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1.
J. bras. nefrol ; 42(4): 484-488, Oct.-Dec. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1154625

ABSTRACT

ABSTRACT Introduction: Idiopathic nodular glomerulosclerosis (ING) is a condition that has a vasculopathic glomerular histological pattern. Case presentation: The authors present the case of a 44-year-old Hispanic smoker female with hypertension and peripheral arterial disease who presented nephrotic syndrome for 2 weeks. The patient was diagnosed with ING by percutaneous renal biopsy results, which showed global nodular mesangial matrix expansion, with linear staining accentuation of glomerular and tubular basement membrane for Immunoglobulin G (IgG) and albumin on immunofluorescence. Conclusions: ING is a rare disease with a poor renal prognosis and wide diagnostic approach; we highlight the importance of analyzing every piece of detail together to reach a definitive diagnosis.


RESUMO Introdução: A glomerulosclerose nodular idiopática (GNI) tem um padrão histológico glomerular vasculopático. Apresentação do caso: Os autores apresentam o caso de uma mulher latino-americana, de 44 anos, fumante, com hipertensão e doença arterial periférica; com síndrome nefrótica por 2 semanas. Ela foi diagnosticada com GNI por biópsia renal percutânea, que mostrou expansão generalizada da matriz mesangial nodular, com acentuação de coloração linear na membrana basal glomerular e tubular para imunoglobulina G (IgG) e albumina à imunofluorescência. Conclusões: A GNI é uma doença rara, com mau prognóstico renal, e com necessidade de uma ampla abordagem diagnóstica. Demonstramos aqui a importância de se analisar todos os detalhes em conjunto para realizar um diagnóstico definitivo.


Subject(s)
Humans , Female , Adult , Diabetic Nephropathies/diagnosis , Hypertension , Nephrotic Syndrome , Diagnosis, Differential , Kidney
2.
J. bras. nefrol ; 41(3): 412-422, July-Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1040242

ABSTRACT

Abstract Diabetic kidney disease (DKD) is a chronic complication of diabetes mellitus associated with significant morbidity and mortality regarded as a global health issue. MicroRNAs - small RNA molecules responsible for the post-transcriptional regulation of gene expression by degradation of messenger RNA or translational repression of protein synthesis - rank among the factors linked to the development and progression of DKD. This study aimed to offer a narrative review on investigations around the use of microRNAs in the diagnosis, monitoring, and treatment of DKD. Various microRNAs are involved in the pathogenesis of DKD, while others have a role in nephroprotection and thus serve as promising therapeutic targets for DKD. Serum and urine microRNAs levels have also been considered in the early diagnosis and monitoring of individuals with DKD, since increases in albuminuria, decreases in the glomerular filtration rate, and progression of DKD have been linked to changes in the levels of some microRNAs.


Resumo A doença renal do diabetes (DRD) é uma complicação crônica do diabetes mellitus associada à elevada morbidade e mortalidade, considerada um problema de saúde mundial. Dentre os fatores associados ao desenvolvimento e à progressão da DRD, destacam-se os microRNAs, que consistem em pequenas moléculas de RNA que regulam a expressão gênica por meio da degradação pós-transcricional do RNA mensageiro ou inibição translacional da síntese proteica. Este estudo teve como objetivo realizar uma revisão narrativa buscando investigar os microRNAs como auxiliares no diagnóstico, monitoramento e tratamento da DRD. Vários microRNAs estão envolvidos na patogênese da DRD, enquanto que outros têm papel nefroprotetor, consistindo assim em alvos terapêuticos promissores para o tratamento da DRD. A dosagem laboratorial dos microRNAs no soro e na urina também é muito promissora para o diagnóstico precoce e o monitoramento da DRD, já que os níveis de alguns microRNAs se alteram antes do aumento da albuminúria e da diminuição da taxa de filtração glomerular e podem ainda se alterar com a progressão da DRD.


