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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A Bulgarian team, within the frames of a multinational study on diabetic vascular disease, sponsored by WHO, studied a group of 473 diabetic patients by the inquiry method and by the determination of blood cholesterin and creatinine and urine albumin. The results were compared with those of the whole group (6695 patients from 14 countries) and with each national group separately. A higher percentage of insulin-treated patients was established in the Bulgarian group as compared with the whole group, fewer hypertonics, lower mean cholesterol values, a little higher average body weight and considerably lower percentages of smokers. The various forms of macroangiopathy among the Bulgarian group proved to be in percentages, approaching the average percentages for the whole group or little lower than them (e.g. for the category "probable infarctions" and "cerebral hemorrhages"). Only for the category "IHD" the affection percentage among the Bulgarian group significantly surpassed that of the whole group. Since the Bulgarian group, as regards the possible risk factors, is in a more favourable condition, the higher IHD percentage is admitted to be due to the circumstances that patients with graver states have been included in the group. That is suggested by the higher percentage of patients (52%), insulin-treated. The severity of diabetes is concluded to be a significant factor in the development of macroangiopathy.
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PMID:[Comparison between the incidence of diabetic macroangiopathy in a group of diabetics from Bulgaria and from 13 other countries]. 646 38

This study presents an obstetric protocol offering better management and prediction for normoglycemic insulin-dependent patients (White Class D4, F, R, or RF) who conceived after they were diagnosed as having vascular disease secondary to diabetes mellitus. Normoglycemia was accomplished during the pregestational phase, and conception occurred only after the glycosylated hemoglobin level was documented to be normal. Normoglycemia was maintained during pregnancy in the outpatient setting through the use of blood glucose monitoring performed by the patient. The obstetric protocol emphasized three additional areas of attention: (1) assessment of fetal growth by serial uterine fundal measurement and ultrasonography at gestational weeks 21 to 22; (2) assessment of fetal movement by patient-perceived fetal movements for 1 hour a week starting at week 35, increasing to 2 hr/day at week 37, and increasing to 3 hr/day from week 38 onward; and (3) cervical assessment at week 37 and preparation for vaginal delivery. Eight patients had a creatinine clearance of less than or equal to 80 ml/min prior to conception (mean = 66 +/- 6 ml/min). By 6 to 12 weeks' gestation all eight showed an increase in creatinine clearance (mean = 91 +/- 20, p less than 0.01). There was no change in the third trimester, and postpartum creatinine clearance was at antepartum levels. Proteinuria increased significantly by the end of the first trimester in all eight women and regressed post partum. Proteinuria (greater than 150 mg/24 hr) did not occur in the 14 women with normal antepartum creatinine clearance. Of 11 women with background retinopathy, six showed improvement in retinal status by fundus stereophotography whereas five showed no change. Of 11 women with proliferative retinopathy, five improved, five required laser therapy, and one remained in stable condition. Despite hemoglobin A1 levels in the normal gestational range (3% to 7.5%), there was a significant correlation of these levels with infant birth weights. None of the 22 infants died, and only one had any perinatal disease. Thus this protocol with its emphasis on fetal growth and size resulted in improvement in both maternal and infant outcome in pregnancies complicated by diabetes mellitus with vascular compromise.
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PMID:Obstetric management when normoglycemia is maintained in diabetic pregnant women with vascular compromise. 674 44

Factor VIII coagulant activity (VIII C) and factor VIII-related antigen (VIII R:Ag) were studied in 86 insulin-dependent diabetic children. All children were without signs of vascular disease based on a negative funduscopy, negative fluorescein angiography, normal serum creatinine levels, and absence of proteinuria. Age ranged from 4 to 17 yr; duration of clinical diabetes ranged from 1 to 12 yr. The children were grouped according to their urinary sugar excretion, the HbA1 levels, and the duration of clinical diabetes. The group with high urinary sugar excretion and the group with high HbA1 levels had a significantly higher VIII C than the group with low urinary sugar excretion and the group with low HbA1 levels. VIII C levels did not differ significantly in the groups with a different duration of clinical diabetes, but VIII R:Ag was significantly higher in the group with the longest duration of diabetes as compared with the group with the shortest duration. VIII R:Ag levels did not differ significantly in the groups with different degrees of urinary sugar excretion or different HbA1 levels. The results show that in children without vascular disease, and even in children with a short duration of diabetes, alterations of the factor VIII complex can be demonstrated.
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PMID:Elevated factor VIII activity and factor VIII-related antigen in diabetic children without vascular disease. 681 42

