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 roles of potential risk factors for background and proliferative retinopathy were evaluated in cross-sectional analyses from the Epidemiology of Diabetes Complications Study, Pittsburgh, Pennsylvania. This report presents results from the 657 insulin-dependent diabetic participants seen at the baseline examination (1986-1988). The presence of and severity of retinopathy were judged from stereoscopic photographs of three views of the ocular fundus using the modified Airlie House classification system. Fifty-three percent of the participants had background retinopathy, and 31% had proliferative retinopathy. Logistic regression analyses showed that among participants aged less than 18 years, those with background retinopathy were older and had higher levels of glycosylated hemoglobin compared with those without retinopathy. In the 18-29-year age group, participants with background retinopathy had a longer duration of diabetes, higher low density lipoprotein (LDL) cholesterol levels, and lower high density lipoprotein cholesterol levels and were more likely to have microalbuminuria compared with those without retinopathy. Participants aged 18-29 years with proliferative retinopathy had a longer duration of diabetes, higher diastolic blood pressure, and higher fibrinogen and LDL cholesterol levels than those with background retinopathy. In the age group greater than or equal to 30 years, diabetes duration, diastolic blood pressure, and fibrinogen, LDL cholesterol, and triglyceride levels were increased in participants with proliferative retinopathy versus those with background retinopathy. In a multivariate model of proliferative retinopathy, controlling for concurrent renal disease weakened the influence of blood pressure, fibrinogen, triglycerides, and LDL cholesterol and improved the overall fit of the model. These results suggest that diabetic nephropathy may contribute to the development of proliferative (but not background) retinopathy by increasing blood pressure and fibrinogen, by altering the lipoprotein profile, and possibly through other mechanisms.
 ...
PMID:The epidemiology of diabetes complications study. IV. Correlates of diabetic background and proliferative retinopathy. 199 2

Parameters of fibrinolysis, including plasminogen, alpha 2 plasmin-inhibitor (alpha 2 PI), tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) antigens, and fibrinogen were assayed in 53 patients (28 women and 27 men; mean age: 64 years, age range: 32-87 years) with non-insulin-dependent diabetes mellitus (NIDDM). The control group was similarly aged (mean age: 60.4 years, age range: 38-81). The levels of t-PA and t-PA/PAI-1 ratio of the diabetic group (mean +/- SD; 9.8 +/- 4.3 ng/ml, 0.94 +/- 0.47, respectively) were significantly higher than that of the control group (5.5 +/- 2.5 ng/ml, 0.51 +/- 0.23, respectively). The increased levels of t-PA antigen and t-PA/PAI-1 ratio in diabetics mean that free t-PA has been released. However, there was no significant difference in the level of PAI-1 between the diabetic group (12.9 +/- 6.4 ng/ml) and the control group (12.1 +/- 5.6 ng/ml). Levels of fibrinogen, plasminogen and alpha 2 PI in plasma were not different in the two groups. Duration of the disease, levels of glycosylated hemoglobin, differences in treatment and presense of diabetic nephropathy or retinopathy did not affect the fibrinolytic parameters. The levels of fibrinogen was higher in those with nephropathy than in the diabetics without nephropathy and retinopathy (p less than 0.05). There were no significant differences in the levels of t-PA, t-PA/PAI-1 ratio and PAI-1 between younger (less than 65 years) and older (65 years or more) subjects, in either the control or diabetic groups.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Tissue-type plasminogen activator and its inhibitor (PAI-1) in plasma in cases of non-insulin-dependent diabetes mellitus (NIDDM)]. 212 12

