumin excretion rate (Ualb V) < 20 micrograms min-1), and in 17 microalbuminuric Type 1 diabetic patients (group D2) (UalbV 20-200 micrograms min-1), all patients being without overt autonomic neuropathy. Supine glomerular filtration rate (GFR (ml min-1 1.73 m-2)) and effective renal plasma flow (ERPF (ml min-1 1.73 m-2)) were determined over a 2-h period using constant infusions of 125I-iothalamate and 131I-hippuran, respectively. The subjects were studied in the fasting state. The diabetic patients were investigated during near normoglycaemia. Data are given as means and SD. In group D1, GFR and ERPF (126 +/- 15 and 538 +/- 89, respectively) were elevated as compared with controls (108 +/- 15 and 478 +/- 73; p < 0.01 and p < 0.05, respectively). In group D2, GFR (124 +/- 25, p < 0.05) but not ERPF (515 +/- 104) was higher than in the controls. GFR and ERPF were negatively correlated with venous plasma NA in group C (r = -0.61, p < 0.005 and r = -0.64, p < 0.001, respectively), in group D1 (r = -0.54, p < 0.03 and r = -0.63, p < 0.005, respectively) and in group D2 (r = 0.53, p < 0.03 and r = -0.60, p < 0.01, respectively). Multiple regression analysis disclosed that diabetes per se, independent from plasma NA, had a positive contribution to GFR. In contrast, ERPF was only related to plasma NA levels. GFR and ERPF are inversely related to venous plasma NA levels, both in healthy and in diabetic subjects, supporting the hypothesis that plasma NA is a vasoconstrictive substance. The independent positive effect of diabetes as a categorial variable on GFR, suggests that concomitant vasodilating mechanisms play a role in the renal haemodynamic alterations in Type 1 diabetes mellitus.
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PMID:Influence of ambient plasma noradrenaline on renal haemodynamics in type 1 (insulin-dependent) diabetic patients and healthy subjects. 762 32

The object of the study was to test whether high dose ascorbic acid (AA) could normalize glomerular hyperfiltration in insulin-dependent diabetes mellitus (IDDM) patients. A prospective, double-blind, randomized, placebo (tartaric acid, TA) controlled study design was used, with parallel treatment lasting 4 weeks. Measurements were made before and after treatment, on 24 normoalbuminuric, normotensive male IDDM patients, who were randomized to ascorbic acid (n = 12, age 35 years (18-39), diabetes duration 12 years (2-12), BP 128/82 mmHg (SD 14/6)), or to placebo (TA) (n = 12, age 30 years (19-36), diabetes duration 8 years (2-17), BP 119/75 mmHg (SD 9/7). The intervention consisted of 6 enterosoluble tablets of 500 mg AA or 213 mg TA, twice a day, being daily doses of 6 g AA or 2.55 g TA. No significant differences in any of the parameters measured were seen, when comparing results following AA or placebo treatment. The glomerular filtration rate (GFR, clearance of 125I-iothalamate) was unchanged while effective renal plasma flow (ERPF, clearance of 131I-hippuran) tended to decline in both groups. The GFRs before and after treatment in the AA-treated group were 141 (SD 15) and 134 (SD 12) ml min-1 1.73 m-2; NS (2p = 0.09). In the TA-treated group they were 142 (SD 19) and 137 (SD 16) ml min-1 1.73 m-2; NS (2p = 0.20). The ERPFs in the AA group were 584 (SD 93) and 545 (SD 47) ml min-1 1.73 m-2; (2p = 0.06). In the TA group they were 618 (SD 108) and 574 (SD 98) ml min-1 1.73 m-2 (2p = 0.03). The filtration fractions (FFs) in the AA group were 0.244 and 0.246 NS.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Unchanged renal haemodynamics following high dose ascorbic acid administration in normoalbuminuric IDDM patients. 762 37