Risk for renal insufficiency (RI) resulting from nonsteroidal anti-inflammatory drugs (NSAID) exists in cirrhosis with ascites, nephrotic syndrome, decompensated congestive heart failure, and chronic renal disease. We saw seven cases of NSAID RI that demonstrate important additional clinical risk factors. These include advanced age (mean, 76 years), use of diuretic drugs (6/7 patients), and evidence of renal vascular disease as suggested by long-standing hypertension, diabetes, or atherosclerotic cardiovascular disease (7/7 patients). Analysis of past case reports of NSAID RI also showed these features. Treatment of acute gouty arthritis was the most common precipitating event. Evolving NSAID RI was suggested by rising serum urea nitrogen, serum creatinine, and serum potassium levels, and body weight gain associated with low fractional excretion of sodium. We conclude that since NSAID RI is preventable and reversible, it is important to recognize and monitor the conditions of those patients at risk.
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PMID:Identification of risk for renal insufficiency from nonsteroidal anti-inflammatory drugs. 686 44

Renal revascularization was performed on 43 patients with vascular disease involving a solitary kidney. Revascularization was undertaken as treatment for severe hypertension in 35 patients and to preserve renal function in 8. There were 2 operative deaths (4.7 per cent) and 3 major complications (7 per cent). No patient suffered acute renal failure after revascularization. Followup ranges from 6 months to 14 years (mean 6 years). The postoperative serum creatinine is improved in 26 patients (63 per cent), unchanged in 9 (22 per cent) and increased in 6 (15 per cent). Of 35 patients with hypertension the blood pressure is cured in 18 (51 per cent) and improved in 14 (40 per cent); there were 3 (9 per cent) failures. In selected patients with renal artery disease involving a solitary kidney revascularization can provide effective treatment of hypertension and stabilization or improvement of renal function.
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PMID:Surgical treatment of renovascular disease in the solitary kidney: results in 43 cases. 705 95

Anuria resulting from obstruction of the renal arteries to both Kidneys or to a solitary kidney is unusual. The tolerance of the kidney to this ischemia is largely dependent upon the presence of collaterals, stimulated by pre-existing arterial disease. Our experience with six patients with anuria caused by renal artery occlusion supports the role of revascularization in the recovery of significant renal function. Four of these patients had hypertension, impaired renal function, and the existence of collateral circulation to an ischemic kidney, prior to occlusion, while two patients had normal renal function (serum creatinine = 0.5 and 0.9 mg/dl) before occlusion. The intervals of anuria for the two previously normal kidneys were six hours and five days, and 2 to 14 days in the four patients with vascular disease. Isotope scanning suggested renal artery occlusion in two patients, but arteriograms confirmed the diagnosis in all six. A thrombectomy restored blood flow through the two previously normal renal arteries. Grafts from the aorta or celiax axis were used for three patients and the splenic artery was used for the sixth patient. Urine flow began during or soon after operation in all patients. Dialysis was necessary for 30 and 45 days in the two patients with normal kidneys, but in only one of the four patients with previous disease (for ten days). Serum creatinine decreased to <2.0 mg/dl after operation, except in the man with a solitary kidney, who five years later has a creatinine of 3 mg/dl. All four patients with previous arterial disease died from cardiac failure within 1 to 30 months after operation. Therefore, anuria of acute onset should be evaluated by renal scan and arteriogram to detect those patients with proximal renal artery occlusion in preparation for revascularization.
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PMID:Successful surgical treatment of anuria caused by renal artery occlusion. 705 45

Polycystic kidney disease (PKD) is the fourth most common cause of end-stage renal disease and is a common cause of hypertension and associated vascular morbidity. Activity of the renin angiotensin system has been identified as a major component of hypertension and altered fluid and electrolyte physiology in PKD. Activity of this pathway also has been proposed as a potential modulator of structural change in both tubules and the interstitium of the kidney. Cilazapril is a long-acting angiotensin-converting enzyme inhibitor that has been effective in producing vascular remodelling in hypertensive vascular disease. We undertook a study to determine whether therapy with cilazapril would modify the expression of PKD in the Han:SPRD-cy rat, a model of autosomal dominant PKD that closely resembles human disease. Male rats were treated for 4 months, starting at 1 month of age. Control animals were hypertensive by 3 months of age, whereas treated animals were noted to be hypertensive only at the exit assessment (P < 0.001 at 3 months, P = 0.005 at 5 months). At 5 months of age, cilazapril-treated animals had modest but statistically significant reductions in serum creatinine (mean, 1.77 mg/dL v 1.97 mg/dL; P = 0.0006) and morphometrically assessed cyst volume (mean, 0.32 mL v 0.67 mL; P = 0.036). Cilazapril is an effective treatment for hypertension in this model of progressive renal disease and may have benefits beyond the prevention of cardiovascular morbidity.
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PMID:Cilazapril delays progression of hypertension and uremia in rat polycystic kidney disease. 750 69

