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

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

We studied the effect of perindopril, administered for a period of 9 months, on renal function, albuminuria and glycemic control of diabetic subjects with mild-to-moderate hypertension. After 1 month of placebo, 40 insulin-treated patients were divided into 3 groups based on the level of albuminuria. Group I had normal albuminuria (less than 15 mg/24 hr), group II had pathological microalbuminuria (15-150 mg/24 hr) and group III had macroproteinuria (greater than 150 mg/24 hr). They were given perindopril (4 or 8 mg) once daily. Diastolic blood pressure was normalized within the first 3 months in 80% of the patients. Twenty-nine of these patients (13, 9 and 7 from groups I, II and III, respectively) were followed for a total treatment period of 9 months. They were matched for age, duration of diabetes and hypertension, daily insulin dose, systolic and diastolic blood pressures and quality of glycemic control. Diastolic blood pressure was decreased by 14 and 17% at 1 and 9 months, respectively. Heart rate was not significantly modified. At 3 months, the angiotensin converting enzyme activity was markedly inhibited, while plasma renin activity was increased. In patients in group II, microalbuminuria was reduced from 59 +/- 13 to 32 +/- 6 mg/24 hr after 1 month and this effect was maintained at 9 months. Despite similar decreases in blood pressure, no significant change in the albumin excretion rate was observed in patients in groups I and III. Creatinine clearance remained stable and glycemic control did not change throughout the study in the 3 groups. We conclude that perindopril normalizes blood pressure in a large majority of hypertensive diabetic patients without affecting the quality of diabetes control. It also induces a marked and sustained reduction in microalbuminuria in patients at risk of developing diabetic nephropathy.
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PMID:Renal function, glycemic control and perindopril in diabetic patients. 269 Nov 28

Favourable results with the use of inhibitors of the angiotension I-converting enzyme in the therapy not only of high-renin but also normo-renin and low-renin hypertension revived interest in research in the area of the renin-angiotensin (RAS) system. The use of classical radioimmunological, radiohistochemical receptor studies as well as of recent methods of molecular biology and pathology revealed that for the regulation of blood pressure and the extracellular volume and pathogenesis of hypertension not only RAS components in systemic blood are important but also local tissue RAS with an autocrine and paracrine action at the site of its origin. Cerebral RAS participates in the central cardiovascular regulation, in the control of the salt and water intake, the secretion of antidiuretic hormone and ACTH. In the cardiovascular apparatus RAS is responsible not only for vasoconstriction but it acts also as a growth factor promoting the development of cardiac and vascular hypertrophy. In the kidneys RAS decides on the blood flow, its distribution, glomerular filtration. Its excessive stimulation may contribute in arterial hypertension, diabetic nephropathy and in residual nephrons during chronic renal failure, to the change from functional hyperfiltration to irreversible structural damage of the nephron. Inhibitors of the converting enzyme not only reduce the peripheral vascular resistance in arterial hypertension but influence also the tissue production of angiotensin II and thus the regression of cardiovascular hypertrophy and progression of renal damage.
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PMID:[Renaissance of the renin-angiotensin system in the pathogenesis and therapy of arterial hypertension]. 280 32

Hypertension is more frequently found in patients with diabetes mellitus than in subjects with normal glucose tolerance. On the other hand, concomitant hypertension accelerates the progression of diabetic nephropathy. To examine whether human atrial natriuretic peptide (human ANF-[99-126], hANP) is involved into the pathogenesis of hypertension and nephropathy of diabetic patients and to find out whether the detection of increased hANP levels can serve as an early marker, helping to identify diabetic patients at increased risk of developing these diabetes complications, we studied 107 randomly selected patients with Type 1 or Type 2 diabetes mellitus (53 women, 54 men). There were no differences between patients with normal hANP levels and patients with hANP levels above normal range regarding age, diabetes duration, metabolic control, kidney function (creatinine clearance and proteinuria), electrolytes, and in plasma renin activity, aldosterone, epinephrine and norepinephrine levels in plasma. However, higher blood pressure was measured and antihypertensive therapy was found more frequently in patients with increased hANP levels (p less than 0.05). This was confirmed by analyzing the subgroup of patients with normal blood pressure without antihypertensive therapy: Again, diastolic blood pressure was found to be higher (p less than 0.05) in patients with elevated hANP than in patients with normal hANP levels. In this subgroup, increased creatinine clearance tended to be found more frequently among patients with increased hANP levels.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[What pathophysiologic significance does increased plasma levels of human atrial natriuretic peptide have in patients with diabetes mellitus?]. 297 Jan 66

