Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011881 (diabetic nephropathy)
 10,836 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The renin-angiotensin system is central to the pathophysiology of a number of cardiovascular disorders. Most obviously this is so with renin secreting tumours, but the system is of central importance in other disorders such as scleroderma renal crisis and most cases of malignant hypertension. Activation of the renin-angiotensin system in unilateral renal artery stenosis is pivotal to the development of hypertension and the disturbances in electrolyte and volume balance -- most particularly in the hyponatraemic-hypertensive syndrome. Likewise, stimulation of the renin-angiotensin system is an important contributor, amongst many other systems, to the pathophysiology of cardiac failure. In diabetic nephropathy, the renin-angiotensin system is often suppressed as gauged by circulating levels of renin, yet it appears to make an important contribution to the progressive decline in renal function. Much less clear is the role of the renin-angiotensin system in essential hypertension insofar as it contributes to the level of blood pressure, to the development of left ventricular hypertrophy, and in the evolution of complications such as stroke and myocardial infarction. Blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors has contributed to our understanding of the role of this system in cardiovascular disease. The advent of selective angiotensin II type-1 receptor blockers will further increase knowledge in this area.
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PMID:The importance of the renin-angiotensin system in cardiovascular disease. 965 50

This study evaluates the impact of diabetic nephropathy on the incidence of coronary heart disease, stroke and any cardiovascular disease in the Finnish population, which has a high risk of Type 1 (insulin-dependent) diabetes mellitus and cardiovascular disease. We performed a prospective analysis of the incidence of coronary heart disease, stroke and cardiovascular disease in all Type 1 subjects in the Finnish Type I diabetes mellitus register diagnosed before the age of 18 years between 1 January 1965 and 31 December 1979 nationwide. The effect of age at onset of diabetes, attained age at the end of follow-up, sex, diabetes duration and of the presence of diabetic nephropathy on the risk for cardiovascular disease was evaluated. Cases of nephropathy, coronary heart disease, stroke and all cardiovascular diseases were ascertained from the nationwide Finnish Hospital Discharge Register and National Death Register using computer linkage with the Type I diabetes mellitus register. Of the 5148 Type 1 diabetic patients followed up, 159 had a cardiovascular event of which 58 were coronary heart diseases, 57 stroke events and 44 other heart diseases. There were virtually no cases of cardiovascular disease before 12 years diabetes duration. The cumulative incidence of cardiovascular disease by the age of 40 years was 43% in Type 1 diabetic patients with diabetic nephropathy, compared with 7% in patients without diabetic nephropathy, similarly in men and women. The relative risk for Type 1 diabetic patients with diabetic nephropathy compared with patients without diabetic nephropathy was 10.3 for coronary heart disease, 10.9 for stroke and 10.0 for any cardiovascular disease, similarly in men and women. The presence of nephropathy in Type I diabetic subjects increases not only the risk of coronary heart disease, but also of stroke by tenfold.
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PMID:Incidence of cardiovascular disease in Type 1 (insulin-dependent) diabetic subjects with and without diabetic nephropathy in Finland. 968 19

Hypertension and diabetes mellitus are both common conditions associated with a high morbidity and mortality. When the two conditions occur together, as they do in 50% of diabetic individuals, the result is a 7.2-fold increase in mortality. If hypertension occurs in association with diabetes mellitus and diabetic nephropathy, mortality rises to 37-fold above that of a healthy population. Despite the increase in incidence of nephropathy, cardiovascular disease remains the major cause of death in diabetic individuals. Therapy should therefore take into consideration the results of large, placebo-controlled trials which have shown reduction in cardiovascular morbidity and mortality as a result of active treatment. Although studies with the newer antihypertensive agents such as calcium antagonists and angiotensin converting enzyme (ACE) inhibitors are ongoing, only diuretics and beta-adrenoceptor antagonists have been clearly shown to reduce cardiovascular risk. Despite concerns regarding adverse metabolic effects and loss of hypoglycaemic awareness, beta-blockers and diuretics do have a role in the management of diabetic patients. While it is clear that ACE inhibitors reduce the progression of diabetic nephropathy, evidence suggests that diuretics may be just as effective. However, unlike diuretics or beta-blockers, ACE inhibitors have no proven benefit in the prevention of stroke of myocardial infarction. Despite the claims of metabolic neutrality made for many antihypertensive agents there appears to be no advantage in their use in the majority of hypertensive diabetic patients, except where there exist specific contraindications to established therapies.
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PMID:Drug treatment of hypertension complicating diabetes mellitus. 971 44

