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

Microalbuminuria is defined as small elevations of urinary albumin excretion not detected by conventional tests. It is associated with elevated arterial pressure, proliferative retinopathy, lipoprotein abnormalities and left ventricular hypertrophy and is predictive of later diabetic nephropathy. Improved glycaemic control and antihypertensive treatment lower urinary albumin excretion but it is not known whether these manoeuvres affect long-term outcome.
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PMID:Implications of microalbuminuria in diabetes. 200 39

We performed a retrospective study on 1,019 patients with noninsulin-dependent diabetes who were followed for the past 20 years in our Diabetic Unit in order to determine the prevalence of overt diabetic nephropathy in relation to the other known complications of diabetes. In comparison with neuropathy, retinopathy and peripheral vascular disease, whose prevalence was 23.4%, 28.0%, and 27.4% respectively, the prevalence of macroproteinuria was significantly lower (7.0%). The prevalence of complications was correlated directly with patient age and duration of diabetes, and inversely with the degree of metabolic control. The reasons for the low prevalence of overt diabetic nephropathy in our population of noninsulin-dependent diabetics may be related to genetic factors, diet, other unknown environmental factors, or higher mortality rates in patients with renal disease.
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PMID:Prevalence of overt diabetic nephropathy in patients with noninsulin-dependent diabetes mellitus. 201 50

Since the late 1970s patients with diabetic nephropathy have formed an increasing proportion of new entrants to the Hospital renal dialysis and transplantation programme, reaching 28% for the three year period to December 1988. Between 1 January 1975 and 31 December 1988, 87 diabetic patients were accepted for treatment. Fifty-one per cent were European, predominantly type I diabetics. Maori (9% of the total reference population) accounted for a disproportionately high 47% due to an over-representation by type II diabetic patients (34 of 41 Maori). These findings cannot be explained by the higher prevalence in Maori of type II diabetes but appear to be due to a more prevalent and/or aggressive diabetic renal lesion in this group. On commencing treatment, nearly all patients had retinopathy and the majority had evidence of peripheral vascular disease, hypertension and neuropathy. CAPD was the initial mode of renal replacement therapy in 70% of patients. Overall patient survival was 77% at one year and 42% at three years, and survival on CAPD was 76% and 37% at one and three years, respectively. Patient survival on transplantation was 63% at one year and 58% at three years. Graft survival was 51% at one year and 46% at three years. Although the short term outlook for diabetic patients on renal replacement therapy is encouraging, longer term survival compared to non-diabetic patients is poor. Vascular disease is the major cause of death and an important factor in patient morbidity.
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PMID:Diabetic end stage renal failure--the Wellington experience 1975-1988. 203 73

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

Disturbed function of the axis hypothalamus-growth hormone-somatomeding C (IGF-1) plays an important role in the development of diabetic angiopathy. Patients with insuline dependent diabetes show increased secretion on GH but secretion of IGF-1 may be normal, decreased or increased. These disturbances are especially distinct in the prepubescent period when susceptibility to develop complications is bigger. Increased secretion of GH and IGF-1 plays an essential role in the development of retinopathy and diabetic nephropathy. The paper explains the role of GH in controlling glycaemia and in the development of vascular complications during diabetes.
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PMID:[The role of growth hormone in the development of complications in insulin-dependent diabetes]. 206 73

Parameters of fibrinolysis, including plasminogen, alpha 2 plasmin-inhibitor (alpha 2 PI), tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) antigens, and fibrinogen were assayed in 53 patients (28 women and 27 men; mean age: 64 years, age range: 32-87 years) with non-insulin-dependent diabetes mellitus (NIDDM). The control group was similarly aged (mean age: 60.4 years, age range: 38-81). The levels of t-PA and t-PA/PAI-1 ratio of the diabetic group (mean +/- SD; 9.8 +/- 4.3 ng/ml, 0.94 +/- 0.47, respectively) were significantly higher than that of the control group (5.5 +/- 2.5 ng/ml, 0.51 +/- 0.23, respectively). The increased levels of t-PA antigen and t-PA/PAI-1 ratio in diabetics mean that free t-PA has been released. However, there was no significant difference in the level of PAI-1 between the diabetic group (12.9 +/- 6.4 ng/ml) and the control group (12.1 +/- 5.6 ng/ml). Levels of fibrinogen, plasminogen and alpha 2 PI in plasma were not different in the two groups. Duration of the disease, levels of glycosylated hemoglobin, differences in treatment and presense of diabetic nephropathy or retinopathy did not affect the fibrinolytic parameters. The levels of fibrinogen was higher in those with nephropathy than in the diabetics without nephropathy and retinopathy (p less than 0.05). There were no significant differences in the levels of t-PA, t-PA/PAI-1 ratio and PAI-1 between younger (less than 65 years) and older (65 years or more) subjects, in either the control or diabetic groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Tissue-type plasminogen activator and its inhibitor (PAI-1) in plasma in cases of non-insulin-dependent diabetes mellitus (NIDDM)]. 212 12

