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Query: UMLS:C0011881 (diabetic nephropathy)
 10,836 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hypertension should be detected and treated early in diabetic patients. It markedly affects the morbidity and mortality of diabetic individuals as a result of both atherosclerosis and microvascular disease. Antihypertensive treatment is an effective tool in slowing the progression of early and advanced diabetic nephropathy. No prospective studies have addressed the effects of antihypertensive regimens on the incidence of congestive heart failure, stroke, and coronary artery disease in large groups of diabetic patients. Such studies are urgently needed. Special consideration should be given to the effects of antihypertensive drugs on glycemic control and the lipid profile of the diabetic patient. Because hyperinsulinemia (and insulin resistance) have been advocated as hypertensive and atherosclerotic risk factors, the effects of antihypertensive drugs on insulin action and plasma insulin levels may become an important element in the selection an antihypertensive agent. More information, however, is needed in these areas. ACE inhibitors, calcium channel blockers, and alpha-adrenergic blockers probably offer a more favorable metabolic profile as compared with diuretics and beta-blockers. The former agents should be used as initial drugs in most clinical settings.
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PMID:Management of hypertension in diabetes. 161 71

The incidence of coronary artery disease (CAD) is markedly increased in both insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). The background for this coincidence is as yet incompletely understood. In uncomplicated IDDM, the levels of cardiovascular risk factors do not show any substantial abnormalities if the metabolic control is good. However, when diabetic nephropathy ensues, even in its early microalbuminuric stage, blood pressure tends to become elevated and multiple atherogenic plasma lipid abnormalities appear. In juvenile-onset IDDM, increased occurrence of clinically manifest CAD emerges after the age of 30 years and becomes particularly marked in patients with diabetic nephropathy. Premenopausal female patients with IDDM develop CAD almost as often as male diabetics with IDDM of the same age--a situation in sharp contrast to that in nondiabetics, with a large excess of CAD in men. IDDM may act as a promoter of the progression of atherosclerotic lesions in subjects who are otherwise prone to develop them. This could explain why patients with IDDM have an increased risk of CAD, even in the absence of diabetic nephropathy, which enhances atherogenesis through several mechanisms. NIDDM is associated with multiple changes in cardiovascular risk factors, including abnormalities in the levels and composition of plasma lipids and lipoproteins and increased frequency of hypertension. These changes in cardiovascular risk factors are already present in subjects with impaired glucose tolerance (IGT), the precursor stage of NIDDM. In patients with NIDDM, the incidence of CAD is markedly increased compared to that in nondiabetic subjects of the same age, and more markedly in women than in men.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diabetes and coronary artery disease: what a coincidence? 171 Jul 45

A personal series of 6780 patients with diabetes mellitus is reported. Of these 1410 were thought to have insulin-dependent (Type 1) diabetes and 4926 non-insulin-dependent (Type 2) diabetes. Among the former, 128 patients were only diagnosed when in severe ketoacidosis or coma. In 116 patients the diabetes was diagnosed in pregnancy. Chronic alcoholism was an aetiological factor in 75 patients; in 52 it led to the diagnosis being made, and it complicated treatment in 129 additional patients. In the patients with Type 2 diabetes whose treatment was stabilized 23.5% were having insulin injections, 44.5% tablets, and 32.0% diet only. Sight-threatening retinopathy developed in 21.3% of patients with Type 1 and 7.9% of those with Type 2 diabetes. The rate of developing sight-threatening retinopathy was 1.1% of patients per year. Blindness occurred in 0.28% of patients with Type 1 diabetes per year and 0.097% per year in Type 2 diabetes. If the mean survival of patients with retinopathy going blind is 7.5 years, this would mean 7500 people in the UK blind from diabetic retinopathy. There was a striking drop in the annual incidence of blindness after 1970 coinciding with the introduction of specific treatment for diabetic retinopathy. Juvenile cataract developed in 1.7% of patients who developed Type 1 diabetes before 30 years of age. Clinically important diabetic neuropathy developed in 17.4% of patients with Type 1 and 11.6% of those with Type 2 diabetes. The main features were paraesthesiae and numbness (49%), neuropathic ulceration (37%), pain (5%), autonomic symptoms (5%), and amyotrophy (4%). Oculomotor palsies and mononeuropathies were noted. Foot ulceration occurred in 81 patients with Type 1 and 279 of those with Type 2 diabetes. Charcot changes in the feet were noted in 21 patients. Major amputations were needed in 18 patients with Type 1 and 60 with Type 2 diabetes. Proteinuria believed to be due to diabetic nephropathy developed in 12.8% of patients with Type 1 and 4.7% of those with Type 2 diabetes. The prevalence of early renal failure was 4.6% and 1.4%, respectively. Coronary artery disease was noted in 9% of patients with Type 1 diabetes, and was more common in those who developed diabetes after 20 years of age. Myocardial infarction was as common in women as in men. In Type 2 diabetes coronary artery disease gave rise to symptoms in 19.1%, and myocardial infarction was more common in men.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Diabetes in the United Kingdom: a personal series. 182 47

