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Query: UMLS:C0730345 (microalbuminuria)
 4,018 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We inquired whether the type of diabetic glomerulosclerosis, diffuse or nodular, is of value as an alternative to microalbuminuria in predicting later progression of renal disease. To answer this question, we conducted a retrospective cohort study in eleven Japanese non-insulin-dependent diabetes mellitus patients with normo- to microalbuminuria. Nodular diabetic glomerulosclerosis was found in six patients, and diffuse diabetic glomerulosclerosis in five patients. The mean follow-up period was 41.5 months (range 12-65). Three patients developed persistent proteinuria and one developed chronic renal failure. Mean level of serum creatinine in all patients was elevated from 0.97 +/- 0.23 mg/dl (SD) to 1.10 +/- 0.37 mg/dl (P = 0.098). The rate of increase in serum creatinine was 0.068 +/- 0.115 mg/dl/year in nodular diabetic glomerulosclerosis, and 0.023 +/- 0.069 mg/dl/year in a diffuse one. No difference was found between these two types of diabetic glomerulosclerosis (P = 0.445). We conclude that in normo- to microalbuminuria diabetic nephropathy the type of diabetic glomerulosclerosis, diffuse or nodular, is not necessarily an alternative to microalbuminuria in predicting its later progression in Japanese non-insulin-dependent diabetes mellitus patients.
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PMID:Are glomerular lesions alternatives to microalbuminuria in predicting later progression of diabetic nephropathy? 879 27

To update 2 National High Blood Pressure Education Program working group reports on hypertension and chronic renal failure and renovascular hypertension, a working group was appointed by the director of the National Heart, Lung, and Blood Institute. Literature was searched through MEDLINE and the National Heart, Lung, and Blood Institute information center library. Scientific evidence was given precedence over clinical anecdotal experience. The working group members produced initial draft documents that were circulated to additional experts on hypertension and renal disease. This reiterative process occurred for 18 draft documents. The final report was sent to the representatives of the 44 organizations on the Coordinating Committee for vote and unanimously approved September 1, 1995. The report recommended treatment of hypertension to the goal of 130/85 mm Hg with whatever therapy is necessary to prevent the development of hypertensive nephrosclerosis or the progression of established renal disease of diverse causes. It seems reasonable to recommend angiotensin-converting enzyme inhibitors as initial therapy for patients with diabetes and microalbuminuria or overt diabetic nephropathy with and without hypertension. Renovascular disease has emerged as a major cause of end-stage renal disease, especially in the elderly. Newer screening procedures for the noninvasive screening of renovascular disease include the captopril test, renal scintigraphy following captopril administration, duplex scanning, and magnetic resonance angiography.
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PMID:1995 update of the working group reports on chronic renal failure and renovascular hypertension. National High Blood Pressure Education Program Working Group. 882 47

Diabetic nephropathy is the most frequent cause of chronic renal failure. The onset of microalbuminuria in patients with diabetes mellitus, which seems to be related to blood pressure and the control of glycemia, is predictive of the development of true proteinuria. This multicenter, single-blind, randomized study examined the effects of benazepril and nicardipine on overnight microalbuminuria in 57 normotensive and 46 hypertensive diabetic patients. At the end of a 3-month placebo run-in period, the patients were stratified on the basis of the presence or absence of arterial hypertension and, within each stratum, randomized to receive one daily tablet of 10 mg benazepril or one tablet of 20 mg nicardipine twice daily for 6 months. Renal hemodynamics was investigated in 25 patients. Both drugs decreased overnight microalbuminuria throughout the study period, but benazepril was more effective than nicardipine (p = 0.025); in the patients with hypertension, both drugs led to a similar marked reduction in systolic and diastolic blood pressure. This study shows that benazepril was more effective than nicardipine in reducing overnight microalbuminuria in patients with diabetes mellitus, independently of their antihypertensive properties.
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PMID:Effects of benazepril and nicardipine on microalbuminuria in normotensive and hypertensive patients with diabetes. 887 95

