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

Between 1979 and December 1987 a total of 50 pancreas transplants were performed, 41 of them together with a kidney from the same donor. End-stage diabetic nephropathy was the indication for the combined procedure, and progressive pre-proliferative retinopathy for a single pancreas transplant. A segment consisting of body, tail but also major parts of the head of the gland was used. Technique-related complications or prolonged hospitalization prompted three changes in surgical technique. In the first five patients the pancreatic duct was occluded at the time of transplantation and in the subsequent eleven cases the graft was anastomosed to a Roux-Y-loop of jejunum. In a series of 17 patients thereafter the pancreatic duct was occluded after stabilization of graft function, and in the most recent 17 patients the pancreatic juice was drained into the urinary bladder. Prophylactic immunosuppression consisted of steroids and azathioprine for the first two patients. From 1981 to 1986 cyclosporin and prednisolone were given and from then on azathioprine was added as a third drug. Patient survival at one year was 25% in the first group, 80% in group II, 97% in group III and 88% in group IV. Cardiovascular and septic complications were the main causes of death. None of the group I transplants functioned at one year. Graft survival rates at one year for the pancreas and the kidney in groups II, III and IV were calculated at 30%, 70%, 58.8% and 77%, 86%, 72% respectively. In 16% of the long-term survivors significant amelioration and in another 50% stabilization of diabetic retinopathy occurred.
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PMID:[Clinical experiences with 50 pancreas transplantations]. 238 73

Psychosomatic aspects of dialysis patients with diabetic nephropathy were examined using various psychological tests such as the MMPI Alexithymia Scale. Alexithymic traits were observed in 83% of dialysis patients with diabetic nephropathy. Moreover, positive correlations between alexithymia and self-control were found suggesting that alexithymic trait, the lack of awareness of one's own body, results in sluggish self-control, and affects prognosis of dialysis patients seriously. Especially, visual disturbance complications such as severe retinopathy are likely to further accelerate this condition. Therefore, it is essential for dialysis patients with alexithymic trait to acquire body awareness.
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PMID:Psychosomatic aspects of patients on hemodialysis. 2. Alexithymic trait of hemodialysis patients with diabetic nephropathy. 248 3

Late complications such as retinopathy and neuropathy contribute substantially to the morbidity of patients with diabetes mellitus but have only moderate effect on their life expectancy. However, once diabetic nephropathy occurs, life expectancy of patients with diabetes mellitus is shortened considerably. This review discusses briefly several possible pathogenetic mechanisms involved in the development of diabetic nephropathy. Changes in renal hemodynamics as the initiating and contributing factor to the development of diabetic nephropathy are discussed in more detail. Finally, the article reviews possible therapeutic measures to prevent the development of diabetic nephropathy, or to slow down its progression.
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PMID:Diabetic nephropathy in insulin-dependent diabetic patients: renal hemodynamics and derived treatment strategies. 252 42

Overnight albumin excretion rates were measured in 940 diabetic patients, 416 with insulin dependent and 524 with non-insulin dependent diabetes, and in 106 healthy volunteers. A significantly higher number of non-insulin dependent diabetic patients had abnormal albumin excretion compared with the insulin-dependent group (X2 = 15.2, p less than 0.002). Ten per cent of non-insulin-dependent and 7 per cent of insulin-dependent diabetic patients had albumin excretion rates in the range 30-150 micrograms/min and thus were at risk of the cardiovascular and renal complications of diabetes. Six per cent of non-insulin-dependent and 5 per cent of insulin-dependent diabetic patients had albumin excretion rates above 150 micrograms/min and thus were entering the phase of clinical diabetic nephropathy. Multivariate analysis revealed that male sex and retinopathy in insulin-dependent diabetes, and systolic blood pressure and retinopathy and peripheral vascular disease in non-insulin-dependent diabetes, were significantly related to albumin excretion. Only one patient with insulin-dependent diabetes of less than 5 years known duration had an albumin excretion rate in the range 30-150 micrograms/min, whereas such an excretion rate indicating patients at risk was observed at all durations of non-insulin-dependent diabetes. It is possible that during the long silent phase of non-insulin-dependent diabetes, before diagnosis, significant renal damage occurred.
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PMID:Comparison of the prevalence and associated features of abnormal albumin excretion in insulin-dependent and non-insulin-dependent diabetes. 259 49