Diabetics have an increased risk of cardiovascular morbidity and mortality. Compelling evidence suggests that there is cause-effect relationship between alterations of serum lipids and lipoproteins, and atherosclerosis and coronary heart disease in non diabetic-population. Among insulin dependent diabetics, the prevalence of macrovascular disease is particularly increased in those with established clinical nephropathy and it has been partly attributed to concomitant hypertension and serum lipoprotein abnormalities. However, the effect of diabetic nephropathy and factors associated with it on Coronary Artery Disease (CAD) appears to be conditional. Many Patients in many studies did not have CAD despite a long duration of persistent proteinuria and renal failure There is the possibility that CAD is an outcome of a multistage process, and diabetes related conditions may accelerate progression through certain stage only. In that case, the pattern of appearance of CAD would be determined by the natural history of atherosclerosis rather than by duration of diabetes. The purpose of our study is to analyze retrospectively the incidence of CAD and its association with blood pressure, serum total cholesterol, HDL cholesterol, duration of diabetes, serum triglycerides and HbAlc in a cohort of insulin dependent diabetic patients without nephropathy.
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PMID:"Cardiovascular risk factors in insulin dependent diabetes". 192 85

Atherosclerotic vascular disease is a major cause of morbidity and mortality in insulin-dependent diabetes mellitus. The frequent coexistence in these patients of microangiopathy and coronary artery disease was observed more than 30 years ago and later verified in large epidemiological studies. Thus, the subgroup (30-40%) of patients who develop clinical nephropathy, also are at extremely high risk of early cardiovascular death. A number of established cardiovascular risk factors are present not only in advanced clinical nephropathy but also in its earliest stages. These include elevated blood pressure, atherogenic changes in the plasma concentrations of lipids and lipoproteins, elevated plasma levels of fibrinogen and probably hyperreactivity of platelets. However, it seems unlikely that these risk factors fully explain the excess cardiovascular morbidity and mortality in insulin-dependent diabetic patients with clinical nephropathy. Patients with slightly elevated urinary albumin excretion are at increased risk of developing not only clinical nephropathy and coronary heart disease but also proliferative retinopathy and cardiomyopathy. We have, therefore, hypothesised that elevated urinary albumin excretion is a marker of generalized disease in the vascular wall of small and large blood vessels. Findings of elevated transcapillary escape rate of albumin, elevated plasma concentration of von Willebrand factor and impaired fibrinolytic capacity in early diabetic nephropathy have supported this hypothesis. However, the initial pathophysiological mechanisms involved are still hypothetical and largely unknown. During recent years the incidence of clinical nephropathy has declined and the prognosis of insulin-dependent diabetic patients has improved. Whether intervention directed against the often clustered cardiovascular risk factors will further improve the prognosis in proteinuric patients is suggested but still unknown. However, the key question is still, why is the vascular wall, in small and large blood vessels, vulnerable in some but not all diabetic patients? In the future more studies of the initial pathophysiological mechanisms involved in this vulnerability are needed.
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PMID:Albuminuria--a marker of renal and generalized vascular disease in insulin-dependent diabetes mellitus. 206 Mar 21

Diabetes is a chronic metabolic disorder with a characteristic hyperglycemia. This elevated blood glucose causes the frequent complications of diabetes that often involve the vascular system. Macrovascular involvement includes coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Diabetic nephropathy and retinopathy are serious microvascular disturbances. There is no cure for diabetes, so early detection and intervention are necessary to limit progression of diabetes and its complications. The advanced nurse practitioner has a vital role in directing care for chronic conditions through education and a holistic approach to the patient as they are key to diabetes management. Standards of practice for diabetes have been defined by the American Diabetes Association. Balancing cost containment with maintenance of these standards is a challenge for health care.
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PMID:Diabetes and vascular disease: a common association. 749 57