We studied the relationship between clinical characteristics and renal structural changes in 29 elderly patients in whom non-insulin-dependent diabetes mellitus was diagnosed when they were 60 years of age or older. The clinical stage of nephropathy was graded according to the criteria of the Ministry of Health and Welfare of Japan: stage 1 (12 patients), normoalbuminuria; stage 2 (11 patients), microalbuminuria; stage 3 (1 patient), persistent proteinuria; stage 4 (5 patients), chronic renal failure. Renal biopsy specimens were semiquantitatively evaluated with regard to diffuse glomerular lesions, nodular lesions, and vascular lesions. In patients at stage 1, minimal-to-moderate diffuse lesions were observed, and vascular lesions were already present. In patients at stage 2, various alterations in diffuse lesions were observed and were associated with prominent changes in the vascular lesions. More advanced changes in the diffuse and vascular lesions were noted in patients at stages 3 and 4, but nodular lesions were found in only one patient. These patients had a high incidence of hypertension and ischemic heart disease. We conclude that elderly diabetic patients with nephropathy of different clinical stages have different underlying diabetic renal lesions.
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PMID:[Clinicopathological study of diabetic nephropathy in the elderly]. 895 41

Diabetic nephropathy is one of the most frequent causes of chronic renal failure worldwide. Altogether, 35% of patients with insulin-dependent diabetes mellitus and a somewhat smaller percentage of patients with non-insulin-dependent diabetes mellitus ultimately develop diabetic kidney disease. Early diagnosis is of utmost importance since the development of diabetic nephropathy affects the general health, the carbohydrate metabolism of the patient, moreover it aggravates hypertension and accelerates atherosclerosis. Microalbuminuria is a sensitive but relatively late marker of diabetic kidney disease. Still, screening of diabetic patients for microalbuminuria is of great importance since there is no other screening test capable of diagnosing diabetic nephropathy at an earlier stage. The description of the genetic substrate of susceptibility to diabetic kidney disease would revolutionize the diagnosis and prevention of diabetic nephropathy. Until then, compliance with therapeutic guidelines outlined in milestone clinical studies of the last years may significantly decrease morbidity, the progression of, and the mortality associated with diabetic kidney disease.
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PMID:[Current issues in the diagnosis and therapy of diabetic nephropathy]. 907 51

Nephropathy is a frequent complication of long-term diabetes. Strong evidence exists that genetic predisposition plays a major role in the development of diabetic nephropathy. The role of the angiotensin I-converting enzyme gene (ACE) in the susceptibility to nephropathy in diabetes, especially in non-insulin dependent diabetes mellitus (NIDDM), remains unclear. This study examines the association of two ACE polymorphisms: a 287-bp insertion/deletion (I/D) in intron 16 and PstI (A/G substitution in intron 7; alleles P/M) with renal complications in 941 NIDDM patients. From this group, for further analysis 127 patients were selected with overt proteinuria or chronic renal failure, 335 patients with microalbuminuria, and a control group of 254 normoalbuminuric patients with a diabetes duration of at least 10 yr. No significant differences in the distribution of ACE I/D and PstI genotypes or allele frequencies were observed between the examined groups. The results of this study strongly suggest that there is no association between the ACE gene I/D and PstI polymorphisms and nephropathy in NIDDM.
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PMID:Angiotensin I-converting enzyme gene polymorphisms: relationship to nephropathy in patients with non-insulin dependent diabetes mellitus. 972 75

Late rearrangement products that accumulate by glycation of proteins, known as advanced glycation end products (AGEs), have been implicated in the pathogenesis of complications related to diabetes. Circulating AGEs, especially in the form of a small peptide (AGE-peptide) of less than 10 kd, increase in the blood of diabetic patients with end-stage renal disease (ESRD). The aim of the study was to evaluate AGE-peptide levels by measuring AGE-specific fluorescence (excitation at 370 nm and emission at 440 nm) and to examine the relationship between AGE-peptide and diabetic nephropathy. AGE-specific fluorescence in serum and urine were examined in diabetic subjects with various levels of renal complications of varying severity: normoalbuminuria (N), microalbuminuria (Mi), macroalbuminuria (Ma), chronic renal failure (C), and hemodialysis (HD). We also assessed correlations among the AGE-peptide level and age, duration of diabetes, hemoglobin A1c (HbA1c), serum creatinine, and creatinine clearance. Serum and urine AGE-peptide levels in C and HD were significantly higher than in N, Mi, and Ma. Serum AGE-peptide levels were significantly correlated with serum creatinine (r=.866, P < .0001) and creatinine clearance (r=-.720, P < .0001) but not with duration of diabetes or age. There was a significant correlation between AGE-peptide levels measured by enzyme-linked immunosorbent assay (ELISA) and levels determined from the specific fluorescence intensity (r=.688, P < .0001). These findings suggest that renal function may play a greater role in the accumulation of AGEs than persistent hyperglycemia in diabetic patients. Measurement of AGE-specific fluorescence (ie, AGE-peptide) may serve as a simple and useful test to assess circulating AGE levels and monitor AGE excretion.
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PMID:Specific fluorescence assay for advanced glycation end products in blood and urine of diabetic patients. 982 11

