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

From August 1974 to January 1985, 53 patients (26 men; seven Maoris) mean age 45 (SD 15) years, with diabetes mellitus for a mean of 12 (SD nine) years had a renal biopsy and were followed. Indications for biopsy were nephrotic syndrome, proteinuria, renal impairment (five) and hematuria (one). Mean plasma creatinine concentration was 0.22 (SD 0.18) mmol/L and protein excretion 3.4 (SD 2.5) g/24 h. Diabetic nephropathy was demonstrated in 39 patients and significantly associated with retinopathy and insulin dependent diabetes mellitus (IDDM). Of the 39 patients followed for 25.7 (SD 22.8) months, 18 had died (nine myocardial infarction, six uremia, two sepsis, one stroke) and nine had begun dialysis. The five-year cumulative renal survival was 28%. The presence of the nephrotic syndrome and the plasma creatinine concentration at presentation were the best predictors of survival. Diabetics with IDDM of 20 years duration, retinopathy and heavy proteinuria, who survive the other complications of their disease, are likely to have diabetic nephropathy requiring renal replacement therapy.
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PMID:Renal disease in diabetics--which patients have diabetic nephropathy and what is their outcome? 324 62

During the period 1973-1983, 1,014 patients with end stage renal failure received a kidney graft at the Helsinki University Central Hospital. As a consequence of diabetic nephropathy, 163 of them (16%) developed renal failure. Ten diabetic (6%) and 72 non-diabetic (9%) patients received grafts from a living donor. One-year patient survival did not differ between diabetic and non-diabetic patients (76% and 79%, respectively). From the second post-transplant year onwards patient survival was worse in diabetic than in non-diabetic patients. The two groups did not differ with respect to graft survival. Sixty-two diabetic patients (38%) died during the follow-up period, with myocardial infarction as the most common cause of death (31%), followed by infection (15%) and cerebral stroke (13%). Seven myocardial infarctions out of 19 occurred within three months of transplantation. However, significantly more fatal and non-fatal myocardial infarctions were observed in post-transplant patients who had returned to dialysis therapy than in patients with a functioning kidney graft. Blindness did not influence the outcome of transplantation. Nor did the transplantation significantly affect the course of this diabetic complication. In conclusion, although the early success rate of kidney transplantation in our study population was acceptable, the later outcome was poor, mainly due to advanced disease-related complications.
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PMID:Outcome of patients with diabetic nephropathy after kidney transplantation. 332 21

According to the W.H.O. criteria (160/95 mmHg), arterial hypertension is present in about one third of diabetic patients. But the W.H.O. criteria are not appropriate in insulin-dependent diabetics. There is increasing evidence that a slight increase of blood pressure values may have a deleterious effect on various localizations of diabetic angiopathy. Arterial blood pressure is a major predictive factor for stroke or death due to coronary heart disease. The incidence and prevalence of diabetic retinopathy are significantly correlated with systolic and/or diastolic blood pressure values. In patients with incipient diabetic nephropathy, a slight elevation of blood pressure values is usually observed, an antihypertensive treatment may reduce albumin excretion rate and may prevent clinical diabetic nephropathy. Antihypertensive treatment is the more effective and the best tolerated of all interventions dedicated to reduce albumin excretion. Calcium antagonists and angiotensin converting enzyme inhibitors are at the present time the drugs to be used in the treatment of hypertensive diabetic patients as they are more effective and better tolerated than the usual antihypertensive agents. A part from their antihypertensive effect, they also improve cardiac, cerebral and intra-renal haemodynamics.
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PMID:[New antihypertensive therapy in diabetics]. 332 28

Hypertensive diabetic animal models have been developed by injecting streptozotocin (STZ) in neonatal stroke-resistant spontaneously hypertensive rats (SHRSR) and stroke-prone SHR (SHRSP) at the age of two days. After the treatment, the animals showed mild insulin deficiency and mild hyperglycemia at the age of three to four months. Diabetic nephropathy was produced particularly in STZ-treated SHRSR at the age of six months. The effect of neonatal STZ injection on hyperglycemia varied among normotensive Wistar-Kyoto rats (WKY), SHRSR, and SHRSP; SHRSR showed the highest glucose levels, SHRSP showed intermediate levels, and WKY was the lowest. All STZ-treated SHRSR showed glycosuria, while glycosuria was not observed in the treated SHRSP and WKY. Histologic study indicated that these strain differences were partly ascribed to differences in islet B-cell sensitivity to toxic effects of STZ. The development of hypertension was not accelerated in these SHRSR and SHRSP compared with respective nontreated controls. Since STZ-treated SHRSR develop mild diabetic symptom with hypertension and develop mild diabetic glomerulosclerosis, they are good models for studying vascular complications or other problems relating to the synergism between hypertension and diabetes mellitus.
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PMID:New establishment of hypertensive diabetic animal models: neonatally streptozotocin-treated spontaneously hypertensive rats. 360 Feb 85