Transplantation of the pancreas in late stages of type I diabetes has been performed increasingly frequently during recent years. By improved surgical techniques and immunsuppressive therapy including cyclosporin A, the 1-year graft function has increased to 60-70% and the patient survival to 85-95% in the institutions with greatest experience. These results are so good, that they nearly reach those from kidney transplantation. Most of the pancreas transplantations have been performed simultaneously with kidney transplantation in patients with end stage diabetic uremia. The results should therefore be evaluated according to these circumstances. In a few institutions transplantation of the pancreas is now performed in patients with persistent proteinuria and proliferative retinopathy in an attempt to avoid development of severe diabetic complications. The first pancreas transplantation in Denmark was performed Januar 31 st 1987, and since then, 17 further transplantations have been performed. All patients had severe diabetic nephropathy and received simultaneous kidney transplantation. According to the Danish heart death criteria the organs were perfused and cooled during the donor operation to keep the warm ischemia as brief as possible. The pancreatic vessels are anastomosed to the iliac vessels. In one group of patients the exocrine pancreatic function was preserved by anastomosis to the jejunum, and in another group of patients the exocrine function was abolished by injection of latex into the pancreatic duct system. The patients receive immunosuppression therapy with methylprednisolone, azatioprine and ciclosporin A and anti-coagulation therapy.
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PMID:[Simultaneous transplantation of the pancreas and kidney in terminal diabetic nephropathies]. 264 99

Plasma inactive renin concentration (IRC) was determined in 92 diabetic patients with or without chronic diabetic complications, 23 non-diabetic patients with renal failure and 36 normal subjects. IRC of the diabetics was higher than that of normal persons. With the Pearson's correlation analysis, IRC of the diabetics correlated with duration of diabetes, degrees of chronic complications (nephropathy, retinopathy and neuropathy), but not with age of patient, HbA1c or mean blood pressure. The stepwise logistic analysis revealed the relation of neuropathy to mean blood pressure, serum creatinine concentration and duration of diabetes, retinopathy to mean blood pressure, duration of diabetes and serum beta 2-microglobulin and nephropathy to IRC and urinary NAG/Cr ratio. In addition, IRC was dependent on nephropathy but not on retinopathy or neuropathy. IRC in diabetics was high even in diabetics without albuminuria (group I) and significantly increased in diabetics with albuminuria but without increased serum creatinine level (group II) and more marked high levels were observed in diabetics with increased serum creatinine concentrations (group III). However, IRC of the non-diabetic patients with renal failure was not elevated, therefore, the increased IRC in nephropathy is likely to be specific to diabetic nephropathy. The correlation of other factors to increased IRC level seem to be due to nephropathy concomitant to these factors. Therefore, the increased level of IRC in diabetics is intimately connected to renal change in diabetes but whether it is the cause or result of nephropathy remains to be elucidated. It is concluded that the determination of IRC in diabetic patients was an effective means of assessment or forecast of nephropathy.
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PMID:[A study on inactive renin in the plasma of patients with diabetes mellitus]. 267 Jul 25

