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)

This study was conducted to determine whether circulating levels of lipoprotein (a), an independent risk factor of macrovascular disease, are increased in non-insulin-dependent diabetes mellitus (NIDDM) patients with microalbuminuria who have an increased risk of cardiovascular mortality. Apolipoprotein (a) [apo(a)] levels and phenotypes, and other circulating lipid levels were determined in 227 Chinese NIDDM patients with varying stages of diabetic nephropathy. None was on lipid-lowering therapy. Apo(a) levels in normoalbuminuric (geometric mean 166 U/L; 95% confidence intervals 137, 200; n = 105) and microalbuminuric patients (162; 132, 209; n = 77) were similar to values in controls (166; 143, 193, n = 168). Albuminuric patients, however, had higher apo(a) levels than both normoalbuminuric patients and controls (242; 184, 317; n = 45; P < 0.05). The overall size range of the apo(a) phenotypes and the frequency of having at least one small isoform, i.e. < 700 kDa, were similar among the four groups of subjects. A positive correlation was found between log apo(a) and log plasma creatinine levels (P < 0.01). Compared to normoalbuminuric patients, both microalbuminuric and albuminuric patients were older (P < 0.01) and had higher HbA1c (P < 0.01), greater BMI (P < 0.05) and longer disease duration (P < 0.05) compared to normoalbuminuric patients. Nevertheless, using multiple linear regression analysis, it was found that the presence of nephropathy conferred an independent influence on increasing total cholesterol (P < 0.001), triglyceride (P < 0.001) and apoB (P < 0.01), and decreasing HDL cholesterol (P < 0.05) levels even when only the normoalbuminuric and microalbuminuric groups were analysed. The prevalence of macrovascular disease was significantly increased in microalbuminuric and albuminuric patients (45.1 and 48.7% respectively vs 20.2% in normoalbuminuric patients, P < 0.01). It is concluded that circulating apo(a) levels were not increased in Chinese NIDDM patients with microalbuminuria. However, atherogenic changes in other lipid and lipoprotein levels may contribute to an increased risk of macrovascular disease in these patients.
Nephrol Dial Transplant 1996 Nov
PMID:Apolipoprotein (a) levels and phenotypes in NIDDM patients with microalbuminuria and albuminuria. 894 83

The role that advanced glycosylation end-products (AGEs) may play in the development of diabetic nephropathy is still not completely understood. In order to elucidate the nature of their effect, the consequences of exogenously administered AGEs on extracellular matrix gene expression were examined in mice by competitive PCR. Normal adult mice receiving repeated injections of AGEs had an increase in the expression of genes coding for type IV collagen and laminin in the glomeruli. The increase was accompanied by up-regulation of TGF-beta 1 but not PDGF-B expression. The expression of smooth muscle and beta-actin did not change, showing that the increase in gene expression was specific for genes implicated in the early stages of diabetic nephropathy. The co-administration of aminoguanidine, a drug that inhibits AGEs cross-links, prevented the up-regulation of gene expression in AGEs-injected mice. Thus, AGEs can induce extracellular matrix genes in the absence of hyperglycaemia.
Nephrol Dial Transplant 1996
PMID:Administration of AGEs in vivo induces extracellular matrix gene expression. 904 10

Glycation of proteins is regarded as one of the major causes of the development and progression of diabetic nephropathy. Based on the numerous reports on experimental models and on our own newly developed techniques, we planned to localize Amadori products and advanced glycation end-products (AGEs), as well as the mRNA expression of cytokines, enzymes and their inhibitors, which are responsible for the expansion of the mesangial areas of the glomeruli. Ten patients with diabetic nephropathy were examined. Patients with immunoglobulin (Ig) A nephropathy and normal portions of the surgically removed kidneys served as controls. Amadori products and AGEs in biopsy specimens were stained by specific monoclonal antibodies, and mRNA expression of the above substances was detected by in situ hybridization. There was a parallel progression in the degree of staining with anti-Amadori product antibody or anti-AGE antibody with the severity of tissue damage in patients with diabetic nephropathy. Patients with IgA nephropathy and normal renal tissues did not show any positive staining with these antibodies. The expression of transforming growth factor beta 1, stromelysin and tissue inhibitor of matrix proteinase 1 in the glomeruli was decreased in diabetic patients with advanced tissue damage, but they were progressively expressed in the advanced stage of IgA nephropathy. It is concluded that Amadori products and of AGEs were formed in parallel in diabetic kidneys. The decrease in the expression of the cytokine and enzymes might be due to altered protein formation associated with glycation.
Nephrol Dial Transplant 1996
PMID:Localization of glycated proteins in the glomeruli of patients with diabetic nephropathy. 904 11