The prevalence of microalbuminuria and persistent proteinuria was studied in a population of 801 diabetic patients (535 with type II and 266 with type I diabetes). Urinary albumin excretion rate (AER) was measured on morning samples by laser nephelometry. Normoalbuminuria, as defined, in the absence of contaminated urine, by an albumin: creatinine (A/C) ratio below 2, was found in 551 patients, microalbuminuria (NC greater than or equal to 2 with AER below 200 mg/l) in 190 patients and persistent proteinuria (AER greater than or equal to 200 mg/l) in 60 patients. Microalbuminuria was present in 48 (18 p. 100) IDDM patients and 142 NIDDM patients. In IDDM patients, AER increased with the duration of the disease with no apparent influence of age at the onset. The prevalence of hypertension was 25 p. 100 and 61 p. 100 in IDDM patients with microalbuminuria and macroproteinuria respectively versus 10 p. 100 in patients with normoalbuminuria. This prevalence increased in NIDDM patients from 39.3 p. 100 with normoalbuminuria to 40.8 p. 100 and 76.2 p. 100 with microalbuminuria or macroproteinuria respectively. Proliferative retinopathy in type I and type II patients with normal AER was 7.4 p. 100 and 1.2 p. 100 respectively increasing to 15.2 p. 100 and 8.9 p. 100 with microalbuminuria and 27.8 p. 100 and 23.1 p. 100 with macroproteinuria. The prevalence of coronary disease increased from 4 to 10.4 p. 100 in patients with type I diabetes and microalbuminuria. The prevalence of cardiac failure increased from 1.5 to 2.1 p. 100 in type I diabetics and from 3.2 to 7.8 p. 100 in type II diabetics in the presence of microalbuminuria. Patients with microalbuminuria had increased levels of glycosylated hemoglobin A 1C but statistical difference was only obtained for patients with type II diabetes. Routine analysis of AER in diabetics allows early detection of diabetic nephropathy and emphasizes the need for tight metabolic and blood pressure control. Hypertension can be detrimental to nephropathy but might also initiate renal lesions in NIDDM patients.
 ...
PMID:[Microalbuminuria and diabetic nephropathy. Detection and correlation with other degenerative complications]. 214 8

Diabetic nephropathy is now the leading cause of renal failure in patients referred for uremia therapy. The diabetic patient is a complicated treatment problem from the first detection of microalbuminmuria, at which time decisions regarding choice of antihypertensive and strictness of metabolic control assume increasing importance. At present, our policy is to advocate strict control of blood pressure, aiming for a systolic blood pressure of less than 140 mm Hg and a diastolic blood pressure of less than 80 mm Hg. We attempt to maintain hemoglobin Alc levels at less than 8%, if the patient does not develop frequent episodes of hypoglycemia. We extend these recommendations to the patient with frank proteinuria, nephrotic syndrome and early uremia, understanding that strict metabolic control may be impossible as patients lose GFR. In addition, we recommend avoidance of a high protein diet in the early nephropathic diabetic, with diet of approximately 1 gm/kg/d. As renal failure progresses, we embark on an analysis of the patient's abilities, lifestyle, and social support. At a GFR of approximately 10 mL/min, we initiate preparations for uremia therapy. If a willing and appropriate living related kidney donor is available, the patient is referred for cardiovascular evaluation and kidney transplantation performed subsequently. If no donor is immediately available, we refer the patient for vascular access placement and/or insertion of a Tenckhoff peritoneal catheter, if preferred. Most of these predialysis patients also undergo screening for placement on the cadaveric kidney transplant list, including cardiac work-up as is done for the patients who receive living-related renal transplants. Because of the long waiting list in Brooklyn, and the universal shortage of organ donors, many of these patients eventually end up on dialysis for some period of time. Other extrarenal problems (urologic, ophthalmologic) are addressed at initial referral and followed up, in hopes of maintaining the patient in optimal physical shape as uremia progresses. The care of the diabetic patient with ESRD ideally involves a consortium of caregivers. We include a nurse-educator familiar with options for uremia therapy, a podiatrist, a cardiologist, and often a urologist, an endocrinologist, and a gastroenterologist. In addition, a social worker is helpful to assess psychologic difficulties in adjustment to uremia, socioeconomic considerations, and rehabilitation status. Finally, the nephrologist, as coordinator of this team works with the vascular or transplant surgeon, to facilitate the transition to ESRD and its therapy.
 ...
PMID:Care of the diabetic patient with end-stage renal disease. 219 Feb 84