The kidney can suffer the consequences of a persistently elevated blood pressure. In fact end-stage renal failure caused by essential hypertension appears to be one of the most prevalent etiologies in patients entering a dialysis program. Blood pressure control is needed in order to prevent the progressive loss of renal function. Target blood pressure control has been established at values as low as 125/75 mm Hg for patients with proteinuria above 1 g/day. Attainment of this target level usually requires the combination of two or more drugs. However, the possibility that differences exist among the different classes of antihypertensive drugs beyond their capacity to simply lower blood pressure remains to be clearly elucidated. The fact that the presence of chronic renal failure is also accompanied by an enhanced cardiovascular risk potentiates the need to explore the renoprotective and cardiovascular protective capacity of the different classes of antihypertensive drugs, in patients with essential hypertension and some degree of renal involvement, characterized by the presence of microalbuminuria, proteinuria and/or an elevated serum creatinine.
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PMID:Therapeutic implications and new perspectives for essential hypertension and renal damage. 983 83

The number of patients with significant chronic renal failure is expanding rapidly in the United States. All physicians and medical-care providers will have an increasingly important role in the detection and management of renal failure in patients who are not undergoing dialysis. Patients with diabetes or hypertension should be carefully monitored for the development of renal insufficiency by using screening tools such as blood pressure measurement, determination of serum creatinine, urinalysis, and determination of 24-hour urinary microalbuminuria. In order to slow the progression of renal disease, attenuate uremic complications, and prepare patients with renal failure for renal replacement therapy, all medical-care providers should "take care of the BEANS." Blood pressure should be maintained in a target range lower than 130/85 mm Hg, and in many patients, angiotensin-converting enzyme inhibitors may be beneficial. Erythropoietin should be used to maintain the hemoglobin level at 10 to 12 g/dL. Access for long-term dialysis should be created when the serum creatinine value increases above 4.0 mg/dL or the glomerular filtration rate declines below 20 mL/min. Nutritional status must be closely monitored in order to avoid protein malnutrition and to initiate dialysis before the patient's nutritional status has deteriorated. Nutritional care also involves correction of acidosis, prevention and treatment of hyperphosphatemia, and administration of vitamin supplements to provide folic acid. Specialty referral to nephrology should occur when the creatinine level increases above 3.0 mg/dL or when the involvement of a nephrologist would be beneficial for ongoing management of the patient.
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PMID:A practical approach to the management of patients with chronic renal failure. 1008 97

Prevention of the onset or worsening of microalbuminuria by good blood glucose control has been confirmed in Type 2 diabetes, though not at the stage of chronic renal failure (CRF). Thus, it would seem desirable to maintain strict blood glucose control whenever circumstances allow. If prescribed sulphonylureas (SU) are effective, they can be continued at adjusted doses until an advanced stage of CRF, subject to strict monitoring. SU are eliminated by the liver, but their metabolites (often active) are eliminated to varying degrees by the kidney. Non-SU insulin secretagogues and thiazolidinediones metabolised by the liver might also be used. The fate of their metabolites (some active) remains to be defined in CRF, and further clinical trials are required. Acarbose and its metabolites, as well as miglitol, very probably accumulate in CRF, causing ill-defined (but especially hepatic) iatrogenic risks. Although the danger of metformin in diabetic patients with renal failure is currently uncertain, CRF remains a regulatory contraindication. Insulin, which is necessary in most Type 2 diabetic patients with CRF, decreases as CRF progresses and when dialysis is started. The kinetics of insulin analogs are modified in CRF. Regardless of the choice of treatment, specialist and regular monitoring is required.
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PMID:Management of drugs affecting blood glucose in diabetic patients with renal failure. 1092 77


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