Available data indicate that the development of diabetic nephropathy is linked to hyperglycaemia. Glucose reacts nonenzymatically with proteins to form Schiff base and Amadori products. Further incubation of these early products leads to the formation of advanced glycation end-products (AGEs). AGEs seem to play a central role in the progression of diabetic nephropathy. Immunohistochemically, AGEs were also detected in an expanded mesangial matrix, especially in nodular lesions from patients with diabetic nephropathy. AGEs staining was noted in the Bowman's capsule, periglomerular fibrosis in sclerosing glomeruli. In our ultrastructural study of mesangial matrix from patients with diabetic nephropathy by high-resolution scanning electron microscopy after cellular removal, the meshwork structure was evident at higher magnification. In nodular lesions, the loose meshwork structure appeared to be composed of various sized strands, ranging from 6 to 24 nm (mean +/- SD: 11.4 +/- 3.8 nm). The pore sizes were variable, ranging from 4 to 70 nm (mean +/- SD: 23.6 +/- 12.3 nm), and were statistically larger than those of normal controls. As the AGEs are localized most notably in nodular lesions, advanced glycations play a role in the progression of diabetic nephropathy through impairment of the assembly of matrix proteins in vivo. Because type V and type VI collagens are the major components of nodular lesions, increases in these interstitial and fibril or microfibril collagens may contribute to the formation of wider strands in the mesangial matrix of a nodular lesion. As no metalloprotease that is specific for type VI collagen has been identified thus far, AGEs formation might occur preferentially in type VI collagen-rich nodular lesions, which are sites of slow turnover.
Nephrol Dial Transplant 1996
PMID:Roles of advanced glycation end-products in the progression of diabetic nephropathy. 904 13

Formation and deposition of advanced glycation end-products (AGEs) has been linked to late diabetic complications. Interactions of AGEs are at least partly mediated by binding of AGEs to their cellular surface receptor RAGE. This review summarizes the immunohistological data obtained for RAGE distribution in vessel segments of diabetic and non-diabetic patients with peripheral occlusive vascular disease and in kidneys of patients with diabetic nephropathy, and inflammatory and non-inflammatory renal disease. It is demonstrated that increased RAGE expression is not restricted to diabetes mellitus but contributes to a range of vascular and renal disorders.
Nephrol Dial Transplant 1996
PMID:Expression of receptors for advanced glycation end-products in occlusive vascular and renal disease. 904 15

Advanced glycation end-products (AGEs) are the pigmented and fluorescent adduct formed by a non-enzymatic reaction between sugar and protein. Since AGEs are generated in high glucose milieu, then induce the structural and functional alteration of matnx proteins, and have biological effects on various kinds of cells including mesangial cells, AGEs have been implicated in tissue damage of diabetic nephropathy. To elucidate the factor(s) that determine the AGEs level in diabetic nephropathy, we quantitated the plasma pentosidine level of different status of diabetic nephropathy by HPLC assay. The plasma pentosidine level in diabetic nephropathy was found to be determined by factors such as renal function control of glucose and the patient's age; of these, renal function was the most critical factor. For a better understanding of the pathological role of AGEs in diabetic nephropathy, we then examined renal tissues of diabetic nephropathy immunohistochemically using antibodies specific for AGE proteins. Immunohistochemistry revealed the positive immunostaining for AGEs in the expanded mesangial area of diffuse diabetic glomerulosclerosis. The degree of staining was stronger than that in patients of IgA nephropathy with a similar degree of mesangial expansion. The nodular lesions, characteristic of diabetic nephropathy, were also stained positive for AGEs. These findings suggests a potential link of AGEs accumulation, which may be determined by renal function, control of glucose and age, to renal tissue damage in diabetic nephropathy.
Nephrol Dial Transplant 1996
PMID:Advanced glycation end-products in diabetic nephropathy. 904 16