This perspective deals with prediction of overt diabetic nephropathy in patients with insulin-dependent diabetes mellitus (IDDM). The role of elevated urinary albumin excretion rate (microalbuminuria) in predicting diabetic nephropathy has been emphasized by new follow-up studies. Development of severe kidney impairment was seen in a large percentage of patients with microalbuminuria, but with more intensive care for diabetic patients, this percentage may be falling. Herein, I analyzed alternatives to microalbuminuria in predicting kidney disease in diabetes. 1) Parental predisposition to hypertension is not seen in all studies and therefore may not be a decisive factor, and it cannot be used in prediction of nephropathy. 2) Prediabetic blood pressure may predict nephropathy in certain non-insulin-dependent diabetic patients, but elevated blood pressure seems to develop after early microalbuminuria and is likely to be an aggravating factor in established microalbuminuria in IDDM patients. 3) At the clinical diagnosis of IDDM, diabetic nephropathy cannot be predicted. 4) Glycemic control is poor in normoalbuminuric patients with later development of microalbuminuria, and multiple glycosylated hemoglobin measurements are therefore important. 5) In diabetes, glomerular hyperfiltration is associated with late nephropathy, but it alone cannot be the decisive factor, because hyperfiltration in nondiabetic individuals does not produce kidney disease, according to new long-term follow-up studies. 6) Studies of glomerular structure and ultrastructure have not yet documented predictive values for overt nephropathy, but further studies are in progress. 7) Isolated blood pressure elevation without microabuminuria (probably representing essential hypertension in diabetes) has not been predictive. 8) It is clear that elevation of serum creatinine is a very late and insensitive parameter, occurring only with pronounced proteinuria.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Prediction of clinical diabetic nephropathy in IDDM patients. Alternatives to microalbuminuria? 219 82

We report a case showing typical diabetic nodular glomerulosclerosis without retinopathy or other apparent clinical findings of DM except for impaired glucose tolerance. The 57-year-old man had a family history but no personal history of DM. In an extensive examination for DM, the results of funduscopy, daily profile of serum glucose and hemoglobin Alc were entirely within normal limits. However, the oral glucose tolerance test was abnormal. A renal biopsy showed typical nodular lesions (Kimmelstiel-Wilson's lesions). Previously, the interesting feature of transient proteinuria had been recognized. Although hypocellular nodular lesions by light microscopy are characteristic of diabetic nephropathy, renal amyloidosis, carbon disulfide intoxication, multiple myeloma and light chain disease, we concluded that the present lesions had resulted from diabetic nephropathy based on the family history, patient history, impaired glucose tolerance, immunofluorescent findings and electron microscopic observations.
 ...
PMID:Nodular glomerulosclerosis in a patient showing impaired glucose tolerance. 225 Apr 5

This study reviewed the histopathology of endometrial curettings following spontaneous abortion in diabetics and controls. The two groups did not differ significantly for an array of histologic features. The relationships between histopathology and diabetic White class, diabetic nephropathy or retinopathy, first trimester hemoglobin A1 percentage, and first trimester serum magnesium level were studied. The only significant correlation found was between diabetic retinopathy and decidual congestion with the presence of venous fibrin.
 ...
PMID:Histopathology of spontaneous abortion in diabetic pregnancies. 237 25

We show our experience, results and complications with Intermittent Peritoneal Dialysis (IPD). We treated with this technique 28 patients with end stage renal disease (ESRD), between 1981-1988; (24 adults, 8 of them with diabetic nephropathy (6 non insulin dependent diabetic patients and 4 children) for 3 to 36 months. IPD was well tolerated. The extracellular volume control, haematocrit and plasma protein values, as well as, ac-base equilibrium nutritional status, ureic nitrogen and creatinine plasma levels, were fully satisfactory. There was statistical difference only in the Na+ (p less than 0.001), alkaline phosphatases (p less than 0.005), glucose (p less than 0.05) plasma values and glycosylated hemoglobin (p less than 0.05), between diabetics and non diabetics group. The peritonitis rate was 0.065 and 0.074 peritonitis/patients-month; respectively (NS) and were caused by Gram (-) bacteria. St Aureus and St Epidermides. The survival curves of patients and method, in both groups, were similar (NS). We conclude IPD is a good alternative of therapy for ESRD, also for diabetics patients, whom haven't got more infection rate than non diabetics patients.
 ...
PMID:[Intermittent peritoneal dialysis: a 6 years' experience]. 251 81

