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

To examine the relationships between the normal dietary intakes of protein and phosphate, blood pressure, and the progression of diabetic nephropathy, we prospectively studied 20 Type 1 diabetic subjects of mean age 43 +/- 10 years (SD) with early nephropathy (mean serum creatinine 115 +/- 43 mumol l-1) over 1 year. Three-monthly measurements of blood pressure, glycaemic control, and normal dietary intake (3-day weighed food records) and 6-monthly measurements of glomerular filtration rate (using a single injection of chromium 51-EDTA) were made. GFR changed at a median rate of -0.89 ml min-1 1.73 m-2 month-1 (range +0.85 to -2.55 ml min-1 1.73 m-2 month-1). Mean dietary protein intake (1.22 g kg-1; range 0.78 to 1.55 g kg-1) and phosphate intake (21.5 mg kg-1; range 14.1 to 30.4 mg kg-1) were not significantly related to the rate of change in GFR. Only mean systolic blood pressure was significantly related to change in GFR, and accounted for 45% of the variability in GFR decline in the 18 subjects who completed the study (r = 0.67; R2 = 0.449; F1,16 = 13.2; p < 0.005; 95% confidence interval for r: 0.336-0.867). A mean systolic blood pressure of 140 mmHg or below was associated with no significant decline in GFR over a median period of 13 months.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Blood pressure, diet and the progression of nephropathy in patients with type 1 diabetes and hypertension. 820 Jan 98

Captopril's short-term effects on clinical and biochemical parameters were studied in 21 diabetic nephropathic patients. Their mean age was 57.50 +/- 2.28 years; 16 of them were women and 5 were men. Eleven patients had been regulated with insulin and 10 of them had been regulated with oral antidiabetics. Fifteen patients were microalbuminuric (200 mg/daily and below albuminuria) and their mean diabetes mellitus history was 14.86 +/- 1.44 years. Six patients had advanced diabetic nephropathy (400 mg/daily and above albuminuria). Their mean diabetes mellitus history was 4.50 +/- 2.87 years. Captopril in a low dose (37.5 mg/daily p.o., three separated doses) was given during 20 days. In the microalbuminuria group there were insignificant alterations in renal function, blood glucose levels, and systolic blood pressure. Diastolic blood pressure decreased significantly in this group (p < .05). Microalbuminuria increased significantly after the therapy in this group (p < .05). In the advanced diabetic nephropathy group, blood glucose and systemic blood pressure levels did not change significantly (p > .05), while serum BUN and creatinine levels increased significantly (p < .05), and GFR decreased significantly in this group (p < .05). Albuminuria decreased after the therapy in this group (p < .05). In all study groups, serum potassium levels increased significantly while serum total protein and albumin levels did not change significantly.We concluded that in the microalbuminuria group, increasing microalbuminuria may be related to a captopril-induced increase in renal plasma flow rate and single nephron glomerular filtration rate. This increase in microalbuminuria cannot be related with blood glucose levels, renal functions, and systemic blood pressure alterations.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The effects of angiotensin-converting enzyme inhibitors on the clinical and biochemical parameters in diabetic nephropathy. 829 Jul 8

The study describes the indications and results of combined liver/kidney transplantation in eight patients suffering from end-stage hepato-renal diseases. The causes of primary renal failure were hyperoxaluria type I (2/8), diabetic nephropathy (2/8), glomerulonephritis (2/8), congenital pyelonephritis (1/8), and polycystic kidneys (1/8). Only five of these patients were on chronic dialysis prior to transplantation. The indication for kidney transplantation in the other three patients was low GFR (< 20 mL/min) and the anticipation of further deterioration of the renal function after liver transplantation as a result of cyclosporine toxicity. The end-stage liver diseases were chronic active hepatitis (4/8) and alcoholic cirrhosis (2/8). There was no evidence for liver failure in two patients undergoing combined transplants for primary hyperoxaluria. The 1-year patient survival rate is 75 per cent, and at that time, kidney and liver function were found to be within normal range. In conclusion, excellent long-term patient survival, as well as kidney and liver graft function, can be achieved in patients suffering from complex end-stage disease of both organs who undergo combined liver and kidney transplantation.
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PMID:The role of combined liver/kidney transplantation in end-stage hepato-renal disease. 836 68

