Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0035078 (renal failure)
 31,970 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Macroangiopathy is multifactorial. It is more severe and frequent in association with nephropathy in diabetes mellitus (DM), being the first cause of mortality in both types of DM. Nevertheless, it is poorly understood in young patients. We report on 2 young diabetic patients with early-onset coronary disease. Case 1, 40 yo, Caucasian, female, type 2 DM for 21 y: treated with sulphonylureas until 25 y, she was switched to insulin upon becoming pregnant. Preeclampsia ensued, but no premature delivery occurred. Macroproteinuria remained (0.99 g/24 h), and she progressed to renal failure (clearance 52.7 mg/min) (conservative treatment). At age 36, she had an acute myocardial infarction. Severe tri-arterial disease was diagnosed, and coronary bypass grafting (CABG) performed. Case 2, 34 yo, black, female, type 1 DM for 24 y: diagnosed by diabetic ketoacidosis. Due to poor metabolic control (HbA1c chronically above 4 points beyond upper limit for normal) she progressed to microalbuminuria (0.26 g/24 h) at age 22, after pregnancy. Macroproteinuria (1.7 g/24 h) ensued after a second pregnancy. At 31 y, she presented with stable angina. After coronary angiography, CABG was indicated. These two cases of macroangiopathy in patients diagnosed with DM at an early age show acceleration in the development of coronary disease, suggesting aggressive multifactorial approach of related risk factors from the beginning, regardless of its etiology.
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PMID:[Early-onset diabetic coronary macroangiopathy in young diabetes: two case reports]. 1654 27

Systemic cholesterol embolism is a rare complication of atherosclerosis, and has various presentations. Arterial catheterisms are a common cause. However, the association with an aortic dissection has been exceptionally reported. We report the observation of a 70 year-old man, with coronary artery disease, hypertension, diabetes and dyslipidemia. Six months before hospitalization, a coronary angioplasty was performed due to recurrent angina. The association of purpuric lesions on the feet, with acute renal failure confirmed cholesterol embolism syndrome. Transoesophageal echocardiography showed a dissection of the descending thoracic aorta associated with complex atheroma. The evolution was marked by the pulpar necrosis of a toe and by a worsening of the renal failure, requiring definitive hemodialysis. Further echographic control highlighted the rupture of the intimal veil of the dissection. Cholesterol embolism syndrome may reveal an aortic dissection in patients without thoracic symptoms. In such cases, transoesophageal echocardiography is a useful and non-invasive examination.
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PMID:[Thoracic aortic dissection revealed by systemic cholesterol embolism]. 1707 70

It is not yet clear whether a difference in in-hospital morality between patients with and without renal insufficiency undergoing percutaneous coronary intervention (PCI) exists. Therefore, the aim of the present study was to investigate if such as association exists in Japan. Data from the Tokai Acute Myocardial Infarction Study II were used. This was a prospective study of all 3274 patients admitted with acute myocardial infarction (AMI) to the 15 participating hospitals from 2001 to 2003. We abstracted the baseline and procedural characteristics as well as in-hospital mortality from detailed chart reviews. Patients were stratified into 2 groups according to the estimated creatinine clearance on admission. The creatinine clearance values were available in 2116, 107 of whom had renal insufficiency. The patients with renal insufficiency were more likely to be older, female, not independent in their daily activities, have lower body mass index and higher heart rate values on admission, lower prevalences of hypercholesterolemia and peptic ulcers, greater prevalences of diabetes, angina, previous heart failure, previous renal failure, previous cerebrovascular disease, aortic aneurysm, worse clinical course such as bleeding, and a multivessel coronary disease. Vasopressors, an intra-aortic balloon pump, and mechanical ventilation were frequently used in the patients with renal insufficiency, while thrombolytics were used less frequently. The patients with renal insufficiency had a higher in-hospital mortality rate than those without. Multivariate analysis identified renal insufficiency as an independent predictor of in-hospital death. The results suggest that renal insufficiency is an independent predictor of in-hospital death among AMI patients undergoing PCI.
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PMID:Association of renal insufficiency with in-hospital mortality among Japanese patients with acute myocardial infarction undergoing percutaneous coronary interventions. 1710 45