Renal functional parameters including creatinine clearance, urinary albumin excretion, basement membrane thickening, and levels of nonenzymatic glycation of glomerular basement membrane were studied in streptozotocin-induced diabetic rats and age-matched controls subjected to low protein diet. In addition, these parameters were also assessed in diabetic and streptozotocin injected nondiabetic animals fed a 24% protein diet, which served as "positive controls." While diabetic animals from both diet groups had similar elevated glycated hemoglobin levels and increased levels of nonenzymatic glycation of glomerular basement membrane, these were significantly elevated as compared to insulin treated diabetic (euglycemic), age-matched controls on an 8% protein diet, and streptozotocin injected nondiabetic animals from both diet groups. However, urinary albumin excretion and creatinine clearance levels were significantly elevated only in the 24% protein diet fed diabetics over values seen in the various groups of animals on 8% and controls on 24% protein diet. In contrast, there were no statistical differences among diabetic, euglycemic and control (8% and 24% protein) animals with respect to creatinine clearance, urinary albumin excretion, and glomerular basement membrane thickness. Taken together these data cast some doubt on the role of nonenzymatic glycation in the development of diabetic nephropathy. Moreover, hyperglycemia per se causes a compensatory increase in kidney size irrespective of protein intake; a low protein diet, however, inhibits the hyperfiltration commonly seen in early diabetic nephropathy. The authors, thus, hypothesize that a low protein diet, by preventing compensatory increase in blood flow to surviving nephrons, in some fashion protects these functional units from subsequent damage and possibly delays the onset of renal failure.
 ...
PMID:Effect of a low protein diet on the relationship of nonenzymatic glycation to altered renal structure and function in diabetes mellitus. 252 37

In order to estimate kidney functions in 61 juvenile diabetes patients, the glomerular filtration rate, urinary extraction of albumin during night, and systolic and diastolic artery blood pressures were examined. The ratio of these variables in relation to the duration of the disease, the metabolic control of the disease, age, and the interrelation of these elements were analysed. The control group consisted of twenty healthy children. The glomerular filtration rate was increased in 59% of patients. It shows a positive correlation with the duration of the disease and the increased urinary extraction of albumin. Tolerable values were established in relation to the systolic artery blood pressure. Diabetic incipient nephropathy (microalbuminuria) marks the increased urinary extraction of albumin. The prevalence of microalbuminuria in the group of children with diabetes was 27.86%. It was significantly higher in patients with a longer duration of the disease, in older patients and in those with an increased glomerular filtration rate. Microalbuminuria shows a positive correlation with glycogenic hemoglobin and systolic and diastolic artery blood pressure values. Systolic and diastolic artery blood pressures correlate with the duration of the disease and the increased urinary extraction of albumin. The results suggest that glomerular hyperfiltration is the most precise indication of disturbed renal functions. The high percentage of its occurrence is found when the disease was diagnosed and these adverse manifestations are highly reversible. The increased urinary extraction of albumin indicates structural renal lesions. The results also indicate the tendency of an increase of artery blood pressure, especially the diastolic pressure, ten years after the occurrence of the disease. High blood pressure accelerates the progress of diabetic nephropathy. The authors are of the opinion that the examination of kidney functions both in children and adolescents with insulin-dependent diabetes is necessary for the early detection of renal lesions and for the application of an adequate therapy.
 ...
PMID:[Diseases of the kidney in children and adolescents with insulin-dependent diabetes mellitus]. 262 64


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