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

The incidence of end-stage renal disease (ESRD) in the US is rising at an alarming rate, with the largest increase among African-American populations. The key risk factors for kidney disease are hypertension and diabetes, which are both becoming more prevalent in the US, and particularly in African Americans. Although African Americans make up 12.6% of the US population, the incidence of diabetes-related ESRD is four times higher than for whites, and the prevalence of ESRD due to hypertension is twice that of white patients. Approximately 30 to 40% of all patients with diabetes will develop nephropathy and many will progress to ESRD, necessitating dialysis or kidney transplantation. Recent studies in patients with type 2 diabetes indicate a significant delay in progression or development of diabetic nephropathy following blockade of the renin-angiotensin-aldosterone system with the use of angiotensin receptor antagonists. Early intervention in patients with hypertension is necessary to prevent kidney damage, and data from the African American Study of Kidney Disease and Hypertension suggest that angiotensin-converting enzyme inhibitors are effective in this population. Although African-American patients receiving hemodialysis appear to have increased survival compared with whites, racial factors and poor access to medical care contribute to the increased risk of kidney disease in minorities. A concerted effort is necessary to raise awareness in minority populations and provide strategies for prevention and early treatment thereby attenuating the increasing prevalence of kidney failure in these groups.
 ...
PMID:Diabetes mellitus and hypertension: key risk factors for kidney disease. 1215 17

Angiotensin II not only is a vasoconstrictor, but it also affects cell growth and apoptosis, inflammation, fibrosis, and coagulation. Blockade of the renin-angiotensin system, either with inhibitors of the generation of angiotensin (angiotensin-converting enzyme [ACE] inhibitors) or with blockers of angiotensin receptors, reduces blood pressure and inhibits other pathophysiological actions. These other effects provide benefits in coronary heart disease, heart failure, diabetic nephropathy, and stroke beyond blood pressure reduction. These benefits were first demonstrated with ACE inhibitors. However, the mechanism of action of angiotensin receptor blockers, which block angiotensin II stimulation at the angiotensin type 1 receptor but not at the type 2 receptor, may have advantages, particularly for endothelial dysfunction and vascular remodeling, as well as cardiac and renal protection. Recent multicenter trials suggest that ACE inhibitors and angiotensin receptor blockers may reduce morbidity and mortality associated with cardiovascular and renal disease beyond blood pressure reduction. Several studies with different angiotensin receptor blockers, including comparisons with ACE inhibitors, are under way, and should provide further guidance for their clinical use.
 ...
PMID:Vascular and cardiac benefits of angiotensin receptor blockers. 1240 36

The renin-angiotensin-aldosterone system (RAAS) is committed to the regulation of circulatory homeostasis. This system, present in the majority of animal species, is constituted by several elements which behave as effectors able to increase their levels in response to the reduction of the intravascular volume and to the decrease of the renal perfusion. In turn, RAAS is regulated by a number of mechanisms. In our review a historical view precedes the description of the major functions of RAAS, i.e. the regulation of arterial pressure and the control of the hydroelectrolytic homeostasis. The evolution of the achievements about the angiotensin I converting enzyme is reviewed and the currently investigated relationship between RAAS and hemostatic system is assessed. The historical perspective of this review is useful to follow the key passages leading from clinical research to evidence-based therapeutic applications, in particular to the development of ACE-inhibitors. The evaluation of the rationale of ACE-inhibitors therapy in the treatment of arterial hypertension, acute myocardial infarction, heart failure, and diabetic nephropathy, and a discussion of the angiotensin receptor blockers, close the review.
 ...
PMID:[The renin-angiotensin-aldosterone system, angiotensin I converting enzyme, and the ACE-inhibitors. Historical perspective and recent findings]. 1240 14

The available evidence on renal protection in type 2 diabetes mellitus favors the administration of an angiotensin receptor blocker (ARB) more than that of an angiotensin converting enzyme inhibitor (ACEi). This evidence is based on recent studies showing that losartan and irbesartan can prevent the development of overt diabetic nephropathy in microalbuminuric type 2 diabetic patients as well as slow the velocity of progression to end-stage renal disease in patients with overt type 2 diabetic nephropathy. These studies do not deny the possibility that ACEi are equally effective, but studies of an adequate magnitude are lacking. These findings on ARB administration do not preclude the importance of strict control of blood pressure and proteinuria and/or albuminuria to avoid or retard renal damage in type 2 diabetic patients.
 ...
PMID:Angiotensin blockade in type 2 diabetic renal disease. 1241 Aug 57