Hypertension in patients with diabetes mellitus increases the risk of both macrovascular and microvascular complications. Such microvascular complications as diabetic nephropathy and retinopathy are accelerated in the presence of arterial hypertension. Evidence suggests that the complications of diabetes mellitus begin early in the course of the disorder as manifested by microalbuminuria and increased vascular reactivity. These findings are accompanied by changes in the renin-angiotensin-aldosterone system including reductions in plasma renin activity. These changes could be secondary to volume expansion that may be a direct consequence of elevated blood glucose, suggesting that the metabolic disorder in diabetes contributes to the etiology of hypertension in these patients. Adequate treatment of hypertension is crucial to the prevention of complications; however, many antihypertensive agents have limited usefulness in diabetes mainly because of their unfavorable side effects. Diuretics lower blood pressure in hypertensive diabetics, but their metabolic effects are especially undesirable in this population. beta-Blockers alter glucose and lipid metabolism in diabetic patients and reduce regional blood flow. Central acting agents and alpha-blockers are often associated with orthostatic hypotension, sexual dysfunction, and central nervous system side effects. Angiotensin-converting enzyme inhibitors (ACEIs) such as captopril effectively lower blood pressure in diabetic patients and have few unwanted effects. They may improve metabolic control and have favorable effects on glucose metabolism. The ACEIs also produce improved regional hemodynamics which may lead to the improvement in or prevention of the progression of diabetic nephropathy.
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PMID:Management of hypertension in the patient with diabetes mellitus. Focus on the use of angiotensin-converting enzyme inhibitors. 305 49

The influence of angiotensin II on kidney function in diabetic nephropathy was assessed by studying the effect of 12 weeks' monotherapy with captopril (25-50 mg twice a day) in 16 hypertensive insulin dependent diabetic patients with persistent albuminuria. In an initial one week randomised single blind trial of captopril versus placebo, captopril (for nine patients) reduced arterial blood pressure from 148/94 (SD11/6) to 135/88 (8/7) mm Hg (p less than 0.05) and albuminuria from 1549 (range 352-2238) to 1170 (297-2198) micrograms/min (p less than 0.05), while glomerular filtration rate remained stable. No significant changes occurred in seven patients treated with placebo. During the 12 weeks of captopril treatment arterial blood pressure in all patients fell from 147/94 (11/6) to 135/86 (13/7) mm Hg (p less than 0.01), albuminuria fell from 1589 (range 168-2588) to 1075 (35-2647) micrograms/min (p less than 0.01), and glomerular filtration rate fell from 99 (SD19) to 93 (25) ml/min/1.73 m2 (p less than 0.01). The renin-angiotensin system showed suppressed plasma concentrations of angiotensin II and increased concentrations of angiotensin I and renin. The study showed that glomerular filtration rate is not dependent on angiotensin II, that captopril reduces albuminuria, probably by lowering glomerular hypertension, and that captopril represents a valuable new drug for treating hypertension in diabetics dependent on insulin with nephropathy.
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PMID:Effect of captopril on kidney function in insulin-dependent diabetic patients with nephropathy. 309 Nov 64