Cardiovascular diseases are the leading causes of morbidity and mortality in the industrialized world and have become a major economic burden. Therefore, not only ethical and medical but also economic reasons suggest more intense efforts in primary and secondary prevention of cardiovascular and, especially, coronary artery disease. The prevention of the progression of heart failure and of the risks inherent in left ventricular dysfunction, including development of heart failure, reinfarctions, and death, are major cornerstones in the ambitious but economically balanced use of our resources. Major trials in chronic heart failure as well as the angiotensin-converting enzyme inhibitor pooling project in heart failure of all major studies have shown almost uniformly a reduction in hospitalizations attributable to slowing of the progression of the disease. In the Munich Mild Heart Failure Trial (MHFT) socioeconomic analysis confirmed the high economic burden of progression to the end-stages of disease: Patients with progressive heart failure had a four- to fivefold increase in hospital costs. The blunting of the progressive course of heart failure was effective enough to offset the costs of drug treatment with captopril in an analysis extrapolating the results of the socioeconomic analysis to the total trial population. Favorable results in preventive treatment of patients with asymptomatic left ventricular dysfunction, hypertension, and diabetic nephropathy also suggest that part of the additional costs of medication is outweighed by fewer hospitalizations and interventions. Thus in many cardiovascular diseases angiotensin-converting enzyme inhibitors have a favorable cost-benefit ratio and can be recommended for broader use.
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PMID:Socioeconomic aspects of ACE inhibition in the secondary prevention in cardiovascular diseases. 781 36

Extracorporeal Ultrafiltration Method (ECUM) could be used in patients with refractory congestive heart failure (CHF). We have encountered a 56-year-old woman with refractory congestive heart failure (CHF) (NYHA II-III) due to coronary artery disease, complicated by moderately advanced diabetic nephropathy (Cr = 2.4 mg/dl). Due to the non-responsiveness to medical treatments, she has begun receiving the intermittent ECUM once or twice a week on an outpatient basis. ECUM effectively reduced cardiac preload and temporarily relieved her intractable respiratory distress. Based on our present clinical experience, we propose that one could consider an outpatient based intermittent ECUM as one of the useful therapeutic modalities to ameliorate refractory CHF.
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PMID:Intermittent outpatient based ECUM. A case report. 794 20

The declining mortality due to coronary artery disease and stroke has been attributed in part to improved effectiveness and application of antihypertensive therapy, and successful identification and treatment of the population at risk. In striking contrast, end-stage renal disease (ESRD) attributed to hypertension has increased annually for the last decade and will probably worsen through the year 2000. Taken together, patients with diabetic nephropathy and those with hypertensive renal disease account for the majority of new cases annually. The reasons for the striking dissociation between the success with coronary artery disease and stroke on the one hand and the inability to lessen the incidence of ESRD remain to be clarified. Evidence reveals that all levels of untreated hypertension are associated with potentially declining renal function. Data from the Hypertension Detection and Follow-up Program and other studies suggest that antihypertensive treatment can prevent or retard development of progressive renal failure. No data are readily available on repeated measurement of glomerular filtration rate during prolonged treatment of mild hypertension in patients with normal or near-normal renal function. Although the importance of blood pressure control is implicit, a theoretical framework based on data derived from experimental animals suggests that angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists may exert specific renoprotective effects beyond those achieved by blood pressure reduction per se. The results of two recent long-term prospective studies support such a formulation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hypertension as a risk factor for progression of chronic renal disease. 820 94

Patients with juvenile-onset, insulin-dependent diabetes mellitus (IDDM) are at high risk of premature coronary artery disease. The risk is concentrated in diabetic patients who develop nephropathy. Synergy in atherogenesis is likely to be present between hyperglycemia and the metabolic alterations of diabetic nephropathy, which include hypertension, hypercholesterolemia, and high lipoprotein (a) levels. The accumulation of advanced glycation end-products in blood vessel walls and on lipoproteins may result in increased vascular permeability and uptake of cholesterol, particularly in the setting of hypertension and hypercholesterolemia. The net result may be acceleration of atherogenesis.
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PMID:Coronary artery disease in diabetic patients with nephropathy. 829 45


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