Diabetic nephropathy develops in approximately 35% of patients with insulin-dependent diabetes mellitus (IDDM) and in a similar proportion of patients with non-insulin-dependent diabetes mellitus (NIDDM). However, we remain at present unable to identify the susceptible subset prior to the development of microalbuminuria. Up to 25% of IDDM patients and a variable proportion of NIDDM patients manifest glomerular hyperfiltration in the first few years of diabetes. It has been debated whether this basal hyperfiltration is predictive of future renal disease and whether better prediction can be achieved by the use of the renal haemodynamic response to a protein meal, defined by some authors as renal reserve. The concept of renal functional reserve in patients with diabetes mellitus is complicated by the dependence of the GFR response on basal GFR, the influence of the prevailing metabolic conditions, and because the response differs to different stimuli. We review the factors affecting renal hemodynamics and renal hemodynamic responses in the context of supranormal, normal, and impaired renal function in diabetes. We conclude that although the measurement of renal functional reserve may help clarify important pathophysiological mechanisms, the assessment of basal GFR in clinical practice is all that is required for predictive and monitoring purposes.
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PMID:Renal functional reserve in subjects with diabetes mellitus. 852 51

Arterial hypertension increase progression of late diabetic complications. Renin-angiotensin-aldosterone system plays an important role in the regulation of arterial pressure. The aim of the study was the assessment of plasma renin activity (PRA) and aldosterone (aldo) in type I euglycaemic diabetic patients on intensive insulin treatment without autonomic neuropathy. 30 type I diabetic patients (including 11 with nephropathy defined as urinary albumin excretion > 30 mg/24 h and 19 without albuminuria) were admitted into the trial. Mean age 31.9 + 1.4 years, duration time of disease was 9.1 + 1.5 years, HbA1c level 7.6 + 0.25%; GFR 124.7 + 3.9 ml/min/1.73 m2 (135.8 + 5.1 in subgroup with nephropathy and 118.2 + 5.08 in non-nephropathic group). Blood samples were taken during normal sodium intake (120 mmol/24 h) after 0.5 h supine. PRA was significantly lower in type I diabetics vs control (0.27 + 0.04, 0.61 + 0.09 pmol/l/s respectively-p < 0.005). PRA was significantly lower both in nephropathic and non-nephropathic diabetic group vs control (respectively 0.22 + 0.06 and 0.31 + 0.05-p < 0.05). Aldo in diabetic patients and in subgroups with and without nephropathy was significantly lower vs controls (respectively 173 + 12.9, 165.1 + 14.4, 182.1 + 18.8 and 257.1 + 24.1 pmol/l; p < 0.01, p < 0.05). Significant differences in hormonal changes between diabetic patients with and without nephropathy were not found. Basing upon the results we conclude that in euglycemic intensively insulin treated type I diabetic patients without neuropathy presented decreased level of PRA and aldo. Early stage of diabetic nephropathy does not influence the examined hormones level.
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PMID:[Activity of the renin-angiotensin-aldosterone system in euglycemic type I diabetic patients on intensive insulin treatment without diabetic neuropathy]. 859 57

During the past years perinatal mortality in diabetic pregnancy has been lowered significantly, in special collections with highly motivated diabetic women even below 2%. In case of optimal metabolic control and absence of diabetic angiopathy the perinatal survival rate is identical to that in normal pregnancy. But adequate metabolic control cannot be reached in all pregnant women during the whole period of gestation, and pre-existing diabetic angiopathy exists frequently; therefore diabetic pregnancy will be associated with elevated perinatal mortality and morbidity also in the future. In case of pre-existing diabetic nephropathy, especially when GFR is decreased before conception there is a high risk for both progression of nephropathy during pregnancy and increased incidence of gestosis and intrauterine growth retardation which lead to earlier delivery (before the 36th week of gestation) in most cases. Perinatal mortality newborns of diabetic women with nephropathy has been decreased significantly during the past years, but perinatal morbidity in these newborns is still high. Pre-existing proliferative retinopathy can show progressive deterioration during pregnancy, but spontaneous regression post partum is usual. In rare cases progression of retinopathy also after delivery has been described even when laser coagulation was performed. Diabetic women with macroangiopathy, especially with coronary artery disease show a high risk for cardiovascular events during pregnancy. The occurrence of acute myocardial infarction in pregnant diabetic women is associated with elevated fetal and maternal mortality. Though there are case reports in the literature describing a successful fetal and maternal outcome after myocardial infarction during pregnancy.
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PMID:[Diabetes and pregnancy]. 871 13