The human arterial system in youth is beautifully designed for its role of receiving spurts of blood from the left ventricle and distributing this as steady flow through peripheral capillaries. Central to such design is "tuning" of the heart to arterial tree; this minimizes aortic pressure fluctuations and confines flow pulsations to the larger arteries. With aging, repetitive pulsations (some 30 million/year) cause fatigue and fracture of elastin lamellae of central arteries, causing them to stiffen (and dilate), so that reflections return earlier to the heart; in consequence, aortic systolic pressure rises, diastolic pressure falls, and pulsations of flow extend further into smaller vessels of vasodilated organs (notably the brain and kidney). Stiffening leads to increased left ventricular (LV) load with hypertrophy, decreased capacity for myocardial perfusion, and increased stresses on small arterial vessels, particularly of brain and kidney. Clinical manifestations are a result of diastolic LV dysfunction with dyspnea, predisposition to angina, and heart failure, and small vessel degeneration in brain and kidney with intellectual deterioration and renal failure. While aortic stiffening is the principal cause of cardiovascular disease with age in persons who escape atherosclerotic complications, it is not a specific target for therapy. The principal target is the smooth muscle in distributing arteries, whose relaxation has little effect on peripheral resistance but causes substantial reduction in the magnitude of wave reflection. Such relaxation is achieved through regular exercise and with the vasodilating drugs that are used in modern treatment of hypertension and cardiac failure.
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PMID:Mechanical factors in arterial aging: a clinical perspective. 1760 38

Our objective was to assess differences in early outcome after completely arterial myocardial revascularization with (on-pump coronary artery bypass grafting or ONCAB) or without cardiopulmonary bypass (off-pump coronary artery bypass grafting or OPCAB). Fifty-eight OPCAB and 91 ONCAB patients receiving exclusively arterial grafts were analyzed. OPCAB patients had more single-vessel (P<0.0001), less triple-vessel (P<0.0001) or left main disease (P=0.0021), higher angina class (P=0.003), more unstable angina (P<0.0001) and previous percutaneous transluminal coronary angioplasty (PTCA; P<0.0001), but similar EuroScores (P=n.s.). ONCAB was associated with longer operation time (P=0.0001) and more anastomoses/patient (P<0.0001). Internal thoracic artery (ITA) use was identical, whereas single left ITA use (P<0.0001) and left ITA jump anastomoses (P<0.0001) were more frequent in OPCAB. Radial artery (RA) use (P<0.0001) and RA jump anastomoses (P<0.0001) were more frequent in ONCAB. Complication rates were similar concerning mortality, arrhythmias, cerebro-vascular accidents (CVA), and renal failure with shorter ventilatory support (P<0.0001) and a trend towards less perioperative myocardial infarction (PMI) (P=0.12) and low output (P=0.089), and more respiratory complications (P=0.056) after OPCAB. Arterial OPCAB patients have less extensive CAD, but more severe symptoms. Early outcome is similar concerning mortality, arrhythmias, CVA, renal failure, or intensive care unit and hospital stay, but with shorter ventilatory support and a trend towards lower PMI and low output, and higher respiratory complication rates after OPCAB.
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PMID:Totally arterial off-pump vs. on-pump coronary revascularization: comparison of early outcome. 1767 Feb 9