We studied renal function of 194 black subjects with duration of diagnosed NIDDM from 1 month to 36 years to determine the interaction of hypertension and diabetes on nephropathy. Renal function was assessed by isotopic GFR and RPF studies, and serum creatinine. One hundred seventeen of the 194 subjects had 24-hour urinary albumin excretion (AER). AER > 300 mg/24 h correlated with longer duration of NIDDM, decrease in GFR and RPF, and rise in serum Cr, and all subjects were hypertensive. AER 30 to 300 mg/24 h also correlated with a longer duration of NIDDM and 80% had hypertension. When 194 subjects were grouped according to duration of NIDDM and the presence or absence of hypertension, subjects who remained normotensive had normal renal function. In hypertensive subjects a decrease in GFR occurred with duration of NIDDM > 1 year and decrease in RPF with duration of NIDDM > 5 years. In hypertensive subjects with NIDDM > 10 years, 36% had impaired renal function (GFR < 80 ml/min/1.73 m2 or serum creatinine > 1.4 mg/dl) and 75% had microalbuminuria or clinical proteinuria. Within this group, those subjects who developed hypertension after their diagnosis of diabetes were likely to have evidence of nephropathy as compared to those subjects whose hypertension was diagnosed prior to or simultaneous with their diabetes: 17 of 20 (85%) versus 7 of 13 (54%), respectively (P = 0.05). These data provide insight into the relationship between hypertension and diabetes in the development of nephropathy in black NIDDM individuals.
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PMID:Interaction of hypertension and diabetes on renal function in black NIDDM subjects. 764 39

The effect was studied of blood pressure lowering treatment on renal failure and albuminuria (UAE) in patients with type I diabetes (IDDM) and imminent nephropathy as well as in patients with over diabetic nephropathy. The group of 24 patients with imminent nephropathy was subdivided: 1. twelve patients with borderline or overt hypertension with mean BP lowered not below 100 mmHg, and 2. twelve patients with BP within the normal limits, taking no hypotensive agents. In the other group of 12 patients with overt diabetic nephropathy hypertension was lowered below 105 mmHg and kept so for at least two years. All patients estimated their glycemia and glycosuria by themselves, ate 0.8 g protein/kg/24 h and about 100 mmol Na/24h. Under hospital conditions the following were estimated: albuminuria, glomerular filtration rate (51Cr EDTA) and effective renal blood flow (131I hippurate). The same examinations were repeated 1 year and 2 years later. The lowering of BP below 100 mmHg in patients with imminent diabetic nephropathy significantly lowered microalbuminuria without changing GFR, ERPF despite good or satisfactory compensation of diabetes. Maintaining BP below 105 mmHg for 2 years did not prevent the patients with overt nephropathy to develop progressive renal failure despite the rate of GFR deterioration and of the increase of albuminuria slowed down.
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PMID:[Effect of treatment of arterial hypertension on renal function in patients with imminent and overt diabetic nephropathy]. 773 1

Prostaglandins of the E series (PGE) are known to contribute to the maintenance of renal hemodynamics in subjects with chronic renal insufficiency. Agents that block PGE synthesis, nonsteroidal anti-inflammatory agents (NSAID), are widely used by people with renal insufficiency. This study was undertaken in subjects with renal insufficiency secondary to diabetes to evaluate the acute effects of a PGE1 analog, misoprostol, on NSAID-induced changes in RBF, as calculated by para-aminohippurate clearance, and GFR, as calculated by inulin clearance. Sodium excretion was also assessed. Twenty-five fasting subjects with a mean age of 56 +/- 4 yr received 800 mg of ibuprofen orally. A concomitant dose of either a placebo (PL) or 200 micrograms of misoprostol was also given. This was followed in 1 h by either a placebo or an additional 200-micrograms dose of misoprostol. Measurements for the determination of RBF, GFR, blood pressure, and fractional excretion of sodium were performed every 30 min for the next 5 h. The greatest reduction in both GFR (-25 +/- 7 mL/min per 1.73 m2 PL versus -10 +/- 4 mL/min per 1.73 m2, misoprostol delta GFR; P < 0.05) and RBF (-48 +/- 21 mL/min per 1.73 m2 PL versus -15 +/- 8 mL/min per 1.73 m2, M delta RBF; P < 0.05) occurred approximately 2 h after the NSAID dose. No significant differences were noted in blood pressure, fractional excretion of sodium, or other measured parameters between groups during the entire study. Gastrointestinal upset was the most common side effect observed in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Renal effects of oral prostaglandin supplementation after ibuprofen in diabetic subjects: a double-blind, placebo-controlled, multicenter trial. 778 57

