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)

Urinary protein concentration and urinary protein pattern as determined by sodium dodecyl sulphate polyacrylamide gel electrophoresis, were investigated in 53 type 1 diabetic children and in 56 (41 type 1 and 15 type 2) diabetic adults. Reversible tubular proteinuria was found in 26 diabetic children with hyperglycaemic ketoacidosis. Among the patients, 43 exhibited physiological, 31 fixed tubular and nine glomerular type proteinuria. The prevalence of retinopathy and neuropathy in the different patient groups has also been evaluated. Urinary protein concentration appeared to be above the usual reference values during hyperglycaemic ketoacidosis, and was normalized with the successful control of metabolism. In the other three groups, urinary protein concentration was increased only in the case of glomerular type proteinuria. It is suggested that the above classification characterizes the development of diabetic nephropathy, progressing from reversible tubulointerstitial dysfunction through fixed tubulointerstitial dysfunction to glomerulopathy.
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PMID:Different types of proteinuria in diabetes mellitus. 647 64

Eighty-six renal transplantations were performed in 69 patients with endstage diabetic nephropathy. Cadaveric kidneys were used in 77 of the transplantations. Most of the patients had severe retinopathy. Patients with severe cardiopathy and neuropathy were not accepted for transplantation. After one year 61% of the patients were alive, after three years 43%, all except one with functioning graft. The quality of life of the survivors was acceptable, only two requiring nursing care. It is concluded that renal transplantation in patients with diabetic nephropathy is justified in selected patients.
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PMID:Renal transplantation in patients with endstage diabetic nephropathy. 675 68

Forty diabetics who had developed end-stage renal failure from diabetic nephropathy and underwent renal transplantation have been followed up from one to six years. After one and two years 63% and 42% survived (45% and 33% respectively with functioning kidneys). Older patients, those with coronary and peripheral vascular disease, and those with severe neuropathy are prone to higher postoperative morbidity and mortality. The presence of advanced retinopathy, on the other hand, does not appear to influence the outcome.
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PMID:Renal transplantation in diabetics nephropathy. 681 42

Patients with diabetes mellitus may have any one of several forms of hypertension. These include essential hypertension, systolic hypertension of three varieties, the hypertension associated with diabetic nephropathy ("diabetic hypertension"), and the hypertension associated with neuropathy (supine hypertension with orthostatic hypotension). Because there are differences in the hypertensive mechanisms in each of these hypertensions, the use of antihypertensive medications should be tailored to the type of hypertension present. In this review, the rationale for treating hypertension in the diabetic will be discussed, the mechanisms of action and potential side effects of antihypertensive drugs peculiar to the diabetic will be outlined, and specific antihypertensive therapy programs based on the mechanisms involved in producing each of the hypertensions will be detailed.
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PMID:The hypertensions of diabetes. 714 May

Factors associated with an excessive rate of dialysis induced symptomatic hypotension (SH) were analysed in a population of 1110 patients treated by chronic haemodialysis in 32 French dialysis centres. Significant risk factors for SH were female sex, diabetic nephropathy as the primary renal disease, two weekly dialysis schedule instead of three, use of Coil type dialysers instead of parallel-flow or hollow-fibre dialysers, low dialysate osmolarity, low dialysate K, high body weight subtraction during sessions, low predialysis plasma proteins, high predialysis blood urea, and low nerve conduction velocity. On a statistical basis, the results show the predominance of volume depletion over dialysate composition or neuropathy.
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PMID:Epidemiology of dialysis induced hypotension. 732 60

Simultaneous kidney-pancreas transplantation represents an established method for the treatment of the diabetic patient with advanced renal failure. Continuous improvements of the surgical technique and of the immunosuppressive protocols resulted in 1-year graft survivals of the pancreas and the kidney of 75% and 85%, respectively. Currently the preferred surgical procedure is represented by the bladder drainage technique with a side-to-side duodenocystostomy. An intensive immunosuppressive regimen consisting of antilymphocytic antibodies, cyclosporine, azathioprine and steroids is mandatory to prevent and to treat rejection episodes. Graft rejection usually affects both kidney and pancreas concurrently; however, rejection generally manifests itself more distinct in the kidney, where it can be recognized and diagnosed much easier than in the pancreas. Simultaneous kidney-pancreas transplantation ensures normoglycaemia without the addition of exogenous insulin. Thereby, a substantial improvement in the quality of life can be attained. Furthermore, the transplantation of the pancreas leads to a stabilization of the neuropathy with a tendency towards improvement and effectively prevents the development of diabetic nephropathy in the simultaneously transplanted kidney. But no clear advantage has been shown for other diabetic complications like proliferative retinopathy and nephropathy. Compared to the transplantation of a kidney alone, one has to take into consideration a modest increase in patient morbidity due to the additional transplantation of the pancreas and to the more pronounced immunosuppressive therapy.
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PMID:[Advantages and disadvantages of combination kidney and pancreas transplantation]. 750 65

