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

Investigation of renal biopsy specimens from 488 patients with diabetic glomerulosclerosis (DGS) of varying severity revealed the following: 1) The severity of DGS increases with the duration of the diabetes. 2) As the severity of DGS increases, it is complicated with increasing frequency by exudative changes, which correspond in detail to hyperperfusion lesions described in the literature. 3) As the severity of DGS increases, the severity of arteriolosclerosis and the incidence of nephrotic syndrome increase significantly. 4) The 5- and 10-year renal survival rates are highest for those diabetic patients in whom the tubules and renal cortical interstitium are of normal appearance. These survival rates are diminished if any of the following are present at the time of biopsy: a) interstitial fibrosis; b) hyperperfusion lesions; c) nephrotic syndrome; d) elevation of the serum creatinine concentration to more than 1.3 mg%. 5) No significant correlation was found between renal survival rate and age, sex, or type of diabetes. 6) The inflammation of the renal interstitium seen in diabetes does not differ from that seen in chronic glomerulonephritis. Monocytes, macrophages, T lymphocytes, fibroblasts and fibrocytes play the major role in this inflammation. This inflammatory process is considered to represent not pyelonephritis, but rather an auto-immune process. In other words, it is proposed that the diabetic kidney fails not only as a result of non-specific glomerular lesions (hyperperfusion lesions) but also because of non-specific tubulointerstitial changes, whereas diabetic glomerulosclerosis alone does not lead to chronic renal failure.
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PMID:The pathogenesis of chronic renal failure in diabetic nephropathy. Investigation of 488 cases of diabetic glomerulosclerosis. 206 8

Clinical changes in oral mucosa minor salivary glands were examined in 30 patients with grave diabetes mellitus treated by transplantation of pancreatic islet cells without immunosuppressant therapy and in 35 patients suffering from chronic renal failure 18 of these operated on for transplantation of an allogenic kidney with immunosuppressant therapy. Clinical condition and function of the minor salivary glands were assessed according to a scheme developed by the authors with consideration for clinical signs: edemas, hyperemia, hyperplasia, retention, and destruction. Morphologic examinations were carried out in various periods after transplantation.
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PMID:[Immunosuppressive therapy and the reaction of the minor salivary glands in the oral mucosa]. 208 10

Kidney biopsy (KB) is controversial in the elderly because it is generally felt that the risks exceed the potential therapeutic benefits. In this review of our personal experience and the literature reports, we discuss the risks of this diagnostic procedure and its use in the four main circumstances of patient referral. On the one hand, KB does not seem to be more hazardous in the elderly, provided that it is not performed in patients in poor condition or with atrophic kidneys or suspected vascular lesions. On the other hand, KB is clearly useful in a number of elderly patients either to assess the diagnosis of a systemic disease involving the kidney or to select the appropriate treatment. 1. In patients with non nephrotic proteinuria, KB should be performed if the proteinuria is associated with extra-renal signs suggestive of systemic disease or with deterioration of renal function. 2. Nephrotic syndrome without evidence of amyloidosis and diabetes, should lead to KB to identify patients with minimal change disease (MCD) requiring steroid treatment. Indeed, MCD can rarely be suspected on clinical grounds as the resulting nephrotic syndrome is rarely "pure" at this age. 3. In acute renal failure, KB seems to be essential and urgent in patients with rapidly progressive glomerulonephritis and in those with renal failure of dubious origin to select the most appropriate treatment according to the etiology and the type of renal lesions (sclerotic or "active"). 4. KB is useless and hazardous in chronic renal failure, except in case of unexplained rapid worsening of renal function in patients with previously moderate renal failure.
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PMID:[For or against renal biopsy after 65 years]. 209 Sep 64

The clinical implications of nuclear T3R alterations of circulating lymphocytes in hyperthyroidism, hypothyroidism and nonthyroidal diseases were investigated. Nuclear T3R in lymphocytes was determined by radio-ligand binding analysis. The results showed that in hyper- and hypothyroid patients the nuclear affinity (Ka) for T3 was similar to that of normal subjects. In hyperthyroidism nuclear T3 maximal binding capacity (MBC) was unaltered, whereas in hypothyroidism the MBC was significantly increased. In the patients with diabetes mellitus, chronic renal failure and hepatic cirrhosis, the nuclear T3R MBC of lymphocytes was about 1.5-1.6 times of the normal controls. It was concluded that there existed hormonal regulation of nuclear T3R, and up-regulation was seen in hypothyroidism and low T3 syndrome.
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PMID:Nuclear 3,5,3'-triiodothyronine receptors (T3R) of circulating human lymphocytes in hyper- and hypothyroidism and nonthyroidal diseases. 211 49