Six weeks after the onset of insulin-treated streptozotocin diabetes (STZ) in Munich-Wistar rats, the effect of a low-sodium (LNa) and a low-salt (LNaCl) diet on renal function and on plasma and kidney tissue angiotensin II (AIIp, AIIk) was tested. Clearance experiments were performed in anesthetized rats 7 days after starting on LNa or LNaCl. On a control diet, STZ exhibited an increase in GFR, RBF, and kidney weight (KW) and a reduction in renal vascular resistance (RVR) and AIIk, but no change in AIIp, compared with nondiabetic normal rats (CON). Although sodium restriction reduced and salt restriction increased AIIk in CON, both diets increased AIIp without affecting renal hemodynamics or KW. In diabetic rats, both salt and sodium restriction further increased GFR and RBF by reducing RVR, increased KW, and changed AIIk and AIIp in a similar pattern, but at significantly lower values compared with CON. Daily treatment of STZ-LNa with the AII-receptor blocker losartan (20 mg/L, in drinking water) did not affect the reduction in RVR and the increase in KW but slightly reduced RBF because of a decrease in mean arterial blood pressure and further increased GFR. It was concluded that (1) AIIk but not AIIp is affected differently by LNa compared with LNaCl in both CON and STZ; (2) LNaCl and LNa change AIIp and AIIk in a similar pattern but at significant lower values in STZ compared with CON; and (3) with regard to renal hemodynamics and KW, the response to LNa and LNaCl is different in CON compared with rats 6 wk after the onset of diabetes mellitus, the latter exhibiting a further increase in renal hyperfiltration and KW by a mechanism that is not directly AII receptor dependent.
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PMID:Renal hemodynamics and plasma and kidney angiotensin II in established diabetes mellitus in rats: effect of sodium and salt restriction. 778 43

In newly diagnosed insulin-dependent diabetes mellitus, the mechanisms underlying the concomitant occurrence of magnesium deficiency and normal blood magnesium concentration are unknown. The renal handling of magnesium was, therefore, studied in 37 children with newly diagnosed insulin-dependent diabetes mellitus and in 13 controls. Circulating magnesium levels were similar in patients and controls (0.86 vs. 0.84 mmol/l). However, the urinary excretion of magnesium was significantly higher in patients (90.6 vs. 32.2 mumol/l GFR). In the patients a significant positive correlation was found between excretion of magnesium and glycosuria or blood hydrogen ion activity. It is concluded that osmotic diuresis and acidosis increase magnesium excretion in newly diagnosed diabetes mellitus.
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PMID:Hypermagnesiuria in children with newly diagnosed insulin-dependent diabetes mellitus. 797 81

Parameters of renal hemodynamics have been determined in 30 male patients with diabetes mellitus, lasting for 1-24 months (mean 0.9 +/- 0.7 year), and in 19 healthy men of the same age. Patients' age ranged from 17 to 33 years (mean 27.5 +/- 5.0). All examined subjects have been normotensive (according to WHO criteria). Glomerula filtration rate with the aid of 51CrEDTA, and ERPF with 125I-hippurate have been determined. Mean GFR values have been significantly higher in diabetics than that in healthy men (142.9 +/- 29 vs 118 +/- 20 ml/min per 1.73 m2). Hyperfiltration (GFR over 140 ml per minute) has been found in 15 patients (50%). ERPF has also been higher in diabetic patients (929.2 +/- 230 vs 821.5 +/- 192 ml/min). This difference has been insignificant. No correlation between arterial blood pressure and GFR, ERPF, filtration fraction (FF), and RVR has been found.
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PMID:[Renal hemodynamics in patients with short-lasting diabetes mellitus type I]. 800 68