Renal replacement therapy of the next decade in Europe will be strongly influenced by certain epidemiological developments, which can be observed in some parts of the world since several years. The overall incidence rates of new patients will rise up to 300 pmp per year, the prevalence rates of patients on treatment will exceed 1000 pmp in some European countries as well as in Japan and in the USA. This is due to a more than proportional increase in the acceptance rates for people older than 65, mostly patients with type II diabetes and hypertensive nephropathy. In Europe, the proportion of patients with NIDDM and diabetic nephropathy shows marked regional differences, which may be more or less important for the development of the whole patient population. Since diabetes as well as hypertensive disease are conditions with high risks for non-renal complications, one cannot expect important improvements in patient survival in spite of technical developments in dialysis therapy.
Nephrol Dial Transplant 1996
PMID:Future evolution of the ESRD patient population--a perspective for the year 2000. 904 43

In recent years there has been a dramatic increase of almost epidemic proportions in the incidence of patients with type II diabetes mellitus who reach end-stage renal failure and enter renal replacement programmes. This is mainly due to the greater prevalence and better survival of patients with type II diabetes and diabetic nephropathy. Against this background measures to prevent the appearance and progression of diabetic nephropathy are of immense interest. Apart from the undoubted role of hyperglycaemia, the importance of genetic determinants of nephropathy has recently been recognized. Factors of proven or suspected efficacy in attenuating progression include: hypertension, hyperglycaemia, smoking and proteinuria. The role of dietary protein intake is less well documented. Nephropathy in type II diabetes has become the single most common cause of end-stage renal failure in Germany and is today a major challenge to clinical nephrology.
Nephrol Dial Transplant 1996
PMID:Nephropathy of type II diabetes mellitus. 905 34

The role of the insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE) gene in the genesis of diabetic nephropathy has been controversial. It has recently been proposed that progression occurs more rapidly in individuals with diabetic and non-diabetic renal disease who are homozygous for the D allele. We studied 658 patients with type II diabetes, 347 without diabetic nephropathy and 311 with various stages of diabetic nephropathy, and determined the I/D polymorphism of the ACE gene. Patients at the extremes of renal risk, i.e. normotensive patients without antihypertensive treatment and without nephropathy (n = 144), vs patients on dialysis (n = 61), differed with respect to genotype (DD 36.8% vs 57.4%; P = 0.007) and allele frequencies (D 0.59 vs 0.76; P < 0.001). In contrast, patients with and without presumed nephropathy as assessed by albuminuria did not differ with respect to DD genotype. In conclusion, in this study, which was limited by sample size, patients with the highest renal risk more frequently had the DD genotype. This would be compatible with a greater risk of (or rate of) progression to end-stage renal failure.
Nephrol Dial Transplant 1997 Mar
PMID:Excess of DD homozygotes in haemodialysed patients with type II diabetes. The Diabetic Nephropathy Study Group. 907 19

Mesangial cells are responsible for the synthesis of mesangial matrix as well as its degradation, which is mediated by a number of proteolytic activities, including metalloproteinases (MMPs). Imbalanced matrix protein metabolism may be responsible for mesangial expansion and glomerulosclerosis in diabetic nephropathy. Heparin prevents this complication. In human and murine mesangial cell cultures, RT-PCR was able to detect mRNA expression for a number of molecules involved in the mesangial extracellular matrix turnover: type IV collagen [alpha 1(IV)COLL], MMP-1, MMP-2, MMP-3, MMP-9 and MMP-10, and the tissue inhibitors TIMP-1 and TIMP-2. The expression of mRNA for alpha 1(IV)COLL and MMP-2/TIMP-2 balance was studied in human cells in the presence of high glucose and heparin. mRNAs for all the studied molecules were expressed at different levels. Interestingly, a shift in the balance of alpha 1(IV)COLL, MMP-2 and TIMP-2 was observed in high glucose, which was partially reversed by heparin supplementation. The new equilibrium was mostly due to the down-regulation of type IV collagen expression, rather than further reduction of potential proteolysis. Our data, while extending the list of potential mediators of mesangial matrix catabolism, highlight a molecular mechanism by which the pathogenesis of diabetic nephropathy may be sustained, and at the same time suggest that heparin may have the potential to correct this abnormality.
Nephrol Dial Transplant 1997 Mar
PMID:Effect of glucose and heparin on mesangial alpha 1(IV)COLL and MMP-2/TIMP-2 mRNA expression. 907 22


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