Diabetic nephropathy has evolved into the single most prevalent cause of uremia among patients sustained by the United States End Stage Renal Disease program. Clarification of the natural history of kidney involvement and insufficiency in Type I and II diabetes has improved substantially over the past 5 years. However, it remains a poorly understood and relatively underreported morbid entity. This report reviews the problem, then reconstructs the natural history of diabetic nephropathy by studying the course of 50 Type I and Type II uremic diabetics treated with hemodialysis at The Long Island College Hospital. It traces the various stages from hyperglycemia to proteinuria to renal failure, and then reports morbidity, including cardiac, eye, stroke, and amputation complications. A new paradox is herein reported--the unpredictable insulin requirement, including new insulin need for the first time once hemodialysis was begun, in 8 of 50 patients studied.
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PMID:The natural history of diabetic nephropathy: unpredictable insulin requirements--a further clue. 636 68

A survival analysis was applied to 1,453 patients treated between 1972 and 1978 in 33 French dialysis centers and prospectively followed up in the computerized Diaphane Dialysis Registry. 198 deaths (overall mortality = OM) were registered, of which 87 (43%) were secondary to cardiovascular complications (cardiovascular mortality = CVM). Risk factors for OM and CVM (p values less than 0.05) were age, male sex, nephroangiosclerosis or diabetic nephropathy as the primary renal disease, elevated systolic and diastolic blood pressure and two weekly dialysis rather then three. In contrast with the results observed for the general population, a high body mass index and elevated cholesterol, triglycerides and uric acid were not found to be associated with significantly increased CVM or OM. On the contrary, low body mass index (less than 20 kg/m2), low cholesterol (less than 4.5 mmol/l) and low mean predialysis blood urea (less than 4.6 mmol/l) were associated with increased OM and CVM, and more especially with high stroke mortality. Results for urea but not for cholesterol remain significant after adjustment for age, sex, weekly dialysis schedule and body mass index. They suggest that, in addition to elevated blood pressure, a poor nutritional state and/or low protein intake may be important factors for explaining the high cardiovascular mortality, particularly for strokes, observed in dialyzed patients.
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PMID:Mortality risk factors in patients treated by chronic hemodialysis. Report of the Diaphane collaborative study. 712 51

Congenital or acquired nephron number reduction and diabetes mellitus both induce hyperfiltration and intrarenal hypertension. These hemodynamic factors have been suggested to play an important role in the initiation and progression of diabetic and nondiabetic glomerulopathies. In a prevalence cohort of all 50 albuminuric (> or = 300 mg/24 hr), non-insulin-dependent diabetic mellitus (NIDDM) patients (aged < 66 years) attending a diabetic clinic during 1987, we identified four patients with acquired oligonephropathy who had developed diabetic nephropathy. Three patients only had a single functioning kidney (nephrectomy in two cases), and the remaining patient had unilateral severely reduced kidney function and elevated plasma renin concentration. These patients represent 8% of our NIDDM population with albuminuria, and are the only patients in our NIDDM population younger than 66 years (n = 363) known to have single kidneys. However, systematic renography screening was not performed. During the observation period, which ranged from 16 to 100 months, albuminuria increased from 2.3 g/24 hr (range, 1.2 to 3.4 g/24 hr) to 3.2 g/24 hr (range, 0.7 to 9.4 g/24 hr), glomerular filtration rate decreased to 6 mL/min/yr (range, 4 to 12 mL/min/yr), and blood pressure remained stable at 142/92 mm Hg. Three patients received antihypertensive medication. Two of the patients died after 16 and 26 months of observation, respectively, due to acute myocardial infarction and stroke. The results of our study of NIDDM patients support the concept that reduced nephron number predispose patients to the development of diabetic nephropathy.
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PMID:Acquired oligonephropathy and diabetic nephropathy. 750 63