Previous studies from this laboratory implicated atrial natriuretic peptide (ANP) as a possible mediator of glomerular hyperfiltration in diabetic rats. In this study, the potential of HS-142-1 (HS), a novel polysaccharide compound with ANP receptor antagonist properties, to ameliorate glomerular hyperfiltration in diabetic rats was assessed. Initially, it was confirmed that a bolus iv injection of HS blocked both diuretic and natriuretic responses to exogenous ANP in normal Munich-Wistar rats. The acute effects of HS in moderately hyperglycemic diabetic rats with glomerular hyperfiltration and hyperperfusion were then determined. In diabetic rats, HS (20 mg/kg bolus iv) lowered GFR by approximately 46% from hyperfiltering (1.86 +/- 0.06 mL/min) to normal (1.13 +/- 0.13 mL/min) levels, whereas GFR in vehicle-treated diabetic rats remained unchanged (1.92 +/- 0.08 mL/min to 1.77 +/- 0.09 mL/min). In nondiabetic euvolemic rats, GFR was reduced by 20% after HS, whereas GFR in vehicle-treated controls was unchanged. In contrast, HS had no effect on GFR in hydropenic rats. Effective RPF was not significantly reduced in either diabetic or normal euvolemic rats in response to HS; consequently, significant reductions in filtration fraction were observed in both groups. Urine flow and sodium excretion rates were significantly reduced after HS in both diabetic and nondiabetic groups but not in hydropenic or vehicle-treated groups. These data show that HS ameliorates glomerular hyperfiltration in diabetic rats, further supporting the hypothesis that intrarenal actions of natriuretic peptides contribute significantly to glomerular hyperfiltration in experimental diabetes mellitus.
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PMID:Effects of an atrial natriuretic peptide receptor antagonist on glomerular hyperfiltration in diabetic rats. 802 30

We investigated the rate of decline in GFR and the changing prevalences of micro- and macrovascular complications in 20 type II diabetic patients [mean age 58 (46-71) years, female:male = 7:13, duration of diabetes 16 (12-30) years] from the stage of macroproteinuria with GFRs which were still normal until the beginning of dialysis or the time of death. Controls of renal function, proteinuria, HbAlc, serum lipids, and blood pressure were performed every 6 months at the beginning of the study and later on at 3-month intervals. Fundoscopy, electrocardiogram at rest and in case of need a symptom-limited treadmill ECG, a Duplex ultrasound examination of the carotid vessels, and a Doppler sonographic examination of the femoral arteries were repeated each year. The creatinine clearance (mean +/- SD) of the patients was 81 +/- 6 mL/min/1.73 m2 at the beginning of the study. The rate of decline in creatinine clearance was 1.01 +/- 0.38 mL/min/month during the whole period of observation. Twelve patients (group A) required dialysis after a mean time of 74 (40-119) months; their creatinine clearance was 7 +/- 2 mL/min/month at the beginning of renal replacement therapy. Eight patients (group B) died a short time before the beginning of dialysis treatment; their creatinine clearance was 13 +/- 5 mL/min/1.73 m2. The causes of death were sudden death (n = 4), cardiac failure (n = 1), and stroke (n = 2); in one case it was unknown. The two patient groups did not differ in respect to the mean age, duration of diabetes, HbAlc values, serum cholesterol levels, and blood pressure. The decline in the creatinine clearance was also similar in both patient groups, with 1.07 +/- 0.35 versus 0.98 +/- 0.41 mL/min/month. Only the mean serum triglyceride concentration was significantly higher in the patients who died before dialysis. At the start of the study, cerebrovascular disturbances (including plaques in the carotid vessels) were found in 30%, cardiovascular disturbances (including pathologic ECG findings) in 45%, a peripheral vascular disease in 15%, and diabetic retinopathy (grade I and II) in 75%. At the beginning of dialysis treatment or the time of death, respectively, the prevalence of cerebrovascular diseases was increased to 70% and the prevalence of cardiovascular diseases to 90%; peripheral vascular disease was present in 50% and diabetic retinopathy in all of the cases. We conclude that type II diabetic patients show high mortality (40%) and poor quality of life, not only when they require dialysis treatment, but also in the predialysis phase.
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PMID:High mortality and poor quality of life during predialysis period in type II diabetic patients with diabetic nephropathy. 804 65


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