Subject(s)
Humans , Animals , Rats , MicroRNAs/urine , MicroRNAs/blood , Diabetic Nephropathies/drug therapy , Biomarkers/urine , Biomarkers/blood , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Diabetic Nephropathies/diagnosis , Diabetic Nephropathies/genetics , Diabetic Nephropathies/pathology , Albuminuria , Molecular Targeted Therapy , Glomerular Filtration Rate
3.
Rev. nefrol. diál. traspl ; 38(4): 258-267, dic. 2018. tab
Article in Spanish | LILACS | ID: biblio-1006983

ABSTRACT

INTRODUCCIÓN: La nefropatía diabética constituye la primera causa de enfermedad renal crónica y sustitución de la función renal a nivel mundial sin excepción, esto debido al acelerado deterioro en la función renal sufrido por los pacientes que se mantienen lejos de las metas de control metabólico en diabetes, así como, las comorbilidades asociadas que contribuyen como factores de progresión adicionales, ocasionando una caída inevitable en la tasa de filtración glomerular con la subsecuente terapia dialítica. Considerando, que actualmente no existen intervenciones preventivas de nefrología enfocados en diabetes, presentamos los resultados de un programa realizado en la atención de primera vez de estos pacientes en el Hospital General Guillermo Álvarez Macías, Tula de Allende, Hidalgo, México. OBJETIVO: La detección temprana de nefropatía diabética y determinación de factores de riesgo asociados. MATERIAL Y MÉTODOS: Estudio descriptivo retrospectivo transversal, mediante análisis de pruebas de función renal, incluido el estudio de albuminuria de 24 horas, se realizó una búsqueda intencionada de hallazgos anormales. Los datos fueron analizados usando el paquete estadístico SPSS versión 15 para Windows. RESULTADOS: Fue posible detectar la nefropatía diabética en el 61% de la población contra 30% mediante técnicas tradicionalmente utilizadas en la consulta general de pacientes diabéticos. Se encontró a la hiperglicemia persistente como el principal factor asociado al desarrollo de nefropatía, constituyendo el nivel de control subóptimo prolongado el denominador común que los diferencia de la población sin nefropatía diabética (p 0.002). CONCLUSIONES: considerando que la nefropatía diabética es una enfermedad prevenible, es de fácil detección al realizar un cribado adecuado en el primer y segundo nivel de atención, que permita su referencia oportuna al especialista en nefrología para su apoyo en el tratamiento


INTRODUCTION: Diabetic nephropathy constitutes the leading cause of chronic kidney disease and renal function substitution all over the world and without exception, given the rapid deterioration of renal function suffered by patients who fail to achieve diabetes metabolic control goals and the associated comorbidities representing additional progression factors. All these cause an unavoidable drop in glomerular filtration rate and a subsequent dialysis treatment. Considering that nowadays there are not any preventive interventions in nephrology focused on diabetes, we present the results of a program conducted on patients treated for the first time at Hospital General Guillermo Álvarez Macías, Tula de Allende, Hidalgo, México. OBJECTIVE: Early diagnosis of diabetic nephropathy and identification of associated risk factors. METHODS: A descriptive, retrospective, cross-sectional study, which included a 24-hour albumin test, was conducted by means of renal function tests deliberately looking for abnormal findings. Data were analyzed using the SPSS 15 statistical software for Windows. RESULTS: By means of traditional techniques used to treat diabetic patients in general, it was possible to diagnose diabetic nephropathy in 61% of the patients vs. 30%. Persistent hyperglycemia was found to be the main factor associated with nephropathy, lengthy suboptimal control levels being the common factor that distinguishes these patients from the population not suffering from diabetic nephropathy (p 0.002). CONCLUSIONS: Given that diabetic nephropathy is a preventable disease, it is easy to diagnose it through an adequate screening at first- and second-level care, which allows a timely referral to a nephrology specialist to treat it


Subject(s)
Humans , Mass Screening , Diabetes Mellitus, Type 2 , Diabetic Nephropathies , Diabetic Nephropathies/diagnosis , Albuminuria , Kidney Failure, Chronic
4.
Rev. Assoc. Med. Bras. (1992) ; 64(1): 85-92, Jan. 2018. tab, graf
Article in English | LILACS | ID: biblio-896416

ABSTRACT

Summary Diabetic nephropathy is the main cause of chronic kidney disease, and represents the most common and serious complication of diabetes. The exact pathogenesis is complex and not elucidated. Several factors and mechanisms contribute to the development and outcome of diabetic nephropathy. An early diagnosis and intervention may slow down disease progression. A variety of biological markers associated with diabetic nephropathy were found in recent years, which was important for predicting the occurrence and development of the disease. Therefore, this article provides an overview of early biomarkers that are associated with diabetic nephropathy.


