Diabetes mellitus nephropathy

FIGURE 43-3. Rates of decline in glomerular filtration rate (GFR) vs the systolic blood pressure (SBP) in studies extending for 3 years or more in patients with type 2 diabetes mellitus nephropathy. From Bakris, with permission. 

Diabetes mellitus (DM) is the most common cause of CKD.2 The risk of developing nephropathy associated with DM is closely linked to hyperglycemia and is similar for both type 1 and type 2, although it is slightly higher in patients with type 2 DM.5 An estimated 3% of patients with DM will develop ESRD, which is 12 times greater than those without DM.6... 

Diabetes mellitus can have serious secondary effects. A constantly raised blood sugar level can lead in the long term to changes in the blood vessels (diabetic angiopathy), kidney damage (nephropathy) and damage to the nervous system (neuropathy), as well as to cataracts in the eyes. 

Captopr/V- Treatment of diabetic nephropathy (proteinuria greater than 500 mg/day) in patients with type 1 insulin-dependent diabetes mellitus and retinopathy. 

Renal function /mpa/rmenf Anuria, acute or chronic renal insufficiency and evidence of diabetic nephropathy are contraindications because potassium retention is accentuated and may result in the rapid development of hyperkalemia. Do not give to patients with evidence of renal impairment (BUN greater than 30 mg/dL or serum creatinine greater than 1.5 mg/dL) or diabetes mellitus without continuous monitoring of serum electrolytes, creatinine, and BUN levels. 

Older patients have predominantly Type 2 diabetes mellitus, which shares with Type 1 the risk for retinopathy, nephropathy and neuropathy, but carries a greater risk for macrovascular complications such as coronary artery disease, stroke and peripheral vascular disease. Many such patients have associated obesity, hypertension and hyperlipidemia, compounding the risk of cardiovascular disease. The goals of treatment of DM in the elderly are to decrease symptoms related to hyperglycaemia and to prevent long-term complications. Treatment of type 2 DM can improve prognosis. In the UKPDS trial, sulphonylureas, insulin, and metformin were all associated with a reduction in diabetes-related... 

Left ventricular dysfunction Post-myocardial infarction Non-diabetic nephropathy Type 1 diabetic nephropathy Type 2 diabetes mellitus Proteinuria Hyperkalaemia Bilateral renal artery stenosis disease... 

Diabetes mellitus causes about 50% of all patients being treated for End Stage Renal Disease (ESRD) in the USA and this is because the disease (type 2 disease) is pervasive. Recent studies have shown that the onset and progression of the disease can be ameliorated if treatment is instituted early on in the course of the disease. ESRD is the commonest complication of type 1 diabetes. A higher proportion of individuals with type 2 diabetes was found to have microalbuminuria and overt nephropathy shortly after the diagnosis of diabetes, because the diabetes had actually been present for many years before the diagnosis was made. There is a correlation between the degree of albuminuria and cardiovascular disease. 

In the treatment of diabetic nephropathy associated with type I insulin-dependent diabetes mellitus, captopril decreases the rate of progression of renal insufficiency and retards the worsening of renal function. 

ACE Inhibitors in Diabetic Nephropathy Trialist Group Should all patients with type 1 diabetes mellitus and microalbuminuria receive angiotensin-converting enzyme inhibitors A meta-analysis of individual patient data. Ann Intern Med 2001 134 370. 

The combination of diabetes mellitus and hypertension inexorably leads to diabetic nephropathy and is the major cause of end-stage renal failure. In numerous animal studies and in several small clinical trials, ACE inhibitors have been shown to significantly retard the loss of kidney function associated with diabetic nephropathy. A large, prospective, placebo-controlled study has clearly established that captopril slows the progression of diabetic nephropathy in patients with insulin-... 

Contrast-induced nephropathy has been defined as an increase in serum creatinine of at least 25% or an absolute increase in serum creatinine of at least 0.5 mg/dL within 48 to 72 hours of iodinated contrast administration and is associated with significant morbidity and mortality (75). Important risk factors include diabetes mellitus, chronic renal insufficiency, administration of large volumes of high osmolar contrast agents, and intravascular volume depletion. Numerous pharmacologic preventive measures have been studied, but consistent benefits have not been demonstrated. In a recent large retrospective study, preprocedural statin therapy was independently associated with a lower risk of contrast nephropathy and nephropathy requiring dialysis (76). 

Weisberg LS, Kurnik PB, Kurnik BR. Risk of radiocontrast nephropathy in patients with and without diabetes mellitus, Kidney Int 1994 45 259-265. 

Serum Diabetic nephropathy (DN) Healthy subjects 25 DN patients 8 type 2 diabetes mellitus patients 33 UPLC Q-TOF MS Leucine, dihydrosphingosine, and phytosphingosine (54)... 

In addition to its antihypertensive effects, the ARB losartan demonstrated cardiovascular benefits beyond lowering blood pressure in the Losartan Intervention for Endpoint (LIFE) Reduction in Hypertension Study [8]. Similarly, results from the Valsartan in Acute Myocardial Infarction Trial showed that valsartan improves survival after acute MI in high-risk patients [15]. Due to a lack of clinical studies involving populations with the same cardiovascular risk profile, it is not possible to extrapolate these findings to all ARBs, particularly since the dose of ARB used appears critically important [7]. Several ARBs carry additional indications, including treatment of hypertension with LVH, stroke prevention, CHF, and nephropathy in typ. 2 diabetes mellitus. 

Salem MA, el-Habashy SA, Saeid OM, el-Tawil MM,Tawfik PH Urinary excretion of n-acetyl-beta-D-glucosaminidase and retinol binding protein as alternative indicators of nephropathy in patients with type 1 diabetes mellitus. Pediatr Diabetes. 2002 3 37-41. 

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