Comorbidity, urea kinetics (Kt/V and normalized protein catabolic rate), dietary protein, total calorie intake, and plasma albumin were measured in 97 continuous ambulatory peritoneal dialysis patients followed prospectively for 30 months. Comorbid disease was graded severe in 12 patients, intermediate in 29, and absent in 56. At entry to the study comorbidity was associated with increased age (P = 0.001), lower dietary protein (P = 0.015) and calorie intake (P = 0.02), and a lower plasma creatinine (P = 0.026). Trends toward lower Kt/V and albumin were not significant, and normalized protein catabolic rate was unaffected. Ability of these measures to predict mortality was assessed by univariate and multivariate analysis using Cox's proportional hazard model. On univariate analysis, comorbidity (P < 0.0001), age (P = 0.0001), Kt/V (P = 0.009), plasma albumin (P = 0.009), calorie intake (P = 0.035), and dietary protein intake (P = 0.03) predicted outcome, whereas normalized protein catabolic rate did not (P = 0.46). Multivariate analysis indicated that comorbidity (P = 0.0003) and age (P = 0.0085) were the only independent predictors of outcome. The addition of plasma albumin and Kt/V increased the significance of the Cox model. Further analysis of comorbidity demonstrated the relative importance of vascular disease and left ventricular dysfunction. This study illustrates the profound influence of comorbid disease on mortality in continuous ambulatory peritoneal dialysis patients and suggests that it causes suppression of appetite independent of the dialysis dose.
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PMID:Comorbidity, urea kinetics, and appetite in continuous ambulatory peritoneal dialysis patients: their interrelationship and prediction of survival. 764 41

Microalbuminuria was recently proposed as a novel atherogenic risk factor. The pathophysiological link between microalbuminuria and atherosclerosis may be mediated through an increased generalized transvascular leakage of albumin. To investigate this hypothesis, urinary albumin excretion and clearance and systemic transvascular albumin leakage (TERalb) were measured in 23 patients with severe clinical atherosclerosis and 25 healthy controls. In addition, renal clearances of three other endogenous plasma proteins (IgG, IgG4, and beta 2-microglobulin) and of creatinine were measured. Measurements of urine and serum proteins were done by enzyme-linked immunosorbent assays. TERalb was measured by the fractional disappearance rate of 125I-albumin from the total intravascular compartment in 1 hour after intravenous injection. Glomerular filtration rate was estimated as creatinine clearance. Urinary albumin excretion (geometric means [95% confidence intervals], 10.5 [6.1 to 18.3] versus 5.7 [4.7 to 6.9] micrograms/min; P < .05), fractional urinary albumin clearance (2.8 [1.6 to 4.8] x 10(-6) versus 1.3 [1.0 to 1.6] x 10(-6); P < .05), and TERalb (6.0 [5.5 to 6.5] versus 5.1 [4.5 to 5.8] %/h; P < .05) were higher in patients than in control subjects. Glomerular charge selectivity (ratio of IgG clearance to IgG4 clearance) was lower in patients than in control subjects (1.5 [1.1 to 2.0] versus 2.3 [2.0 to 2.6]; P < .05). These alterations were independent of blood pressure, glomerular filtration rate, tubular function, and smoking status. It is concluded that atherosclerotic vascular disease is associated with renal and systemic transvascular leakiness for albumin. Theoretically, such leakiness may in addition allow for an increased lipid insudation into the large vessel wall, thereby linking microalbuminuria to atherogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Renal and systemic transvascular albumin leakage in severe atherosclerosis. 767 Sep 45

1. Microalbuminuria in non-diabetic elderly subjects is predictive of vascular disease and mortality, and related to levels of blood pressure. 2. This study was designed to examine whether more restricted periods of urine collection retained the relation to the prevailing level of blood pressure and successfully identified subjects with microalbuminuria. 3. Fifty elderly subjects (aged over 60 years) made two consecutive 24-h urine collections for measurement of urinary albumin excretion, divided between daytime and night-time periods. Thirty-three subjects also provided a random 'spot' urine sample. Clinic and 24-h ambulatory blood pressure were also recorded. 4. Median 24-h urinary albumin excretion was 15.75 mg; 17 subjects had microalbuminuria. The median 24-h albumin-creatinine ratio was 1.91 mg/mmol. A threshold albumin-creatinine ratio of > or = 3.0 mg/mmol in a random urine sample predicted microalbuminuria with 92% sensitivity and 90% specificity. Alternatively, threshold values of 2.5 mg/mmol for men and 4.5 mg/mmol for women in an overnight urine collection predicted microalbuminuria with 88% sensitivity and 100% specificity. 5. The closest relation between albumin-creatinine ratio and blood pressure was that between spot albumin-creatinine ratio and clinic systolic blood pressure (r = 0.64, P < 0.001). Albumin-creatinine ratio was generally related to clinic systolic blood pressure, diastolic blood pressure and ambulatory systolic blood pressure. Microalbuminuric subjects had significantly higher levels of clinic and ambulatory systolic blood pressure than non-microalbuminuric subjects. 6. Microalbuminuria in the elderly is most related to clinic systolic blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Screening tests for microalbuminuria in non-diabetic elderly subjects and their relation to blood pressure. 772 Mar 43


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