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

Eighteen individuals with IDDM (type I) and diabetic nephropathy in whom the initial glomerular filtration rate (GFR) was reduced but not below 60 ml/min per 1.73 m2 were observed for an average of 3 yr. The rate of further decline of GFR was found to range between -2 and 21 ml/min/yr. The duration of diabetes until the GFR was first found to be reduced varied between 14 and 33 yr and was not correlated to the ensuing rate of decline in GFR (r = -0.13). In 10 individuals who developed uremia 40 yr or more after onset of IDDM, the development of persistent proteinuria was followed by hypertension and increased serum creatinine 2 yr later and by terminal uremia after an average of 8 yr. This is also the normal time span for individuals who develop terminal uremia after shorter duration of diabetes. We conclude that the course of clinical diabetic nephropathy is not more favorable in individuals with late onset of this complication and that there is no point at which a person with diabetes can be considered to be spared from developing diabetic nephropathy.
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PMID:Time as a risk factor in diabetic nephropathy. 407 45

Autopsies of all uraemic patients in Leningrad for three years, and materials of the City Nephrological Service have demonstrated that the structures of nephrological diseases in their early and terminal stages were different. Chronic glomerulonephritis has been noted in patients with normal renal function just as often as chronic pyelonephritis but the former prevails considerably among the causes of uraemia. The proportion of polycystic kidney disease, amyloidosis, and diabetic nephropathy increases in patients with chronic renal failure. Due to these changes and the difference in the death age of patients with various diseases the majority of patients suitable for treatment with long-term dialysis suffer from chronic glomerulonephritis and only 14.89-20.5% from chronic pyelonephritis.
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PMID:Epidemiology of chronic renal diseases. 622 4

Uremic patients on maintenance hemodialysis, but without clinical evidence of atopy or diabetes mellitus, had serum levels of total IgE significantly lower than in healthy controls matched for age and sex. Patients with uremia due to diabetic nephropathy had higher IgE levels than the reference group. No correlation was found between total IgE levels and length of dialysis treatment. After renal transplantation, the IgE levels decreased on average to 31% of the pretransplant values over a 60-day observation period. Bacterial or viral infections or episodes of kidney rejection had no apparent influence on the IgE synthesis in the patients with transplant. No correlation was detectable between pretransplant IgE levels and six-month survival of the kidney graft. The low IgE concentrations in uremia are suggested to reflect altered T-cell regulation of the IgE production. The raised IgE levels in diabetic patients could not be explained by specific reagins against insulin, but may have reflected an influence of abnormal carbohydrate metabolism on IgE synthesis. The fall in IgE levels following transplantation is proposed to be attributable to the combined corticosteroid-azathioprine treatment.
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PMID:Total serum IgE in uremia and after renal transplantation. 635 89

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

The results of treatment with continuous ambulatory peritoneal dialysis (CAPD) of 24 unselected patients with end-stage diabetic nephropathy are reported. The total treatment time was 346 months. Six patients died, eight received a kidney allograft, two returned to CAPD after graft failure, six were transferred to other forms of dialysis and one to another centre. Five patients remained on CAPD. Good control of symptoms, biochemical values and hypertension was achieved. Intraperitoneal administration of insulin resulted in very good metabolic control of diabetes. In view of the unfavourable prognosis of uremic diabetics, the results of this study indicate that CAPD is a suitable method for treatment of uremia in end-stage diabetic nephropathy.
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PMID:Continuous ambulatory peritoneal dialysis in the treatment of end-stage diabetic nephropathy. 637 27

