Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0033687 (proteinuria)
 24,015 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetic nephropathy is a major cause of illness and premature death in diabetic patients, largely through accompanying cardiovascular disease and end-stage renal failure. Proteinuria heralds the clinical nephropathy, and the worsening of proteinuria parallels the progression of renal disease towards chronic renal failure. A large body of evidence has accumulated that emphasizes the role of elevated blood pressure in the progression of renal disease, as well as the clear benefit of antihypertensive treatment. However, the choice of antihypertensive drug to protect renal function was less clear in the past. In earlier studies, a reduction in the rate of progressive renal failure in hypertensive subjects has been shown with diuretics, beta-blockers, and vasodilators. However, there is now increasing evidence that angiotensin converting enzyme (ACE) inhibitors and some calcium antagonists produce a more beneficial effect on nephropathy in terms of reducing proteinuria and slowing progression to renal failure. These drugs are attributed nephroprotective capacity beyond their systemic blood pressure lowering effects, and initial clinical trials with combinations have revealed additive nephroprotective effects. Finally, ACE-inhibitors and calcium antagonists have no adverse effects on glycemic control or lipid levels and may even improve insulin sensitivity. This further promotes these antihypertensives to first-line drugs when treating subjects at risk of metabolic disorders or people with diabetes.
 ...
PMID:Protecting the residual renal function: which drugs of choice? 923 93

Patients with chronic renal failure (CRF) have an increased risk of cardiovascular disease (CVD). Elevated lipoprotein(a) (LP(a)) levels have been shown to be an important risk factor for CVD. This study examined Lp(a) changes during the progression of renal disease in patients following different dietary regimens. Fifty-seven patients with CRF of different etiology and degree (mean age 58 +/- 10 yrs) were divided into four groups according to their serum creatinine (sCr) levels. The first group had sCr 1.5-3; the second 3-6; the third > 6, all on a conventional low-protein diet (CLPD), and the fourth had sCr > 6 on a supplemented vegetarian diet (SVD). Lp(a), apoproteins AI, B, E, CII, CIII, CII/CIII, Apo A/Apo B ratios and the lipid pattern (total cholesterol (TC) and its fractions LDL, HDL, HDL3 and triglycerides) were investigated. Patients with diabetes, proteinuria > 1.5 g/24 h, hepatic disease or taking contraceptives or lipid lowering drugs were excluded. Results were compared with a reference group (N = 12) with sCcr < 1. Lp(a) concentrations increased with the progression of renal failure, and a significant correlation was observed with sCr. Despite the elevated sCr levels, patients on the SVD had an almost normal Lp(a) concentration. Only 15% of the reference group had Lp(a) levels > 30 mg/dl, compared to 33%, 50% and 78% of the 1st, 2nd and 3rd groups and 38% of the 4th group. No relationship was found between Lp(a), lipids or apoproteins. Our results indicate that renal function influences Lp(a) levels and suggest a SVD helps to lower them. This might be ascribed to some antioxidant factors in the SVD.
 ...
PMID:Lp(a) levels: effects of progressive chronic renal failure and dietary manipulation. 924 24

Although men and male rats are at increased risk for age-related renal and cardiovascular disease compared with women and female rats, the mechanisms are unknown. However, castration of male normotensive rats protects against age-related glomerular sclerosis, and castration of spontaneously hypertensive rats (SHR) attenuates the age-related progression of hypertension to levels found in female SHR. The present study was performed to determine whether there are differences between male and female renal function in SHR with aging, and if so, the role that androgens play in the age-related changes in renal function in SHR. Renal hemodynamics, glomerular filtration rate (GFR), and proteinuria were measured in anesthetized male and female SHR aged 7 to 8, 14 to 15, and 30 to 32 weeks (n=5 to 7 per sex per age group). Studies were also performed in male SHR that had been castrated at 4 weeks of age and allowed to age to 7 to 8, 14 to 15, and 30 to 32 months of age (n=5 to 9 per age group). At 7 to 8 weeks of age when blood pressures are similar between male, female, and castrated male SHR, there were no differences in renal hemodynamics between male and female SHR. As the rats aged, mean arterial blood pressure increased in all groups and was higher in the intact male SHR than in females. Blood pressure in aging castrated males was similar to the pressure in aging female SHR. With advancing age, GFR in intact male SHR decreased by 20% to 30% at 14 to 15 and 30 to 32 weeks of age, respectively. Renal plasma flow (RPF) also tended to decrease in male SHR but not statistically so. There was no age-related reduction in GFR or RPF in female or castrated male SHR. With advancing age, renal vascular resistance (RVR) increased in all rats. RVR increased by 40% and 60% at 14 to 15 and 30 to 32 weeks in male SHR. In comparison, RVR increased by 20% and 40% in female SHR at similar ages. RVR in castrated male SHR was similar to RVR in females. The levels of urinary protein excretion increased with aging to 14 weeks in the male SHR, but in females and castrated males urinary protein excretion reached a plateau at 6 to 8 weeks that was maintained until 14 weeks of age and was approximately sixfold lower than in male SHR. These data suggest that androgens may play an important role in mediating the hypertension and the age-related alterations in renal function in the male SHR.
 ...
PMID:Decline in renal hemodynamic function in aging SHR: role of androgens. 932 4