Diabetes mellitus increases the risk for hypertension and associated cardiovascular diseases, including coronary, cerebrovascular, renal and peripheral vascular disease. The risk for developing cardiovascular disease is increased when both diabetes and hypertension co-exist; in fact, over 11 million Americans have both diabetes and hypertension. These numbers will continue to climb, internationally, since the leading associated risk for diabetes development, obesity, has reached epidemic proportions, globally. Moreover, the frequent association of diabetes with dyslipidemia, as well as coagulation, endothelial, and metabolic abnormalities also aggravates the underlying vascular disease process in patients who possess these comorbid conditions. The renin-angiotensin-aldosterone system (RAS) and arginine vasopressin (AVP) are overactivated in both hypertension and diabetes. Drugs that inhibit this system, such as ACE inhibitors and more recently angiotensin receptor antagonists (ARBs), have proven beneficial effects on the micro- and macrovascular complications of diabetes, especially the kidney. The BRILLIANT study showed that lisinopril reduces microalbuminuria better than CCB therapy. Numerous other long-term studies confirm this association with ACE inhibitors including the HOPE trial. Furthermore, the European Controlled trial of Lisinopril in Insulin-dependent Diabetes (EUCLID) study, showed that lisinopril slowed the progression of renal disease, even in individuals with mild albuminuria. In fact, there are now five appropriately powered randomized placebo-controlled trials to show that both ACE inhibitors and ARBs slow progression of diabetic nephropathy in people with type 2 diabetes. These effects were shown to be better than conventional blood pressure lowering therapy, including dihydropyridine CCBs. In patients with microalbuminuria, ACE inhibitors and ARBs reduce the progression of microalbuminuria to proteinuria and provide a risk reduction of between 38 and 60% for progression to proteinuria. This is important since microalbuminuria is known to be associated with increased vascular permeability and decreased responsiveness to vasodilatory stimuli. Recently, increased AVP levels have been lined to microalbuminuria and hyperfiltration in diabetes. The microvascular and macrovascular benefits of ACE inhibition, ARBs and possible role of AVP antagonists in diabetic patients will be discussed, as will be recommendations for its clinical use.
 ...
PMID:Treatment of the diabetic patient: focus on cardiovascular and renal risk reduction. 1243 44

Angiotensin-converting enzyme inhibitors (ACEIs) are an important class of drugs in cardiovascular disease. As their name suggests, they act by blocking angiotensin converting enzyme, thereby limiting the production of angiotensin II, the most active component of the renin-angiotensin- aldosterone system. This system plays an important role in maintenance of blood pressure and electrolyte and fluid balance. Therefore, by blocking this system, the ACEIs have wide ranging effects. Recent trials have reaffirmed their place in the management of hypertension, congestive cardiac failure, in the prevention of renal complications in diabetes and the prevention of strokes in 'at risk' patients. There are still many ongoing trials using the ACEIs. These trials are mainly aimed at comparing their efficacy with 'older' drugs (such as betablockers) and 'newer' drugs such as the angiotensin receptor blockers and calcium antagonists in different indications, such as heart failure and diabetic nephropathy. The impact of these drugs on the prevention of macro- and micro vascular complications in diabetes is also being investigated. The results of all these trials, when available, are expected to reaffirm the important role of this class of drugs in our modern day medical armamentarium. In this review, the ongoing clinical trials involving ACEIs, the rationale behind these trials and what impact they hope to have on our current understanding of the role of this important class of drug in medical practice, will be discussed.
 ...
PMID:Ongoing trials involving angiotensin-converting enzyme inhibitors. 1243 9