Endothelin is a 21-residue peptide vasoconstrictor produced by endothelium. Using a radioimmunoassay, endothelin values were measured in four groups of individuals: normal controls (0.54 +/- 0.12 pmol/l, n = 20); undialysed patients with chronic renal failure (CRF) (0.82 +/- 0.13 pmol/l, n = 38); chronic renal failure patients on continuous ambulatory peritoneal dialysis (CAPD) (2.81 +/- 0.63 pmol/l, n = 20); and patients with CRF on haemodialysis (HD) (4.52 +/- 1.21 pmol/l, n = 14). The endothelin values were significantly greater in undialysed patients with CRF when compared with controls (P less than 0.001) and significantly greater in both dialysis groups when compared with controls and the undialysed CRF group (P much less than 0.001). The difference between the two dialysis groups was not significant (P = 0.07). There was no correlation between endothelin and serum creatinine, mean arterial pressure, presence of chronic hypertension and/or diabetes, use of calcium-channel blockers and/or ACE inhibitors, or primary renal diagnostic category. A single haemodialysis session had no significant effect on endothelin values in the ten patients in whom this was assessed. Fast protein liquid chromatography (FPLC) appeared to confirm that the molecular species found in chronic renal failure were the same as those found in diabetic patients.
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PMID:Endothelin in renal failure. 212 16

This study was performed to investigate the effects of atrial natriuretic peptide (ANP) and mannitol on renal blood flow (RBF) and radiocontrast-induced nephropathy (RCIN) in human subjects with chronic renal failure. ANP preserves glomerular filtration rate or RBF (or both) in severe animal models of acute renal failure. Radiocontrast is known to substantially decrease RBF and can induce acute renal failure. Twenty consecutive patients with chronic renal failure (60% with diabetes) were randomized in a prospective, double-blind fashion to receive either ANP (50 micrograms bolus, then 1 microgram/min infusion) or mannitol (15% at 100 ml/hr) for 2 hours before and during cardiac catheterization with diatrizoate. Baseline serum creatinine level (ANP 2.4 +/- 0.7 mg/dl, mannitol 2.5 +/- 0.8 mg/dl), medications, and quantity of radiocontrast were similar in both groups. Direct measurements of RBF were made with thermodilution catheters placed in the left renal vein. RBF rose significantly (p less than 0.05), to 198% of baseline at 15 minutes and 166% of baseline at 65 minutes in the group receiving ANP and remained stable in the group receiving mannitol. ANP levels rose significantly from baseline at 5, 15, 65 and 120 minutes in both groups (p less than 0.05). Acute renal failure defined as a 0.5 mg/dl rise of creatinine within 24 hours of cardiac catheterization, developed only in patients with diabetes mellitus and was similar in both experimental groups (ANP, 50%; mannitol, 30%). Only patients with diabetes mellitus responded with an increase in RBF after a 5-minute infusion of either ANP or mannitol (diabetes, 165% +/- 28% baseline; no diabetes, 96% +/- 8% baseline) (p less than 0.05). In conclusion, RBF was maintained or increased despite administration of radiocontrast, a documented renal vasoconstrictor. Patients with diabetes mellitus had a renal vasodilatory response to drug infusion. Acute renal failure occurred to a similar extent in both groups. Plasma ANP levels rose significantly in both groups. Mannitol may induce ANP release, thus contributing to mannitol's renal effects.
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PMID:Effects of atrial natriuretic peptide versus mannitol on renal blood flow during radiocontrast infusion in chronic renal failure. 214 49

Concentrations of human atrial natriuretic peptide-like immunoreactivity (hANP-LI) were measured by a highly sensitive and specific radioimmunoassay (Biochem Biophys Res Commun 1986;137:231-6) in normal subjects and in renal disease patients without accompanying congestive heart failure, hypertension, edema, diabetes, or pregnancy. We attempted to clarify whether the hANP-LI concentration in plasma was increased by loss of renal mass. We found no correlation between the hANP-LI concentration in plasma and creatinine clearance (Ccr, 4.6-122.3 mL/min) in patients with renal disease (n = 63, r = -0.196), nor between hANP-LI concentrations in plasma and urine (n = 97, r = -0.207). The fractional excretion of hANP (FEhANP) correlated significantly with Ccr (n = 63, r = 0.520, P less than 0.01) and with FENa (n = 35, r = -0.503, P less than 0.01). Increased FEhANP in patients with chronic renal failure may have resulted because of an increase in single-nephron glomerular filtration rate similar to the FENa increase in these patients. The present data indicate that decreased renal function itself does not increase the concentration of hANP-LI in plasma.
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PMID:Concentrations of atrial natriuretic peptide in plasma and urine of kidney disease patients. 214 94