Subject(s)
Humans , Diabetic Nephropathies/diagnosis , Biomarkers/analysis , Risk Factors , Early Diagnosis , Diabetes Complications/diagnosis , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Diabetic Nephropathies/etiology , Renal Insufficiency, Chronic
5.
Rev. medica electron ; 39(supl.1): 718-728, 2017.
Article in Spanish | LILACS, CUMED | ID: biblio-902251

ABSTRACT

Introducción: la nefropatía diabética, es un trastorno metabólico en el que la hiperglucemia induce disfunción en diversos tipos de células del riñón, que deriva en insuficiencia renal progresiva. Objetivo: describir el comportamiento de variables de funcionamiento renal en pacientes diabéticos tipo 2 en tres consultorio médicos de la familia del Policlínico Comunitario "José J. Milanés", Municipio de Matanzas, entre mayo del 2013 y mayo del 2014. Materiales y métodos: se realizó un estudio descriptivo transversal en un universo conformado por 129 pacientes con diabetes mellitus tipo 2. La muestra fueron 85 pacientes seleccionados por muestreo aleatorio simple. Variables objeto de estudio: tiempo de evolución de la enfermedad, glucemia, creatinina, microalbuminuria y filtrado glomerular. Resultados: 39 pacientes se encontraban con un período de diagnóstico entre 6 y 10 años, correspondiendo a esta etapa el mayor por ciento (45.9 %). 74 pacientes (87 %) presentó hiperglicemia y el 76,9 % (30 pacientes) presentaron cifras elevadas de creatinina. Para el filtrado glomerular predominaron los pacientes que se encuentran en el estadio II con un 43.6 % y tiempo de evolución entre los 6 y los 10 años, en la microalbuminuria, se destaca que el 42,1 % de los pacientes con menos de 5 años de evolución de la enfermedad presentaban cifras de microalbuminuria por encima de 30 mg/l). Conclusiones: predominaron los pacientes con tiempo de evolución entre los 6 a 10 años, grupo con los mayores porcentaje de pacientes con glucemia, creatinina, filtrado glomerular y microalbuminuria elevados. EL total de pacientes con más de 16 años de evolución de la enfermedad tenían cifras elevadas de filtrado glomerular y microalbuminuria (AU).


Introduction: diabetic nephropathy is a metabolic disturbance in which hyperglycemia induces dysfunction in different kinds of kidneys cells. It derives in progressive renal insufficiency. Objective: to describe the behaviour of renal function variables in type 2 diabetic patients in three family physician consultation (CMF, abbreviation in Spanish) of the Community Polyclinic "José J. Milanés", municipality of Matanzas in the period May 2013-May 2014. Materials and methods: descriptive, transversal study in a universe of 129 patients with type 2 diabetes mellitus. Simply randomized sample composed by 85 patients. The studied variables were time of disease evolution, glycemia, creatinine, microalbuminuria and glomerular filtration. Results: 39 patients were found in a diagnostic period between 6 and 10 years, the biggest percent (45.9 %) corresponding to this stage. 74 patients (87 %) presented hyperglycemia and 30 patients (76.9 %) showed high quantitites of creatinine. Patients that were in the II stage for 43.6 % and evolution time between 6 and 10 years predominated in the glomerular filtration; 42.1 % of the patients with less than 5 years of the disease evolution showed amounts of microalbuminuria of over 30 mg/l. Conclusions: it was found the predomination of patients with 6-10 years of evolution time, the group with the highest percent of patients with increased glycemia, creatinine, glomerular filtration and microalbuminuria. The total of the patients with more than 16 years of disease evolution had high amounts of glomerular filtrate and microalbuminuria (AU).