Mitochondrial dysfunctions of the muscle in diabetic amyotrophy and of the liver in diabetic fatty liver have been reported. We investigated mitochondrial gene mutations in three cases: (1) a patient with diabetic amyotrophy in the muscles of the lower extremities, and neuropathy; (2) 5 diabetics with myoatrophy, diabetic nephropathy, and chronic renal failure; and (3) an IDDM patient with a diabetic fatty liver. We identified a 5778-bp deletion (8214-13991) in mitochondrial DNA from the muscle and liver biopsy specimens by the primer shift PCR and PCR-direct sequence methods. It is speculated that 5778-bp deletion is due to homogeneous recombination in the 7-bp repeat sequence of TCCTAGA flanking the region deleted in the mitochondrial DNA. Determination of respiratory chain enzyme activities in fresh muscle mitochondria demonstrated the defect in complex I activity. The deletion covers areas coding ND3, ND4, ND4L, and ND5 in complex I. The 5778-bp deletion might cause a defect in mitochondrial oxidative phosphorylation and contribute to the pathogenesis of diabetic amyotrophy, myoatrophy with diabetic nephropathy, and chronic renal failure, as well as diabetic fatty liver in IDDM.
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PMID:A new mitochondrial DNA deletion associated with diabetic amyotrophy, diabetic myoatrophy and diabetic fatty liver. 760 16

The Diabetes Control and Complications Trial (DCCT) has demonstrated that intensive diabetes treatment delays the onset and slows the progression of retinopathy, nephropathy, and neuropathy in patients with IDDM. A detailed description of the effects of this treatment on diabetic nephropathy is presented here. In the primary prevention cohort, intensive treatment reduced the mean adjusted risk of the cumulative incidence of microalbuminuria (> or = 28 micrograms/min) by 34% (95% CI 2, 56%; P = 0.04). Furthermore, intensive treatment decreased the albumin excretion rate (AER) by 15% after the first year of therapy (6.5 vs. 7.7 micrograms/min, P < 0.001). Thereafter the rates of change for AER within each treatment group were no different from zero, retaining a constant difference in AER between groups in the trial. In the secondary intervention cohort with baseline AER < 28 micrograms/min, intensive therapy reduced the mean adjusted risk of microalbuminuria (> or = 28 micrograms/min) by 43% (95% CI 21, 58%; P < 0.0001); the risk of a more advanced level of microalbuminuria (> or = 70 micrograms/min) by 56% (95% CI 26, 74%; P = 0.002); and the risk of clinical albuminuria (> or = 208 micrograms/min) by 56% (95% CI 18, 76%; P < 0.01). In the secondary intervention cohort, values for AER at year 1 were identical at 9 micrograms/min, but the 6.5% change per year in the conventional group greatly exceeded the rate of change of -0.3% in the intensive group (P < 0.001). Among the 73 secondary cohort subjects with AER levels > or = 28 micrograms/min but < or = 139 micrograms/min at baseline, the reduction of progression to clinical albuminuria with intensive therapy was not statistically significant. The longitudinal treatment effect of conventional versus intensive therapy (11.0% vs. 2.5% per year, respectively, P = 0.087) was similar in magnitude to that among patients with AER < 28 micrograms/min at baseline. For the primary, secondary and combined cohorts, there were no significant differences in the rates of change in creatinine clearance (CCr) between treatment groups during the study. Only seven subjects in the entire study (2 intensive, 5 conventional) developed urinary AER > or = 208 micrograms/min coupled with a CCr < 70 ml/min/1.73 m2. Neither the rate of change of blood pressure nor the appearance of hypertension (BP > 140/90 mm Hg) differed significantly between treatment groups in the primary, secondary or combined cohorts.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. The Diabetes Control and Complications (DCCT) Research Group. 764 40

A series of recent observations have shown raised levels of plasma fibronectin (FN), an alpha 2-glycoprotein produced by vascular endothelia, in diabetic patients with retinopathy and overt nephropathy. However, there are no available data on urinary FN and behavior of its excretion in patients affected by diabetic nephropathy characterized by the presence of microalbuminuria. The main purpose of the present study was to investigate whether the urinary excretion of FN (U-FN) is associated with early diabetic nephropathy and other diabetic complications. Fifty-nine diabetic inpatients classified as type II and 15 age-matched control subjects were included in this study. The amount of U-FN, assessed as microgram/g creatinine/24 h, was significantly greater in the patients as a group (348.1 +/- 48.3), than in the controls (108.6 +/- 22.7, p < 0.01). Although patients with overt proteinuria showed an extremely high level of U-FN (1080.5 +/- 184.0; range 216.1 +/- 1726.8), mean U-FN tended to be higher in the group with microalbuminuria (262.4 +/- 21.9; range 101.9-591.9) than in the group without it (188.1 +/- 34.3; range 19.4 +/- 582.4, p < 0.08). In patients who did not have retinopathy and neuropathy, the U-FN was significantly higher in the group with microalbuminuria (222.5 +/- 28.5) than in the group without it (116.1 +/- 22.6, p < 0.01). A highly significant negative correlation existed between endogenous creatinine clearance values and the amounts of U-FN in the patients (r = -0.642, p < 0.01), while there was no such relationship in the controls (r = 0.167, p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Increased urinary fibronectin excretion in type II diabetic patients with microalbuminuria. 766 99

Captopril given in dosages of 25 mg reduced the doubling of serum creatinine levels by 48% in patients with insulin-dependent diabetes mellitus. Intensive insulin therapy in patients with IDDM delays the onset and slows the progression of diabetic nephropathy, retinopathy, and neuropathy.
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PMID:Nephrology. 775 21


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