Morbidity and mortality in diabetes are caused mainly by its vascular complications, both in the microcirculation and in the large vessels. Diabetic nephropathy and retinopathy are the clinical hallmarks of microangiopathy, which may lead to end-stage renal failure and blindness. The cardiovascular complications in diabetes consist mainly of an accelerated form of atherosclerosis. Systemic hypertension is an early and frequent phenomenon. Nocturnal hypertension is also more frequent in people with diabetes compared with the nondiabetic population. Capillary hypertension has been demonstrated in type 1 diabetic patients. Poor metabolic control may induce elevation in blood pressure, but data are conflicting. The prevalence of white-coat hypertension in the diabetic population is comparable with that in the nondiabetic population. Prospective observational studies in type 1 and type 2 patients have revealed that abnormally increased urinary albumin excretion and other potentially modifiable risk factors--such as hypertension, smoking, poor metabolic control, and social class--predict increased all-cause mortality and cardiovascular mortality. Arterial hypertension is a risk factor in the initiation and progression of diabetic micro- and macroangiopathy. Diabetes, hypertension, and smoking are the three most important risk factors for fatal and nonfatal stroke. A randomized, double-blind, parallel study has revealed that the 5-year major cardiovascular disease rate was lowered by 34% for antihypertensive treatment compared with placebo. Furthermore, the study found a trend for lower all-cause mortality for low-dose antihypertensive-treated diabetic patients. Effective blood pressure reduction with ACE inhibitors and/or non-ACE inhibitors, frequently in combination with diuretics, reduces albuminuria, delays the progression of nephropathy, postpones end-stage renal failure, and improves survival in diabetic nephropathy.
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PMID:Diabetic hypertensive patients. Is this a group in need of particular care and attention? 1009 4

The main risk factors for diabetic nephropathy are hypertension, hyperlipidemia, and hyperglycemia. Nephropathy heralds the downhill course of arteriosclerosis. Early and intensive blood pressure and glucose control will attenuate the course of nephropathy and significantly reduce cardiovascular events and stroke.
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PMID:Risk factors for nephropathy in type 2 diabetes mellitus. 1047 May 21

Achieving the optimal outcome in hypertensive patients requires the selection and use of appropriate strategies to lower the blood pressure and reduce the patient's risk of cardiovascular events such as stroke and coronary heart disease. It also requires ongoing monitoring of the patient to ensure that the desirable end-points of treatment are being met, and that the heart, kidneys and other sites are being effectively protected from potential complications. Current guidelines on the treatment of hypertension continue to emphasise the use of low dose diuretics as appropriate first-line therapy whenever pharmacological intervention is indicated, except where there are positive indications (e.g. coexisting congestive heart failure or diabetic nephropathy) for other classes of drugs. Diuretics have repeatedly been shown to reduce the morbidity and mortality associated with hypertension, both in the elderly and in younger adults, and their combination with other antihypertensive agents (when clinically indicated) permits the use of lower total dosages. The thiazide-related diuretic indapamide has been reported to have a number of advantages over the thiazides, including minimal or no adverse influence on plasma lipids and glucose metabolism, or on kidney function in patients with renal insufficiency. It has also been found to produce regression of left ventricular hypertrophy, which is now accepted as an important objective of antihypertensive therapy. The recently developed sustained release (SR) formulation of indapamide allows use of a lower daily dosage of the drug, thereby improving its efficacy:safety ratio in comparison with immediate release formulations. Clinical studies have confirmed the efficacy of indapamide SR 1.5 mg daily in lowering elevated blood pressure, and this formulation can be considered an appropriate choice whenever a diuretic is indicated for the treatment of hypertension, including elderly hypertensives and, because of its metabolic 'neutrality', hypertensive patients with diabetes.
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PMID:Concluding remarks. Pursuit of the optimal outcome in hypertension. 1049 31

The attributes of Release 3.0 of the user friendly version (UFV) of the global diabetes model (GDM) are described and documented in detail. The GDM is a continuous, stochastic microsimulation model of type 2 diabetes. Suitable for predicting the medical futures of both individuals with diabetes and representative diabetic populations, the GDM predicts medical events (complications of diabetes), survival, utilities, and medical care costs. Incidence rate functions for microvascular and macrovascular complications are based on a combination of published studies and analyses of data describing diabetic members of Kaiser Permanente Northwest Region, a non-profit group-model health maintenance organization. Active risk factors include average blood glucose (HbAlc), systolic blood pressure (SBP), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), triglycerides, smoking status, and use of prophylactic aspirin. Events predicted include diabetic eye disease, diabetic nephropathy, peripheral neuropathy amputation, myocardial infarction, stroke, peripheral artery disease, congestive heart failure, coronary artery surgery, coronary angioplasty, and death.
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PMID:The global diabetes model: user friendly version 3.0. 1108 May 61