Alterations in renal function and structure are found even at the onset of diabetes mellitus. Studies performed over the last decade now allow definition of a series of stages in the development of renal changes in diabetes. Such a classification may be useful both in clinical work and in research activities. Stage 1 is characterized by early hyperfunction and hypertrophy. These changes are found at diagnosis, before insulin treatment. Increased urinary albumin excretion, aggravated during physical exercise, is also a characteristic finding. Changes are at least partly reversible by insulin treatment. Stage 2 develops silently over many years and is characterized by morphologic lesions without signs of clinical disease. However, kidney function tests and morphometry on biopsy specimens reveal changes. The function is characterized by increased GFR. During good diabetes control, albumin excretion is normal; however, physical exercise unmasks changes in albuminuria not demonstrable in the resting situation. During poor diabetes control albumin excretion goes up both at rest and during exercise. A number of patients continue in stage 2 throughout their lives. Stage 3, incipient diabetic nephropathy, is the forerunner of overt diabetic nephropathy. Its main manifestation is abnormally elevated urinary albumin excretion, as measured by radioimmunoassay. A level higher than the values found in normal subjects but lower than in clinical disease is the main characteristic of this stage, which appeared to be between 15 and 300 micrograms/min in the baseline situation. A slow, gradual increase over the years is a prominent feature in this very decisive phase of renal disease in diabetes when blood pressure is rising. The increased rate in albumin excretion is higher in patients with increased blood pressure. GFR is still supranormal and antihypertensive treatment in this phase is under investigation, using the physical exercise test. Stage 4 is overt diabetic nephropathy, the classic entity characterized by persistent proteinuria (greater than 0.5 g/24 h). When the associated high blood pressure is left untreated, renal function (GFR) declines, the mean fall rate being around 1 ml/min/mo. Long-term antihypertensive treatment reduces the fall rate by about 60% and thus postpones uremia considerably. Stage 5 is end-stage renal failure with uremia due to diabetic nephropathy. As many as 25% of the population presently entering the end-stage renal failure programs in the United States are diabetic. Diabetic nephropathy and diabetic vasculopathy constitute a major medical problem in society today.
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PMID:The stages in diabetic renal disease. With emphasis on the stage of incipient diabetic nephropathy. 640 Jun 70

A symmetrically growth retarded premature infant was born to a mother with advanced diabetic nephropathy, chronic renal failure, and hypertension, and managed with aggressive medical therapy without the use of dialysis. The neonatal course was uncomplicated, except for cord blood creatinine and BUN concentrations of 4.7 mg/dl and 116 mg/dl, respectively, that fell to 1.1 mg/dl and 44 mg/dl by 2 days of age. Strict glucose control, careful management of the metabolic abnormalities of uremia, and periodic surveillance of fetal well-being led to a successful pregnancy.
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PMID:Fetal-neonatal uremia in advanced maternal diabetes. 669 31

We have studied the histocompatibility (HLA) antigens A and B in 99 insulin dependent diabetics (IDDN) with terminal uremia due to diabetic nephropathy and in 96 insulin dependent diabetic patients (IDD) without clinically detectable kidney disease. The two groups were matched for duration of disease and other clinical features. The frequencies of the HLA antigens B8, B15, B18 and B8/B15 were significantly increased in both groups and B7 and B12 were decreased. There were no significant differences between the two groups. These results contrast with previously described similar studies of HLA and diabetic proliferative retinopathy. In these studies B7 was significantly less common in patients with proliferative retinopathy as compared with patients without proliferative retinopathy and B15 was more common in a subset of patients with proliferative retinopathy. The differences between the two studies may reflect sample bias or a genetic difference between the two types of diabetic microangiopathy.
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PMID:Is diabetic microangiopathy genetically heterogeneous? HLA and diabetic nephropathy. 694 52

In juvenile--onset diabetes uremia is the main cause of death. Since 1972 until Oct. 1979 a total of 47 diabetics have been transplanted in Gothenburg, of these 40 were juvenile--onset diabetics without concomitant renal disease. Twenty-four were male and 16 female. The diabetic nephropathy was not an isolated phenomenon. Complications from other organs were present parallel with the kidney disease. Hypertension was present in 39 of 40 patients before transplantation. Most patients have been transplanted in terminal uremic stage, 21 were on dialysis. The overall mortality at the end of the observation period was 33% but during the later part, that is from 1976 onwards only 2 out of 26 transplanted patients have died so far (8%). Fourteen of these 26 patients were grafted with kidneys from living related donors compared to one of fourteen during the first period. This may be one of the main reasons to the improved results during the last years.
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PMID:Transplantation in patients with diabetic nephropathy. 700 34

In summary, we believe that combined PKT can be performed safely and effectively in the absence of uremia, thereby providing the potential for arresting the progression of diabetic complications prior to the development of ESRD. Furthermore, performing solitary PTx prior to the need for a kidney transplant can be accomplished with morbidity and results comparable to PKT. Rehabilitation potential tends to favor patients undergoing either solitary PTx or preemptive PKT. In selected IDDM patients without end-stage diabetic nephropathy, we believe that solitary PTx or PKT are effective treatment options and need not be considered as preemptive, especially in view of increasing waiting times and the variable progressive nature of diabetic complications. As results continue to improve, solitary PTx may offer a potential solution to the growing number of IDDM patients awaiting kidney transplantation in the United States. Ultimately, the role of solitary PTx in the treatment of IDDM will be determined by long-term studies documenting the prevention or arrest of secondary diabetic complications. In the short-term, improvement in quality of life and rehabilitation potential makes preemptive PKT or solitary PTx important therapeutic alternatives for consideration.
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PMID:Pancreas transplantation: the Nebraska experience. 754 48


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