The study was undertaken to analyze the long-term results in patients with coronary heart disease (CHD) one year or more after Cypher stent implantation. It covered 1221 patients. One-, two-, and three- vessel lesions were observed in 693 (56.8%), 344 (28.2%), and 184 (15%) patients, respectively. A total of 1967 Cypher stents were implanted. The results of treatment were analyzed 1 and 2 years after intervention. The efficiency of a procedure was evaluated by the following parameters: the presence or absence of anginal symptoms, the presence and absence of complications (fatal outcome, myocardial infarction). The following morphological parameters: the rate of restenosis and that of late stent thrombosis were also assessed. The results of one- and two-year follow-ups were used to make a multivariate analysis of the clinical and morphological predictors of coronary complications (fatal outcome, myocardial infarction, recurrent angina pectoris) in the late period, as well as the predictors of restenosis and late stent thrombosis. Restenosis following 1 year of Cypher stent implantation is 3.1%. The factors that significantly increase the risk of this complication within the first year are diabetes mellitus and revascularization in the patients operated on. The one-year rate of Cypher stent thromboses is 1.6%. Patients' discontinuation of antiaggregant therapy is the sole factor that significantly increases the rate of their late thromboses in this period. Within the second year of a follow-up, the rate of late Cypher stent thromboses is 1.8%. The risk of this complication is significantly increased by factors, such as a lengthy (more than 3 mm) stented portion, renal failure, and less than 40% left ventricular ejection fraction.
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PMID:[Long-term clinical efficiency of endovascular treatment using Cypher rapamycin-eluting stents in patients with coronary heart disease]. 1803 67

The failing heart produces a variety of biologically active humoral factors such as catecholamines, vasopressin, angiotensin II, aldosterone, atrial natriuretic polypeptide (ANP), brain natriuretic polypeptide (BNP), cytokines and so on, in order to recover the cardiac function through the mechano- and chemo-receptors in vivo. In particular, it has recently shown that the central nervous system plays a pivotal role in the progression of cardiac remodeling and the heart failure. Thereby, endogenous digitalis-like factor, angiotensisn II, aldostereone, and inflammatory cytokines in the brain are acting as the mediators. In fact, mineralocorticoid receptor blockers, such as spironolactone and eplerenone, are clinically useful to treat cardiac failure. However, these biomarkers are not available as laboratory tests because they are under investigation clinically. On the other hand, failing heart by itself produces natriuretic hormones such as ANP and BNP to rescue it. They dilate resistant vessels to reduce the afterload of the heart with the lowest concentrations. Then, natriuresis is caused with the increased concentrations to reduce the pre-load to the heart. The natriuresis is brought partially by reducing concentrations of plasma aldosterone. Therefore, concentrations of these natriuretic hormones are excellent biomarkers for the cardiac function. They increase in a variety of disease states like hypertension, acute/old myocardial infarction, angina pectoris, arrhythmias, cardiac failure, cardiomyopathy, renal failure and myocarditis. In particular, they are remarkably increased in patients with heart failure. Recently, a new biomarker, N-terminal pro-BNP (NT-proBNP) is registered as a clinically available laboratory test, which may be superior to BNP at the laboratory stand of view. It is because NT proBNP is not degraded in the circulation, stable even in serum and the higher concentration as compared to BNP.
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PMID:[Pathophysiology of heart failure and the biomarkers; brain natriuretic hormone as the class-1 recommendation by the new Japanese Guideline for Heart Failure]. 1828 62

Chronic kidney disease (CKD) is a major public health problem. However, few studies have examined the significance of body mass index (BMI) as a risk factor for the development of CKD in the general Japanese population. Study participants without a clinical history of stroke, transient ischemic attack, myocardial infarction, angina or renal failure (754 men aged 56+/-15 [mean+/-SD] years and 962 women aged 59+/-13 years) were randomly recruited from a single community at the time of their annual health examination. We examined the relationship between increased weight (i.e., BMI) and renal function evaluated by the estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study Group equation. Increased BMI was consistently associated with reduced eGFR. Estimated GFR was lower in participants with upper normal body weight (BMI, 22.0 to 24.9 kg/m2) or who were overweight or obese (BMI>or=25 kg/m2), compared with participants with lower normal body weight (BMI, 18.5 to 21.9 kg/m2). Stepwise multiple regression analysis using eGFR as an objective variable, adjusted for various risk factors as explanatory variables, showed that BMI (beta=-0.075) was significantly and independently associated with eGFR, in addition to age, log triglycerides, low-density lipoprotein cholesterol and log fasting blood glucose. Compared with those with lower normal body weight, multivariate-adjusted odds ratios for moderately reduced renal function, defined as an eGFR<60 mL/min/1.73 m2, were 1.86 (1.01-3.42) for upper normal weight and 2.02 (1.01-4.03) for overweight or obese individuals. In conclusion, increased BMI is strongly associated with decreased eGFR in community-dwelling healthy persons.
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PMID:An association between body mass index and estimated glomerular filtration rate. 1897 30