Lipoprotein [a] (Lp[a]) is known to show high values in patients with ischemic heart disease (IHD). In the present study attempts were made to determine Lp[a] levels and to investigate the association of Lp[a] and other atherosclerotic risk factors in patients with chronic renal failure treated by hemodialysis. Lp[a] concentrations were measured in 30 hemodialysis patients in the age range 34 to 77 years. Mean (+/- SD) levels of serum Lp[a] were not elevated in the hemodialysis patients compared to controls (19.3 +/- 18.0 mg/dl vs. 18.3 +/- 10.4 mg/dl, respectively). We found no statistically significant correlation of Lp[a] with either cholesterol, triglycerides, HDL-C or apoproteins. However, compared with controls, more than fivefold as many of those hemodialysis patients had high risk (greater than 30 mg/dl) concentrations of Lp[a]. Lp[a] tended to increase in hemodialysis patients with diabetes mellitus and/or ischemic heart disease. In patients with high levels of Lp[a] (greater than 30 mg/dl), Lp[a] tended to correlate positively with cholesterol, LDL-, HDL-C, apo B or apo B/AI. Incidence of IHD was also elevated in these patients. Along with other known risk factors such as hyperlipidemia and hypertension, an increased concentration of Lp[a] may play an important role in accelerating development of atherosclerosis in this condition.
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PMID:[A study of clinical significance of Lp[a] lipoprotein in patients with chronic renal failure treated by hemodialysis]. 214 55

Several factors are involved in the persistence of endocrine alterations after renal transplantation, among which the following are to be mentioned: (1) duration of chronic uraemia before renal transplantation; (2) residual function of the patients' native kidneys; (3) quality of function of the renal graft; (4) modulation of secretion, transport, and degradation of hormones, and/or (5) altered target organ responsiveness to hormones induced by immunosuppressive drugs (glucocorticoids, azathioprine, cyclosporin A) or altered internal environment. In kidney transplant patients the following endocrine abnormalities are to be mentioned: dissociation of the physiological relationship between aldosterone synthesis and function of the renin-angiotensin system, abnormal volumetric regulation of arginine vasopressin secretion, suppressed responsiveness of cortisol secretion to stimulatory manoeuvres, persistent secondary hyperparathyroidism, relative deficiency of insulin (induced by glucocorticoid therapy), with consequent carbohydrate intolerance or even diabetes mellitus, suppressed response of gastrin and pancreatic hormone secretion to a test meal, and reduced responsiveness of atrial natriuretic peptide secretion to central hypervolaemia. Episodes of acute graft rejection are characterized by endocrine alterations similar to those seen in patients with acute or chronic renal failure.
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PMID:Endocrine alterations in kidney transplant patients. 219 17

The relative importance and behaviour of plasma and platelet plasminogen activator inhibitor (PAI-1) in disease has not hitherto been examined. In this study the concentration of PAI-1 in the plasma and platelets of patients with a variety of disorders was examined using a specific ELISA and a functional assay. Mean plasma PAI-1 was elevated in groups of patients with diabetes mellitus, hypertension, alcoholic cirrhosis, angina and myocardial infarction. Plasma PAI-1 was raised in the post-operative phase and the PAI-1 released after surgery was not derived from platelets. In all groups PAI-1 in the platelet pool reflected the platelet count, except in type II diabetes mellitus and chronic renal failure, where a reduced quantity of PAI-1 antigen per platelet was found. In severe chronic renal failure, abnormal platelets and diminished platelet PAI-1 may contribute to the haemorrhagic tendency sometimes seen in this disorder. Plasma PAI-1 represents a larger proportion of total circulating PAI-1 in disease than it does in healthy individuals; PAI-1 per platelet is abnormal only in a minority of disorders. Plasma and platelet pools of PAI-1 vary independently in disease and both merit consideration in evaluating the importance, if any, of PAI-1 in thrombosis or haemorrhage.
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PMID:The platelet and plasma pools of plasminogen activator inhibitor (PAI-1) vary independently in disease. 220 5


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