In 83 diabetic patients (23 of them were insulin-dependent) and 34 healthy subjects the influence of water immersion (WI) for 2 hrs on plasma renin activity (PRA), plasma aldosterone and vasopressin (AVP) level was examined. In both examined groups WI exerted a suppressive effect on PRA, plasma aldosterone and AVP level. In this respect only quantitative but not qualitative differences between diabetics and normals were observed. Presence of moderately advanced diabetic nephropathy and autonomic neuropathy influenced only slightly WI induced alterations of the renin-aldosterone system and AVP secretion. In all diabetic patients a defective volumetric mechanism of both the renin-aldosterone system and AVP secretion was stated. In addition in diabetic patients with late diabetic complications a defective osmotic mechanism of AVP secretion was observed. These findings suggest participation also of factors other than hypervolemia and decrease of the plasma osmolality in the mechanism of the observed WI induced suppression of the renin-angiotensin system and AVP secretion in diabetic patients.
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PMID:[Effect of water immersion on plasma renin activity, vasopressin and aldosterone level in diabetics]. 331 Apr 25

The renal response to volume expansion produced by water immersion to the neck at 35 degrees C was examined in eight young normotensive uncomplicated insulin-dependent diabetic subjects and in eight matched normal control subjects. Both the diabetic and normal subjects manifested a renal response of natriuresis and kaliuresis on immersion, but the natriuretic response was reduced in the diabetic group. Thus the induced excretion of sodium over the 4 h of immersion was 40 +/- 5 mmol (mean +/- SEM) in the normal group compared with 22 +/- 4 mmol in the diabetic group (P less than 0.02). In the normal subjects creatinine clearance did not change during immersion compared with pre-immersion control values while in the diabetic group it rose from pre-immersion control values of 112 +/- 11 ml/min to a mean value of 127 +/- 11 ml/min during immersion (P less than 0.01). The diabetic subjects thus excreted less sodium despite an increased filtered load during water immersion. Fractional excretion of sodium was significantly reduced in the diabetic subjects compared with the normal control subjects (P less than 0.05). The suppression of plasma renin and aldosterone was similar in normal and diabetic groups. Tubular sodium retention could be an early functional change in the diabetic kidney, and be implicated in the development of diabetic nephropathy.
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PMID:Impaired sodium excretion in response to volume expansion induced by water immersion in insulin-dependent diabetes mellitus. 353 Jun 11

A patient with cirrhosis and coexistent hyporeninemic hypoaldosteronism secondary to diabetic nephropathy rapidly formed ascites despite marked reductions in plasma aldosterone concentration and urinary aldosterone excretion. To my knowledge, this association has not been previously reported. This case supports the concept that hyperaldosteronism is not a necessary component of the salt retention of advanced liver disease. Furthermore, it suggests that certain renal disorders should be considered in cases of cirrhosis and ascites with decreased plasma renin activity.
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PMID:Hyporeninemic hypoaldosteronism in a patient with cirrhosis and ascites. 353 21

The objective of this study was to examine total exchangeable sodium, plasma-blood volume, and the status of the renin-angiotensin system in hypertensive diabetic patients with established nephropathy. We also evaluated hypertensive patients with diabetes who were free of clinically apparent nephropathy or other diabetic complications. Total exchangeable sodium (by 24Na dilution) was expressed as percentage predicted. Subjects were studied as inpatients receiving unrestricted sodium intake and in stable metabolic control. Total exchangeable sodium was 100 +/- 2% in controls (n = 42), higher (p less than 0.01) at 108 +/- 2% in normotensive patients with diabetes (n = 30), and higher still (p less than 0.005) in hypertensive patients with diabetic nephropathy (n = 16) 118 +/- 4% (p less than 0.05 vs normotensive diabetics). The value correlated with blood pressure only in diabetics with nephropathy (r = 0.61, p less than 0.01). Plasma renin activity, and blood and plasma volumes were similar in nephropathic diabetics and controls. Hypertensive patients with maturity-onset (type II) diabetes free of nephropathy (n = 18) were compared with nondiabetic controls (n = 16) and normotensive patients with type II diabetes (n = 18) of similar age. Total exchangeable sodium in the controls was 100 +/- 3%, higher (p less than 0.01) in normotensive diabetics at 109 +/- 2%, but not significantly elevated in hypertensive diabetics at 106 +/- 2%. Again, blood and plasma volumes did not differ among the groups. Plasma renin activity was suppressed (p less than 0.01) to a comparable degree in both normotensive and hypertensive patients with type II diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Exchangeable sodium and renin in hypertensive diabetic patients with and without nephropathy. 390 21


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