Serum gamma-glutamyl transferase (GGT) activity is a general clinical marker of excessive alcohol consumption, and GGT reflects changes in oxidative stress and implicated in the progression of hypertension. Recent guidelines classify persons with above-optimal blood pressure (BP) but not clinical hypertension as having prehypertension for a systolic BP (SBP) of 120 to 139 mmHg and/or a diastolic BP (DBP) of 80 to 89 mmHg; however, only limited data are available on the association between serum GGT and this entity among community-dwelling men in Japan. We performed a cross-sectional study to examine whether serum GGT was associated with prehypertension. Study participants (754 men, age 56 +/- 15 years) without a clinical history of stroke, transient ischemic attack, myocardial infarction, angina, or renal failure were recruited from a single community. Thirty-seven percent of participants had prehypertension and 39.3% had hypertension. Multiple regression analysis using SBP and DBP as objective variables, adjusted for risk factors as explanatory variables, showed that log GGT was significantly and independently associated with elevated SBP (beta = 0.109, P = 0.006) and DBP (beta = 0.238, P < 0.001). Compared with participants in the lowest tertile of serum GGT (< 29 IU/L), the multivariate-adjusted odds ratio (OR) (95% CI) for prehypertension was 1.73 (1.06-2.81) for the middle tertile (29-53 IU/L) and 2.37 (1.31-4.31) for the highest tertile (> 53 IU/L). Moreover, the respective ORs for hypertension were 1.82 (1.04-3.18) and 3.11 (1.61-6.03). These results suggest that higher serum GGT levels are associated with prehypertension or hypertension in the general male population.
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PMID:Association between serum gamma-glutamyl transferase level and prehypertension among community-dwelling men. 1898 55

Prophylactic coronary revascularization in vascular surgery patients with extensive coronary artery disease was not associated with an improved immediate postoperative outcome. However, the potential long-term benefit was unknown. This study was performed to assess the long-term benefit of prophylactic coronary revascularization in these patients. Of 1,880 patients scheduled for major vascular surgery, 430 had > or =3 risk factors (age >70 years, angina pectoris, myocardial infarction, heart failure, stroke, diabetes mellitus, and renal failure). All underwent cardiac testing using dobutamine echocardiography or nuclear stress imaging. Patients with extensive stress-induced ischemia (> or =5 segments or > or =3 walls) were randomly assigned to additional revascularization. In total, 101 patients showed extensive ischemia and were assigned to revascularization (n = 49) or no revascularization (n = 52). After 2.8 years, the overall survival rate was 64% for patients randomly assigned to no preoperative coronary revascularization versus 61% for patients assigned to preoperative coronary revascularization (hazard ratio [HR] 1.18, 95% confidence interval [CI] 0.63 to 2.19, p = 0.61). Rates for survival free of all-cause death, nonfatal myocardial infarction, and coronary revascularization were similar in both groups at 49% and 42% for patients allocated to medical treatment or coronary revascularization, respectively (HR 1.51, 95% CI 0.89 to 2.57, p = 0.13). Only 2 patients assigned to medical treatment required coronary revascularization during follow-up. Also, in patients who survived the first 30 days after surgery, there was no apparent benefit of revascularization on cardiac events (HR 1.35, 95% CI 0.72 to 2.52, p = 0.36). In conclusion, preoperative coronary revascularization in high-risk patients undergoing major vascular surgery was not associated with improved postoperative or long-term outcome compared with the best medical treatment.
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PMID:Long-term outcome of prophylactic coronary revascularization in cardiac high-risk patients undergoing major vascular surgery (from the randomized DECREASE-V Pilot Study). 1932 12


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