The declining mortality due to coronary heart disease and stroke has been attributed in part to improved effectiveness and application of antihypertensive therapy and the 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 at least through the year 2000. Taken together, patients with diabetic nephropathy and patients with hypertensive renal disease account for the majority of new cases annually. The reasons for the striking dissociation between our success with coronary heart disease and stroke on the one hand and our inability to lessen the incidence of ESRD on the other 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. Although the importance of blood pressure control is implicit, a theoretic framework based on data derived from experimental animal suggests that ACE-inhibitors and perhaps calcium antagonists may exert specific renoprotective effects beyond those achieved by blood pressure reduction per se. The results of recent long-term prospective studies are consistent with such a formulation. In view of the increasing importance of ACE-inhibitors and calcium antagonists in the antihypertensive armamentarium, additional prospective randomized studies are required to delineate further the effects of these agents on the progression of chronic renal insufficiency.
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PMID:Effects of ACE inhibitors and calcium antagonists on progression of chronic renal disease. 758 66

The study of the current status of renal replacement therapy in Japan is based on the analysis of data from the registry reports for regular dialysis therapy and kidney transplantation. The total number of patients receiving regular dialysis therapy was 123,926 at the end of 1992: 117,809 (95.1%) on hemodialysis and 6,117 (4.9%) on peritoneal dialysis. The primary diseases of newly accepted patients were chronic glomerulonephritis (42.2%), diabetic nephropathy (28.4%), nephrosclerosis (5.9%), polycystic kidney disease (2.7%), chronic pyelonephritis (1.6%), and others. The number of kidney transplant patients in Japan was 8,384 at the end of 1991: 6,154 (73.4%) received a living donor transplantation and 2,230 (26.9%) received a cadaver donor transplantation. Overall 5-year survival rates of dialysis patients were 60.4%: 69.7% for chronic glomerulonephritis, 41.7% for diabetic nephropathy, 39.6% for nephrosclerosis, 73.6% for diffuse polycystic kidney disease, and 66.6% for chronic pyelonephritis. The causes of death of dialysis patients were heart failure (31.1%), cerebrovascular accident (13.6%), infectious diseases (11.3%), malignancies (7.1%), cachexia/uremia (6.7%), myocardial infarction (5.8%), and others. The gross mortality rate of dialysis patients was increased in cases of less than 4 hours of the average length of each dialysis session, less than 4% and more than 9% of the average weight loss during each dialysis session, less than 1.0 of Kt/V, and less than 0.9 and more than 1.7 g/kg/d of protein catabolic rate. Overall 5-year patient and graft survival rates of kidney transplant patients since 1964 were 82.7% and 60.3%: 84.4% and 65.0% in living donor cases, and 77.4% and 46.2% in cadaver donor case, respectively. Those since 1983 were 90.1% and 68.2%: 91.3% and 72.6% in living donor cases, and 87.8% and 59.3%, respectively. Graft survival rates were superior in cases treated with combined steroid, cyclosporine and azathioprine or mizoribine, to those treated with other immuno-suppressive regimens, and they decreased as the number of HLA-A, -B and -DR increased.
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PMID:Current status of renal replacement therapy in Japan. 781 May 20

A higher prevalence of stroke is found in the patient with both diagnosed and undiagnosed diabetes and glucose intolerance. Because of local cerebral acidosis caused by ischemia and hyperglycemia, morbidity and mortality from a stroke are increased. Most studies show that individuals with admission serum glucose > 120 mg/dl (6.7 mM) have a higher morbidity and mortality from a stroke. The prevalence of cerebral infarcts, especially lacunar infarcts, is increased and the prevalence of subarachnoid hemorrhage, cerebral hemorrhage, and transient ischemic attacks are decreased in the diabetic patient. Age, race, hypertension, and the presence of diabetic nephropathy and coronary and peripheral vascular disease are risk factors for stroke in the diabetic patient, whereas obesity, smoking, hyperlipidemia, and glycemic control are not. Investigation and treatment of the diabetic patient with a stroke is discussed.
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PMID:Stroke in the diabetic patient. 817 50


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