Subject(s)
Humans , Male , Female , Biomarkers/urine , Diabetes Mellitus, Type 2/epidemiology , Diabetic Nephropathies/epidemiology , Mass Screening/methods , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/urine , Diabetes Mellitus, Type 2/rehabilitation , Diabetes Mellitus, Type 2/therapy , Diabetic Nephropathies/diagnosis , Diabetic Nephropathies/urine , Diabetic Nephropathies/therapy , Observational Studies as Topic
8.
Article in English | WPRIM | ID: wpr-106131

ABSTRACT

BACKGROUND/AIMS: Diabetic cystopathy is a frequent complication of diabetes mellitus. This study assessed the association between the post-voiding residual (PVR) urine volume and diabetic nephropathy in type 2 diabetics with no voiding symptoms. METHODS: This study investigated 42 patients with type 2 diabetes who were followed regularly at our outpatient clinic between July 1, 2008 and June 30, 2009. No patient had voiding problems or International Prostate Symptom Scores (IPSSs) > or = 12. An urologist performed the urological evaluations and the PVR was measured using a bladder scan. A PVR > 50 mL on two consecutive voids was considered abnormal, which was the primary study outcome. RESULTS: The mean patient age was 60 +/- 10 years; the IPSS score was 3.7 +/- 3.3; and the diabetes duration was 11.9 +/- 7.8 years. Seven of the 42 patients (16.7%) had a PVR > 50 mL. The presence of overt proteinuria or microalbuminuria was associated with an increased risk of a PVR > 50 mL (p 50 mL had a significantly lower estimated glomerular filtration rate (eGFR) compared with those with a PVR 50 mL. CONCLUSIONS: Patients with diabetic nephropathy had a significantly higher PVR and a lower eGFR was associated with an abnormal PVR.


Subject(s)
Adult , Aged , Aged, 80 and over , Diabetes Mellitus, Type 2/complications , Diabetic Nephropathies/diagnosis , Female , Glomerular Filtration Rate , Humans , Kidney/physiopathology , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Outpatient Clinics, Hospital , Republic of Korea , Risk Factors , Time Factors , Urodynamics
9.
Arq. bras. endocrinol. metab ; 58(8): 798-801, 11/2014. tab, graf
Article in English | LILACS | ID: lil-729789

ABSTRACT

Objective To evaluate the clinical usefulness of urinary N-acetyl-beta-D-glucosaminidase (NAG) excretion for the detection of early tubular damage in type 2 diabetes mellitus (T2DM). Subjects and methods Thirty six patients with T2DM were divided into two groups based on urinary albumin to creatinine ratio (ACR): normoalbuminuria (ACR <30 mg/g; n=19) and microalbuminuria (ACR =30‐300 mg/g; n=17). The following parameters were determined in both groups: urinary NAG and albumin, serum and urine creatinine, fasting plasma glucose and glycated hemoglobin (HbA1c). Results Urinary NAG levels [Units/g creatinine; median (range)] were significantly increased in microalbuminuria group [17.0 (5.9 - 23.3)] compared to normoalbuminuria group [4.4 (1.5 - 9.2)] (P<0.001). No differences between groups were observed in fasting glucose, HbA1c, serum creatinine levels and estimated glomerular filtration rates (eGFR). Urinary NAG positively correlated with ACR (r=0.628; p<0.0001), while no significant association was observed between NAG and glycemia, HbA1c, serum creatinine and eGFR. Conclusions The increase of urinary NAG at the microalbuminuria stage of diabetic nephropathy (DN) suggests that tubular dysfunction is already present in this period. The significant positive association between urinary NAG excretion and ACR indicates the possible clinical application of urinary NAG as a complementary marker for early detection of DN in T2DM. .


Objetivo Avaliar a utilidade clínica da excreção urinária da N-acetil-beta-D-glucosaminidase (NAG) para a detecção de dano tubular precoce no diabetes melito tipo 2 (DM2). Sujeitos e métodos Foram estudados trinta e seis pacientes com DM2 que se dividiram em dois grupos com base na excreção urinária de albumina (EUA): normoalbuminúrico (EUA <30 mg/g de creatinina; n=19) e microalbuminúrico (EUA =30‐300 mg/g de creatinina; n=17). Em ambos os grupos foram determinados os seguintes parâmetros: NAG e albumina urinária, creatinina sérica e urinária, glicemia de jejum e hemoglobina glicada (HbA1c). Resultados Os níveis de NAG urinária [unidades/g de creatinina; mediana (intervalo interquartílico)] foram significativamente maiores no grupo microalbuminúrico [17,0 (5,9 - 23,3)] em comparação com o grupo normoalbuminúrico [4,4 (1,5 - 9,2)] (p<0,001). Não se observaram diferenças significativas entre os dois grupos nos níveis de glicemia de jejum, HbA1c, creatinina sérica e taxa de filtração glomerular estimada (TFGe). A NAG urinária se correlacionou positivamente com o EUA (r=0,628, p<0,0001), não sendo observada associação significativa da NAG com glicemia, HbA1c, creatinina sérica e TFGe. Conclusões O aumento da NAG urinária na fase de microalbuminúria da nefropatia diabética (ND) sugere que a disfunção tubular já está presente nesse período. A associação positiva significativa entre a excreção urinária da NAG e EUA indica a possível aplicação clínica da NAG urinária como marcador complementar para a detecção precoce da ND no DM2. .