Hypertension is both an exacerbating factor for, and a consequence of, diabetic renal disease. In diabetic patients, hypertension is associated with increased total body sodium secondary to impaired renal excretion, and increased vascular reactivity, notably to catecholamines and angiotensin II. The mechanisms causing these changes are discussed. Control of hypertension will slow the progression of diabetic renal disease and the inexorable decline in GFR. A number of studies now suggest that in proteinuric IDDM and NIDDM patients angiotensin converting enzyme inhibitors (ACE-I) may have additional reno-protective effects in addition to their hypotensive action. In addition ACE-I will reduce proteinuria and delay the onset of diabetic nephropathy in normotensive microalbuminuric IDDM and NIDDM patients. Use of ambulatory blood pressure monitoring indicates that such patients may not be truly 'normotensive'. On-going studies seem to suggest that the most reno-protective blood pressure is the lowest one achievable, as long as the patient remains asymptomatic. Further studies are required to assess the impact of blood pressure control, and especially ACE-I, on the incidence of end-stage renal failure. In addition, more direct comparisons between different pharmacological agents in early diabetic renal disease would be useful.
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PMID:The management of hypertension in diabetes: with special reference to diabetic kidney disease. 873 20

In patients with diabetic nephropathy blood pressure increases progressively before the conventional threshold of normal blood pressure (140/90 mm Hg) is transgressed. In patients with glomerulonephritis, no information on this point is available. To clarify this issue we sequentially examined 20 untreated patients with biopsy-proven primary chronic glomerulonephritis (GN) who had casual blood pressure below 140/90 mm Hg and normal GFR by inulin clearance. Patients were compared with normotensive healthy controls who were matched for BMI, gender and age. We measured ambulatory 24-hour blood pressure (SpaceLab system), echocardiography (ASE criteria, Acuson 128 XP 10), CIn and CPAH, urinary Na excretion, PRA and insulin concentration. In patients with GN, the median 24 hour (P < 0.0005), daytime (P < 0.001) and nocturnal sleeping time (P < 0.0001) MAP values were significantly higher than in matched controls (daytime, mean 97 mm Hg, 85 to 106 GN vs. 89 controls range 82 to 102; nocturnal sleeping time, mean 80.3 mm Hg, 71 to 89.5 GN vs. 73 controls, range 63 to 84). Echocardiographic examination showed significantly greater posterior wall thickness (P < 0.01) and ventricular septal thickness (P < 0.003). In addition the early diastolic to late diastolic (E/A) ratio of mitral valve peak inflow velocity was significantly (P < 0.0008) lower in patients. The data point to left ventricular wall thickening accompanied by LV diastolic malfunction. The study documents elevated ambulatory blood pressure in patients with primary chronic glomerulonephritis despite normal body weight and normal GFR. This is associated with evidence of target organ damage in the heart. The findings suggest that in patients with glomerulonephritis blood pressure increases initially within the normotensive range. This observation in conjunction with evidence of early target organ changes provides an argument for early antihypertensive intervention, but controlled trials to test efficacy and safety of this proposal are necessary.
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PMID:Early increase in blood pressure and diastolic left ventricular malfunction in patients with glomerulonephritis. 888 94

It has been considered unlikely that patients with insulin-dependent diabetes and diabetic nephropathy with nephrotic range proteinuria can substantially reduce proteinuria and continue for many years without further loss of renal function. We present a patient who had the diagnosis of insulin-dependent diabetes made at age 15, had his first of 6 laser treatments for proliferative and hemorrhagic retinopathy at age 27 and was found to have nephrotic range proteinuria and edema with hypertension at age 29, when results of a renal biopsy were typical of diabetic nephropathy. Ten years later, with the last 5.5 years on ACE inhibitors, proteinuria has been < 0.65 g/24 h for 2 years and recently 0.22 g, serum creatinine is unchanged at 90 to 102 mu mol/l, DTPA GFR is 104 ml/min and retinopathy has remained stable without laser therapy for 7 years. Blood pressure on clinic visits has averaged 126/74 for the last 8 years. This duration of stable renal function and the major decrease in proteinuria after being in the neprotic range is very rare in reports, if not unique.
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PMID:Stable renal function in insulin-dependent diabetes mellitus 10 years after nephrotic range proteinuria. 890 67

Tight metabolic control as assessed by estimation of glycated hemoglobin or albumin seems to be the main prophylactic factor in the prevention of most diabetic complications. By regular monitoring of the kidney size, GFR, and urinary albumin excretion, detection of early (reversible) diabetic nephropathy is possible. By appropriate dietary (protein restriction) and pharmacological (ACEI, antihypertensive drugs) treatment development of overt diabetic nephropathy may be prevented or markedly slowed.
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PMID:Biochemical monitoring of diabetic patients. 890 15


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