Three cases are presented in which biopsy-proven diabetic nephropathy was found in nephrotic patients with no prior history of diabetes. One patient presented with advanced retinopathy and end-stage renal disease (ESRD), another with retinopathy and mild renal insufficiency, and a third with mild renal insufficiency alone. In each case, biopsy showed diffuse and nodular glomerulosclerosis with no evidence of kappa or lambda light chains. The patients had normal fasting serum glucose values, and two had normal oral glucose tolerance tests. Twenty-three similar cases in the literature were reviewed, and in most, some evidence of diabetes or hyperglycemia was found; five cases remained in which there was no evidence of hyperglycemia at any time. The cases reviewed included a disproportionate number of men (65%) and blacks (42%). It is concluded that diabetic nephropathy may exist in the absence of detectable hyperglycemia in a small number of extraordinarily susceptible individuals. Men and blacks appear to be at increased risk.
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PMID:Diabetic nephropathy without hyperglycemia. 214 35

The role of specific risk factors in the development of diabetic nephropathy was examined among noninsulin-dependent diabetic subjects attending the Diabetes Clinic of Christian Medical College Hospital, Vellore during 1986-87. Seventy-three subjects with normal protein excretion (less than 150 mg/24 hr) were compared with 66 microproteinuric (150-500 mg/24 hr) and 61 macroproteinuric subjects (greater than 500 mg/24 hr). The risk factors included family history of diabetes, tobacco use, dietary habits and metabolic control; the latter was assessed from an average of 5 clinic blood sugar determinations done annually per patient. Patients who had developed proteinuria were characterized as mostly men, with increased tobacco consumption and early onset of proteinuria in relation to duration of diabetes. The mean blood sugar value was significantly high in both the proteinuric groups compared to the group with no proteinuria (p less than 0.01). There was a striking increase in the prevalence of ischemic heart disease, hypertension and retinopathy in the macroproteinuric group compared to the other two groups (p less than 0.01). It is concluded that the risk of developing nephropathy was significantly higher in men, in smokers and in those with poor metabolic control (mean postprandial blood sugar more than 200 mg/dL). Furthermore, it was clearly evident from our study that the diabetic subjects with nephropathy had a higher incidence of hypertension, retinopathy, hyperlipidemia and ischemic heart diseases.
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PMID:Nephropathy in noninsulin-dependent diabetes mellitus: comparative study with normoproteinuric and microproteinuric subjects. 214 34

Coagulation-fibrinolytic system is known to be one of the exacerbating factors in patients with diabetic nephropathy. The aim of the present study was to evaluate whether coagulation-fibrinolytic system in patients with diabetic nephropathy were significantly correlated with the development of this disease using new parameters of plasma thrombin antithrombin III complex (TAT) and plasmin alpha 2 plasmin inhibitor complex (alpha 2PIC). Fifty-six patients with NIDDM were examined. None of these patients showed more than 1.3 mg/dl of serum creatinine levels. These patients were divided into three groups according to the levels of albumin creatinine ratio (ACR) in urine as follows: 1) group I had ACR of less than 30 mg/g.Cr; 2) group II had ACR of greater than 30 mg/g.Cr and less than 100 mg/g.Cr; 3) group III had ACR of greater than 100 mg/g.Cr. Correlations of levels of plasma TAT and alpha 2PIC, levels of HbAlc, duration of diabetes, and presence of retinopathy were determined in these groups. The levels of plasma TAT and alpha 2PIC increased as the levels of urinary ACR increased regardless of presence of retinopathy. The levels of TAT and alpha 2PIC with retinopathy increased compared with those without retinopathy. There was a significantly positive correlation between plasma TAT and alpha 2PIC (r = 0.52, p less than 0.01). The levels of HbAlc and duration of diabetes did not significantly correlate to plasma TAT and alpha 2PIC. These data suggest that the existence of increase in coagulation-fibrinolytic system seem to be one of the exacerbating factors in patients with diabetic nephropathy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Studies on coagulation-fibrinolytic system in diabetic nephropathy--with reference to plasma TAT and alpha 2PIC]. 214 99

Microalbuminuria, an increased excretion of urinary albumin undetectable by Albustix test strips, appears to predict the late development of diabetic nephropathy at a stage that albuminuria might be reduced by good metabolic control Once albuminuria is detected by Albustix, it indicates the likelihood of diabetic nephropathy. Microalbuminuria is also related to an increased prevalence of proliferative retinopathy, blindness, and peripheral neuropathy. It is therefore important to detect microalbuminuria by a sensitive, rapid and simple method. Microalbuminuria can be measured by radial immunodiffusion, immunoelectrophoresis, radioimmunoassay, enzyme immunoassay, latex-bead immunoagglutination, turbidimetric immunoassay and dye-binding. The disadvantages of radioimmunoassays are: short shelf life, isotope-related health and safety hazards, and the expense of equipment used to measure gamma-emitting isotopes. Our aim in this study was to develop a simple, rapid and sensitive one-step sandwich enzyme immunoassay using anti-human albumin monoclonal antibodies for screening microalbuminuria.
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PMID:Enzyme immunoassay for urinary albumin at low concentration in diabetes mellitus. 217 12


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