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Acetylglucosaminidase/urine , Albuminuria/urine , /urine , Diabetic Nephropathies/diagnosis , Kidney Tubules , Biomarkers/urine , Blood Glucose/analysis , Colorimetry , Cross-Sectional Studies , Creatinine/blood , Creatinine/urine , /complications , Diabetic Nephropathies/complications , Diabetic Nephropathies/urine , Glomerular Filtration Rate/physiology , Glycated Hemoglobin A/analysis , Kidney Tubules/injuries
10.
Rev. ANACEM (Impresa) ; 7(1): 4-6, abr. 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-716198

ABSTRACT

INTRODUCCIÓN: La nefropatía diabética es una complicación relevante de la Diabetes Mellitus. Por esto, la American Diabetes Association (ADA) recomienda la determinación de la velocidad de filtración glomerular (VFG) como screening de nefropatía. Existe una fórmula, la MDRD (Modification of Diet in Renal Disease), que permite hacer una estimación bastante exacta dela VFG. La utilización de ésta ha sido comparada permanentemente con la Cockcroft-Gault. OBJETIVO: comparar ambas fórmulas para la VFG en la realidad local. MATERIAL Y MÉTODO: se realizó un estudio retrospectivo sobre 243 pacientes, seleccionados al azar, de un total de 1.057 pacientes diabéticos tipo 2 registrados en el Plan de Salud Cardiovascular en el CESFAM San Rafael de la comuna La Pintana que contaban con medición seriada de Creatinina plasmática en sus controles periódicos. Se consideraron los valores de creatinina plasmática más recientes tomados en el período Enero 2010-Octubre 2011 y obtuvimos la VFG aplicando ambas fórmulas. RESULTADOS: del total de pacientes seleccionados, 158 fueron mujeres (65 por ciento) y 85 hombres (35 por ciento), con una media de edad de 53 años (DE 8,08). La VFG media estimada con MDRD fue de 89 ml/min/1,73 m2 (DE 21) y con la Cockcroft-Gault fue de 108 ml/min (DE 32), p<0,001. Realizamos un estudio de correlación entre ambas fórmulas. DISCUSIÓN: ambas mostraron correlación aceptable para estimar la VFG, aunque en pacientes obesos las estimaciones de VFG fueron más elevadas con Cockcroft-Gault que con MDRD. Por otro lado, en pacientes añosos la tendencia fue a que la fórmula MDRD diera estimaciones más altas.


INTRODUCTION: Diabetic Nephropathy is a significant complication of Diabetes Mellitus. That’s why, the American Diabetes Association (ADA) recommended for screening the determination of the glomerular filtration rate (GFR). MDRD (Modification of Diet in Renal Disease), is a formula which allows a very exactly estimation of GFR. Permanently, it had always been compared with Cockcroft-Gault formula. OBJECTIVE: Compare both formulas in the local reality. MATERIAL AND METHOD: It was done a retrospective studio over 243 patients, randomly selected, of a total of 1,057 type 2 diabetes patients registered in Cardiovascular program of San Rafael CESFAM that had serial measurement of plasmatic creatinine in their periodic controls. It was considered the most recent values of plasmatic creatinine taken between January 2010 – October 2011. RESULTS: Of the patients selected, 158 women (65 percent) and 85 men (35 percent), with average age of 53 years (SD 8,08), the GFR estimated with MDRD was of 89 ml/min/1.73 m2 (SD 21) and 108 ml/min (SD 32) for Cockcroft-Gault formula, p<0.001. We realized a correlation studio between both formulas. DISCUSSION: Both formulas demonstrated an acceptable correlation to estimated GFR, although obese patients had higher estimations with Cockcroft-Gault formula, on the other side, elderly patients had elevated results with MDRD.