The objective of this study was to analyze the prognostic factors of a cohort of diabetic patients starting dialysis. This prospective, 3. 6-year population-based cohort study included 111 diabetic patients starting dialysis in all 18 dialysis centers of the metropolitan area of Porto Alegre, Brazil, between July 1995 and October 1996. The survival rate was analyzed by Kaplan-Meier curves and prognostic factors for death by Cox's proportional-hazards model. During the study period, 685 patients started dialysis; 182 (26.5%) had diabetes and 111 patients were included. Eighty-four percent of the 111 patients were classified as type 2 diabetes (random C-peptide>0. 6 ng/ml), and these patients presented more coronary artery disease (60% vs. 29%; P<0.02) than type 1 patients. In type 2 patients, later diagnosis of diabetes was associated with a shorter interval until beginning of dialysis (r=0.67; P=0.001). Diabetic nephropathy was the primary renal disease in 61% of all patients. Overall median survival (26 months) was similar for types 1 and 2 diabetic patients. Survival in the first, second, and third year was 69%, 51%, and 28%, respectively. Cardiovascular disease was the most common cause (63%) of death. According to Cox's proportional-hazards model, history of stroke (HR: 4.53, CI: 2.09-9.86, P<0.0001), amputations (HR: 3.2, CI: 1.61-6.35, P<0.0009), and coronary artery disease (HR: 1.67, CI: 0.95-2.96, P<0.076) at baseline were significantly associated with mortality. In conclusion, macrovascular complications were the main predictors of mortality in this cohort of diabetic patients starting dialysis. Intensive treatment of cardiovascular risk factors during dialysis might reduce the mortality rate of diabetic patients.
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PMID:Prognostic factors in Brazilian diabetic patients starting dialysis: a 3.6-year follow-up study. 1111 89

This study examined the association between urinary markers of early diabetic nephropathy and non-renal diabetic complications in 946 patients with type 2 diabetes mellitus. The association with hypertension was also studied. Data on macrovascular complications (ischaemic heart disease, stroke, peripheral vascular disease) and microvascular complications (retinopathy, peripheral neuropathy) were obtained from case records and clinical examination. Urine samples collected were analysed for albumin, beta(2)-microglobulin, retinol-binding protein (RBP), and N-acetyl-beta-D-glucosaminidase (NAG). Results showed that urinary albumin, RBP and beta(2)-microglobulin levels were higher in patients with macro- and/or microvascular complications, compared to those without. NAG levels were higher only in patients with both types of complications. A higher proportion of patients with complications had abnormally raised urinary protein and enzyme levels, compared to those without. Patients with associated hypertension had higher urinary levels of albumin and beta(2)-microglobulin, regardless of whether complications were present or not. RBP excretion was, however, markedly higher only in patients with microvascular complications, whereas hypertension did not influence NAG excretion. Urine albumin and RBP excretion were predictive of microvascular, as well as both macrovascular and microvascular complications, whereas NAG excretion was predictive of macro- and microvascular complications. These findings could mean that increased urinary protein and enzyme excretion were associated with more severe disease in these patients.
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PMID:Urinary protein excretion in Type 2 diabetes with complications. 1111 88

In general, nonrheumatic atrial fibrillation is associated with a high risk of stroke. However, its impact on stroke in the setting of chronic hemodialysis treatment is insufficiently addressed in the literature. We assessed the incidence of stroke among 430 chronic hemodialysis patients and the impact of atrial fibrillation and various other potential risk factors on stroke in a retrospective study covering 1,111.16 patient-years. The overall incidence of stroke was 3.78/100 patient-years. Among patients with chronic atrial fibrillation without any antithrombotic therapy besides regular dialysis anticoagulation, the stroke incidence was 1.0/100 patient-years and did not differ statistically significantly from the rate among patients without this arrhythmia, in whom the incidence was 2.8/100 patient-years (p = 0.220). Conversely, the overall rate of stroke incidence per 100 patient-years was statistically significantly higher in patients with diabetic nephropathy (6.46, p = 0.0036), age > 65 years (5.90, p = 0.0001), moderate to severe hypertension (6.8, p = 0.0017), weight gain of > 2 kg between dialyses as a marker of poor patient compliance (6.47, p = 0.0433), and antithrombotic therapy with salicylates or warfarin (8.33, p = 0.0002), as compared with corresponding groups without these risk factors. Our data suggest that in contrast to other risk factors nonrheumatic atrial fibrillation in itself is not associated with an increased risk of stroke in patients on maintenance hemodialysis treatment.
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PMID:Incidence of stroke among chronic hemodialysis patients with nonrheumatic atrial fibrillation. 1127 30


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