In the present paper, longitudinal studies in non-insulin-dependent diabetes mellitus (NIDDM) dealing with risk factors, especially microalbuminuria, blood pressure, and glycemic control, and the course of the kidney function are addressed. The definition of microalbuminuria, limits for abnormal albuminuria, and possible causes of microalbuminuria in NIDDM are discussed. Microalbuminuria is a major independent risk marker for early mortality, and new studies indicate that even "high normoalbuminuria" carries a risk. Furthermore, risk markers agreed on among various studies include apart from abnormal albuminuria, age and preexisting cardiovascular disease, whereas there is some inconsistency concerning glycemic control, lipoproteins, and even hypertension. People with microalbuminuria, NIDDM patients as well as nondiabetics, share an increased prevalence of atherosclerosis and its risk factors as well as an increased TER(alb). Albuminuria in NIDDM may thus have two different causes: general vascular disease and diabetic glomerulopathy. The clinical course of renal function is with large interindividual variation in both patients with or without overt proteinuria. Systolic blood pressure, glycemic control, and level of albuminuria appear to determine the deterioration in kidney function and progression of albuminuria, and to influence the overall prognosis, thus being obvious items for intervention. Long-term intervention studies demonstrating improved survival are, however, still awaited.
 ...
PMID:Microalbuminuria, blood pressure, metabolic control, and renal involvement: longitudinal studies in white non-insulin-dependent diabetic patients. 932 21

Hypertension occurs about twice as frequently in diabetics as in the general population, with a prevalence of approximately 25% in young patients with insulin-dependent diabetes mellitus (IDDM) and 50% in patients with newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM). Studies strongly suggest that hypertension is involved in the progression and perhaps the onset of diabetic nephropathy, which is a major cause of illness and premature death in diabetic patients, largely through accompanying cardiovascular disease and end-stage renal failure. A large body of evidence has accumulated that emphasizes the beneficial effects of antihypertensive treatment in reducing proteinuria and preserving renal function in both IDDM and NIDDM. It appeared that angiotensin converting enzyme inhibitors and certain calcium antagonists, notably nondihydropyridine, calcium antagonists, and second-generation dihydropyridine calcium antagonists, produce a more beneficial effect on nephropathy in terms of reducing proteinuria and slowing progression to renal failure. These drugs are attributed nephroprotective capacity beyond their systemic blood pressure lowering effects, and initial clinical trials with combinations have revealed additive effects on reduction in albuminuria and have led to the lowest rate of decline in glomerular filtration rates with the lowest incidence of adverse effects.
 ...
PMID:Effects of antihypertensive drugs on renal function in patients with diabetic nephropathy. 932 24

Proteinuria has been shown to be strongly associated with the prevalence and incidence of cardiovascular disease. It has been difficult to determine if the link is causal and independent. The mortality follow-up for the Multiple Risk Factor Intervention Trial (MRFIT) randomized cohort provides an opportunity to examine these relationships. Between 1973 and 1975, 361,662 men, ages 35 to 57, were screened for blood pressure, serum cholesterol, and cigarette smoking. Patients receiving medication for diabetes were excluded. Men in the upper 10 to 15% of coronary heart disease (CHD) risk (12,866) were randomized into the MRFIT trial. Standard casual urine dipstick determinations (Labstix) for protein were done at baseline and annually for six years. Post-trial cause-specific mortality was ascertained using the National Death Index. During the trial, 2326 (18.1%) of participants had + or higher proteinuria, and 593 (4.6%) had +2 or higher proteinuria. The presence of proteinuria during the six years of follow-up was consistently associated with higher all cause, cardiovascular disease (CVD) and CHD mortality, even after adjusting for other risk factors. The higher and more persistent the proteinuria, the greater the risk. In this data set, proteinuria is a strong and independent risk factor for CVD mortality.
 ...
PMID:Proteinuria is a risk factor for mortality over 10 years of follow-up. MRFIT Research Group. Multiple Risk Factor Intervention Trial. 940 12