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Creatinine/blood , Diabetes Mellitus/physiopathology , Diabetic Nephropathies/physiopathology , Kidney Function Tests/methods , Glomerular Filtration Rate/physiology , Body Weight , Diabetes Mellitus/blood , Kidney Diseases/physiopathology , Diabetic Nephropathies/diagnosis , Diabetic Nephropathies/blood , Predictive Value of Tests , Retrospective Studies , Sex Factors
11.
Article in English | WPRIM | ID: wpr-159661

ABSTRACT

This cross-sectional study was done to identify and determine the socio-demographic and health-related factors associated with diabetic retinopathy and nephropathy screening in Korea. Participants included 2,660 adults, aged 40 or older, with diabetes. Of the 2,660 adults, 998 (37%) and 1,226 (46.1%) had received a diabetic retinopathy and a nephropathy screening within one year, respectively. Regarding retinopathy, subjects older than 65, living in urban areas, with high educational levels, and with self-reported "unhealthy" status were likely to receive annual screening. Subjects living in urban areas, with higher educational levels, with self-reported "fair" or "unhealthy" status, and with 1 to 2 co-morbidities were likely to receive annual nephropathy screening. The Korea Composite Stock Price Index (KOSPI) continued to rise until 2007 when it started to decline over the subsequent years, following the same curve as the diabetic retinopathy and nephropathy screening rates during that time. Together with the financial matter, lack of patient education proved to be a hindrance to diabetes-related screening. The relatively low screening rates in Korea compared to the Western countries are likely to be due to the difference in the health system, economic situations and national demographics.


Subject(s)
Adult , Aged , Cross-Sectional Studies , Diabetes Complications/pathology , Diabetes Mellitus/diagnosis , Diabetic Nephropathies/diagnosis , Diabetic Retinopathy/diagnosis , Female , Health Behavior , Health Status , Humans , Male , Mass Screening , Middle Aged , Nutrition Surveys , Odds Ratio , Republic of Korea , Risk Factors , Severity of Illness Index
12.
Article in English | WPRIM | ID: wpr-175093

ABSTRACT

BACKGROUND/AIMS: In several recent studies, renal biopsies in patients with type 2 diabetes and renal disease have revealed a heterogeneous group of disease entities. Our aim was to study the prognosis and clinical course of nondiabetic renal disease (NDRD) and to determine risk factors for NDRD in patients with type 2 diabetes. METHODS: Renal biopsy reports of 110 patients with type 2 diabetes who were seen at Kyung Hee University Medical Center and Kyung Hee University Hospital at Gangdong, Seoul, Korea between January 2000 and December 2011 were retrospectively analyzed. RESULTS: Of 110 patients with type 2 diabetes, 41 (37.3%) had diabetic nephropathy (DN), 59 (53.6%) had NDRD, and 10 (9.1%) had NDRD superimposed on DN. Immunoglobulin A nephropathy (43.5%) was the most common NDRD. Patients with NDRD had a shorter duration of diabetes, lower frequency of diabetic retinopathy, and better renal outcomes, which might have resulted from the use of aggressive disease-specific treatments such as steroids and immunosuppressants in patients with NDRD. CONCLUSIONS: Compared with DN, NDRD was associated with better renal outcomes in patients with type 2 diabetes, as evidenced by a higher cumulative renal survival rate and lower rate of end-stage renal disease (ESRD). Shorter duration of diabetes and absence of retinopathy were independent predictors of NDRD in patients with type 2 diabetes and renal involvement. Renal biopsy is recommended for patients with type 2 diabetes and risk factors for NDRD, to obtain an accurate diagnosis, prompt initiation of disease-specific treatment, and ultimately better renal outcomes with the avoidance of ESRD.