Diabetic nephropathy is the number one cause of endstage renal disease in the United States. Blockade of the renin angiotensin system (RAS) is important in the treatment of diabetic nephropathy. With the reports of recently completed trials examining the role of angiotensin receptor blockers (ARBs) in type 2 diabetic nephropathy, the question has arisen as to which agents are best to block the RAS in type 2 diabetes. ACE inhibitors have been to preserve renal function in type 1 diabetics with nephropathy in large, randomized, placebo controlled trials, but such data is lacking in type 2 diabetes. Neverthelesss, ACE inhibitors have been recommended for use in type 2 diabetic nephropathy for some time. In type 2 diabetics, ACE inhibitors may have a role in preventing development of nephropathy, and, importantly, ACE inhibitors have been shown to reduce cardiovascular disease in diabetics with and without nephropathy. In addition, ACE inhibitors have beneficial effects on other diabetic complications such as retinopathy and neuropathy. Until better comparative data between ACE inhibitors and ARBs on nephropathy and cardiovascular outcomes is available, ACE inhibitors should remain an important consideration for treatment of diabetic nephropathy.
 ...
PMID:Therapeutic controversies in hypertension management: angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers for diabetic nephropathy? A case for ACE inhibitors. 1247 55

In the past few years diabetes has become the leading cause of end-stage renal disease in all Western countries. A correlation between blood pressure and rate of progression in diabetic nephropathy was noted very early, and increased local activity of the renin angiotensin system was identified as a major pathophysiological mechanism for proteinuria and nephrosclerosis in diabetic patients. Angiotensin converting enzyme (ACE) inhibitors have been shown to slow progression of nephropathy in type 1 diabetic patients. The majority of diabetic patients with nephropathy, however, are suffering from type 2 diabetes and until last year there was no convincing evidence of ACE inhibitors being able to slow progression in type 2 diabetic patients with nephropathy. Three new studies now fill this gap, showing that angiotensin receptor blockers (ARB) are nephroprotective in patients with type 2 diabetes, independently of blood pressure. This review provides an in-depth discussion of the results of these studies and provides recommendations for patient management.
 ...
PMID:Angiotensin receptor antagonists in patients with nephropathy due to type 2 diabetes. 1255 90

Angiotensin receptor blockers are a new class of agents that have made a major contribution to the treatment of hypertension. These agents effectively reduce blood pressure and are well tolerated. Other clinical trials have focused, however, on the much wider use of angiotensin receptor blockers in conditions such as congestive heart failure, postmyocardial infarction management, and diabetic nephropathy. Recent studies have provided evidence that these agents might confer target organ protection in hypertension that is equal to, and possibly better than, the benefits provided by conventional antihypertensive agents. Moreover, there is now little doubt that these drugs are effective alternatives to ACE inhibitors in heart failure and will become treatments of choice for patients with type 2 diabetes and nephropathy. Cardiovascular study outcomes have still not determined, however, whether high-risk patients would do better on angiotensin receptor blockers or angiotensin converting enzyme (ACE) inhibitors or a combination of both, except in cases of intolerance to ACE inhibitors.
 ...
PMID:The angiotensin II receptor blockers: opportunities across the spectrum of cardiovascular disease. 1255 52

Diabetes mellitus is the leading cause of end-stage renal disease and also increases the risk of atherosclerotic vascular disease. Hypertension amplifies both problems. Detection of microalbuminuria, a common and early manifestation of diabetic nephropathy and a marker for cardiovascular risk, permits early treatment to reduce progression of nephropathy and vascular disease in diabetes. Although optimal glycemic control is essential to reduce the risk of nephropathy, aggressive blood pressure lowering to a level of 130/80 mg Hg or below in hypertensive diabetic patients is as important as glycemic control. Initial drug therapy for nephropathy should include an angiotensin-converting enzyme inhibitor (or if contra-indicated, an angiotensin receptor blocker), as several large randomized double-blinded multicenter clinical trials have demonstrated an independent renoprotective effect with renin angiotensin system inhibition. The role of advanced glycation end products in the pathogenesis of renal and vascular disease in diabetes is becoming more clearly established. However, the use of therapeutic strategies directed at blocking their effect still awaits further investigation. A multifaceted intervention program that combines optimal glycemic control, lifestyle modification/cardiovascular prevention guidelines such as lipid control and smoking cessation, with appropriate antihypertensive therapy when indicated, will prevent or delay both the occurrence and progression of diabetic nephropathy.
 ...
PMID:Combating diabetic nephropathy with drug therapy. 1264 11


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>