It has been suggested that hereditary risk for hypertension and cardiovascular disease (CVD) as well as intrauterine growth may be involved in the pathogenesis of diabetic nephropathy. In the present study, we investigated the influence of familial and perinatal risk factors on the occurrence of micro- and macroalbuminuria in young IDDM patients. A cohort of 1,150 young patients with > or =5 years' duration of IDDM was screened for microalbuminuria. Data on family history of hypertension, CVD, IDDM, and NIDDM; perinatal factors such as birth weight, gestational age, and duration of breastfeeding; and maternal education, smoking, hypertension, and proteinuria during pregnancy were collected. We identified 75 patients with an albumin excretion rate > or =15 microg/min in more than two overnight urinary samples and compared them in a nested case-control study with three normoalbuminuric control subjects per patient from the same cohort, matched for diabetes duration. Perinatal factors were analyzed in all patients born at term (+/- 2 weeks), 59 of the 75 patients and 155 of the 225 control subjects. In univariate analysis, hypertension in parents (odds ratio [OR] 4.21), CVD in parents and grandparents (OR 1.26), maternal smoking during pregnancy (OR 3.21), and a low level of maternal education (OR 2.33) were significantly associated with the development of micro- and macroalbuminuria. When adjusted for other familial and perinatal factors, current mean blood pressure, HbA1c, smoking, BMI, sex, age, and postpubertal diabetes duration, using logistic regression analyses, only parental hypertension in all patients and maternal smoking during pregnancy and low level of maternal education in full-term patients were independent risk factors. When patients with poor glycemic control were analyzed separately, familial CVD, poor metabolic control, parental hypertension, maternal smoking during pregnancy, and level of maternal education were independent risk factors, with the adjusted OR markedly increased, compared with the matched subgroup with better HbA1c. In conclusion, familial hypertension and CVD, maternal smoking during pregnancy, and low level of maternal education may independently increase the risk for incipient nephropathy in full-term offspring who later develop IDDM. Current poor glycemic control seemed to increase the effect of these risk factors.
 ...
PMID:Familial and perinatal risk factors for micro- and macroalbuminuria in young IDDM patients. 964 37

Although a number of risk factors for cardiovascular morbidity and mortality have been identified in young and middle-aged adults, their prevalence and importance are less known in the elderly. Elderly people have a risk profile different from that of younger subjects, but representative data on risk factors for cardiovascular disease in the elderly are difficult to find in the literature. Some typical 'major' risk factors, like blood pressure (BP), total cholesterol or left ventricular hypertrophy, do not have a clear predictive role for cardiovascular mortality in the elderly, especially in the extreme ages, while risk indicators usually labelled as 'minor' (serum uric acid, ventilatory function or proteinuria), do have a strong predictive value in these individuals. This must be taken into account when evaluating the cumulative risk of the elderly, in order to avoid overtreatment of subjects with mildly elevated BP or cholesterol.
 ...
PMID:Cardiovascular risk factors in the elderly. 978 83

In this Danish multicentre study, predictive clinical factors of mortality and survival were calculated for 513 patients with systemic lupus erythematosus (SLE), 122 of whom died within a mean observation period of 8.2 years equalling a mortality rate of 2.9% per year. Survival rates were 97%, 91%, 76% and 64% after 1, 5, 10 and 15 years, respectively. The direct causes of death included SLE (n = 35), infections (n = 25), malignancy (n = 9), cardiovascular disease (n = 32) and other causes (n = 21). Uni- and multivariate analyses of survival and mortality were performed for all deaths and for SLE-related deaths. Azotaemia (one-fifth of the patients) was a strong predictor of increased overall and SLE-related mortality, but nephropathy per se (one-half of the patients) and large proteinuria (one-sixth of the patients) were unrelated to survival. Haemolytic anaemia had a significant negative influence on survival related to mortality caused by infections. Diffuse central nervous system disease and myocarditis were related to increased SLE-related mortality, whereas photosensitivity predicted a decreased mortality. Non-fatal infections and thrombotic events predicted a decreased overall survival. Since 1980 the mortality caused by SLE manifestations has decreased significantly.
 ...
PMID:A multicentre study of 513 Danish patients with systemic lupus erythematosus. II. Disease mortality and clinical factors of prognostic value. 989 Jun 75

The medical literature of the last decade enables us to estimate survival of diabetics. Insulin dependent diabetic (IDDM) present a 3 to 6-fold mortality and die after age 30, the most frequent causes being end stage renal and vascular diseases. Non insulin-dependent diabetic (NIDDM) mortality is 1.4 to 3.7 times that of non-diabetics. Cardiovascular events and strokes are the major causes of death. Pancreatic carcinoma occurs twice as frequently in NIDDM compared to non-diabetics. Early markers of late severe complications are hypertension and proteinuria. Retinopathy has little influence on morality if other risk factors are considered. Yet, glaucoma and lens changes are associated with three- and twofold mortalities. One of five IDDM with microalbuminuria progresses to overt nephropathy in 5 years. In NIDDM micro-albuminuria predicts cardiovascular disease with a mortality of up to 2 times. Careful treatment of cardiovascular risk factors and of microalbuminuria combined with optimal metabolic control substantially reduces mortality of diabetics.
 ...
PMID:Diabetes mellitus--long time survival. 1018 35


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