The prevalence of smokers among patients with diabetes is found to be lower than in the population as a whole. Diabetic patients have increased morbidity and mortality from cardiovascular diseases and, in the majority of investigations, smoking is found to be a risk factor in this relationship which does not differ quantitatively from that found in non-diabetics. On the basis of the literature, it has not proved possible to quantitate smoking as a risk factor for the development of peripheral arteriosclerotic vascular disease. Smoking involves hormonal and metabolic changes which are of particular interest in relation to diabetes mellitus. Thus, smoking stimulates the secretion of the antiinsulin hormones, particularly catecholamines, resulting in subcutaneous vasoconstriction which may be unfortunate as it influences insulin absorption. Patients who smoke do not, however, appear to present poorer glycaemic control than non-smokers. A few investigations have shown that smokers have greater insulin requirements than non-smokers. In type 1 (insulin-dependent) diabetes, there is evidence to suggest that diabetic nephropathy and proliferative retinopathy occur more frequently in smokers than in non-smokers. Smoking aggravates the pre-existing more pronounced osteoporosis which occurs in female insulin-dependent patients. It is therefore advantageous to advise diabetic patients against smoking from the point of view of diabetes as such.
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PMID:[Smoking and diabetes mellitus]. 268 32

In Type I diabetes, hypertension is usually associated with the development of diabetic nephropathy. In proteinuric patients hypertension has a deleterious effect on the progression of microangiopathy and macroangiopathy, which in turn impairs their quality of life and long-term prognosis. As shown in numerous studies, hypertension accelerates loss of renal function. After kidney transplantation, the percentage of functioning grafts is much lower in diabetic patients who remain hypertensive. Furthermore, the rate of development of proliferative retinopathy, a common complication in proteinuric diabetics, increases in the presence of hypertension. Finally, hypertensive blood pressure values at the start of maintenance hemodialysis are significant predictors of cardio-vascular death among diabetics of renal replacement therapy. It has recently been demonstrated that during the last two decades blood pressure control has improved in proteinuric Type I diabetic patients. These results are associated with better renal prognosis and higher life expectancy.
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PMID:Impact of hypertension on prognosis in IDDM. 269 53

Although diabetes mellitus is reported in 29% of patients with renal papillary necrosis (RPN), the frequency of RPN among patients with insulin-dependent diabetes mellitus (IDDM) has from autopsy studies been estimated to be only 4.4%. In vivo data on the prevalence of RPN in patients with IDDM have been lacking. We therefore studied the prevalence of RPN in 76 patients with long-standing IDDM and in 34 age-matched control subjects by intravenous urography. None of the control subjects showed radiographic signs of papillary necrosis. RPN was observed in 18 patients (23.7%); 15 were women (83.3%). Age and duration of diabetes was not different between patients with and without papillary necrosis, and there was no significant difference between the two groups regarding the prevalence of microangiopathic complications, i.e., proliferative retinopathy and diabetic nephropathy. Microscopic hematuria was three times more frequent in patients with than without RPN (44 vs. 16%; P less than .02). In addition, pyuria was reported in 40% of patients with papillary necrosis, and 61% of them gave a positive history of urinary tract infection compared to 16% (P less than 05) and 32% (P less than .02), respectively, in patients without papillary necrosis. It is concluded that RPN is a more frequent complication of long-standing IDDM than appreciated from autopsy studies, and being female and having a history of urinary tract infection are associated with an increased risk of RPN.
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PMID:Renal papillary necrosis in patients with IDDM. 270 11

From 1978 through 1984, the incidence of treated end-stage renal disease (ESRD) secondary to diabetic nephropathy increased from 3 to 19 per million population among the membership of the Kaiser Permanente Medical Care Program in Northern California. Forty-eight percent had type II diabetes. Among 66 type II diabetics retinopathy was less severe and hypertension was more frequent than among 50 type I diabetics. Blacks were represented in a higher proportion than expected from their proportion of the health plan membership. Among type II diabetics who developed ESRD, once proteinuria occurred, nephropathy progressed at the same rate observed in type I diabetics. This observation suggests that the clinical progression of diabetic nephropathy may be similar for both types of diabetes after the development of proteinuria, but requires prospectively collected data for confirmation.
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PMID:Comparison of type II and type I diabetics treated for end-stage renal disease in a large prepaid health plan population. 273 29


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