Subject(s)
Adult , Biopsy , Chi-Square Distribution , Diabetes Mellitus, Type 2/complications , Diabetic Nephropathies/diagnosis , Disease Progression , Female , Glomerulonephritis, IGA/complications , Hospitals, University , Humans , Kaplan-Meier Estimate , Kidney Diseases/complications , Kidney Failure, Chronic/diagnosis , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Prognosis , Retrospective Studies , Risk Factors , Time Factors
13.
Arch. pediatr. Urug ; 84(supl.1): S34-S41, 2013. ilus
Article in Spanish | LILACS | ID: lil-756665

ABSTRACT

Introducción: la diabetes mellitus (DM1) es la enfermedad crónica endocrinológica más frecuente en pediatría y de mayor repercusión sanitaria por la gravedad de sus complicaciones. Dentro de estas complicaciones tienen especial relevancia la afectación de la microvasculatura, que causa retinopatía, neuropatía y nefropatía. Estas complicaciones, si bien se manifiestan durante la edad adulta, comienzan a desarrollarse en la niñez. Existen normas internacionales para su identificación. Se citan factores de riesgo que favorecen su desarrollo. Objetivos: determinar la prevalencia de complicaciones microvasculares en niños y adolescentes portadores de DM1; evaluar si las recomendaciones internacionales para su búsqueda se cumplen; describir la presencia de factores de riesgo asociados a su desarrollo. Material y método: estudio descriptivo retrospectivo, en base a la revisión de historias clínicas de pacientes menores de 15 años con diagnóstico de DM1, asistidos en el Centro Hospitalario Pereira Rossell en el período comprendido entre el 1/1/2000 y el 31/12/2009. Resultados: en el período analizado se identificaron192 pacientes; con una media de edad al debut de 7,5años, con un promedio de 5,8 años de evolución deDM1. El 73,4% tenía mal control metabólico, casi 18%tenía sobrepeso, 2,1% presentaba obesidad, 22,6%tenía dislipemia y 17% eran sedentarios. Se habíasolicitado albuminuria al 39,6% y fondo de ojo al 77%de los que deberían haber sido estudiados, deacuerdo a pautas internacionales.


Introduction: type 1 diabetes mellitus (DM1) is themost common chronic endocrine pediatric disease. Ithas a greater impact by the severity of it chroniccomplications. Among these complications areparticularly relevant microvasculature involvement,causing retinopathy, neuropathy and nephropathy.These complications, although manifested inadulthood begin to develop in childhood. There areinternational standards for identification. Risk factorsthat favor its development are mentioned.Objectives: to determine the prevalence ofmicrovascular complications in children andadolescents with DM1; assess whether internationalrecommendations for the search are met; describe thepresence of risk factors associated with theirdevelopment.Methods: retrospective descriptive study, based on areview of medical records of patients younger than 15years diagnosed with DM1, assisted in the PereiraRossell Hospital in the period between 1/1/2000 and31/12/2009. Results: during the reporting period 192 patients wereidentified, with a mean age at onset of 7,5 years, withan average of 5,8 years of evolution of DM1. 73,4% hadpoor metabolic control, almost 18% were overweight,2,1% were obese, 22,6% had dyslipidemia, and 17%were sedentary...


Subject(s)
Humans , Adolescent , Infant, Newborn , Infant , Child, Preschool , Child , Diabetic Angiopathies/diagnosis , Diabetes Mellitus, Type 1/complications , Diabetic Nephropathies/diagnosis , Risk Factors
14.
West Indian med. j ; 61(9): 881-889, Dec. 2012. ilus, tab
Article in English | LILACS | ID: lil-694360

ABSTRACT

OBJECTIVE: The purpose was to compare the characteristics of Tunisians with Type 2 diabetes mellitus (Type 2 DM) and nephropathy with those without nephropathy. This study assessed whether or not phenotypic characteristics can predict nephropathy development in Type 2 DM. The prevalence of nephropathy in Tunisian Type 2 DM patients, and their relationship with clinical and biochemical factors as well as chronic complications of the disease were determined. METHODS: This was a cross-sectional study of patients with diabetes diagnosed between January 2008 and December 2010. Altogether, 73 Type 2 DM and 42 healthy volunteers from the Basic Health Group of Sousse, were targeted for the study. Clinical, biochemical data, as well as complications of diabetes were collected. Kidney malfunction was defined by glomerular filtration rate (GFR). RESULTS: Diabetic patients were older. Diabetic women were more likely to have higher body mass index than men (p = 0.004). Obesity was more in women than men (60/23%). Complications including hypertension and dyslipidaemia were co-associated in women. Urinary creatinine clearance in Type 2 DM patients without nephropathy was significantly lower than in healthy participants (p < 0.0001). Microalbuminuria and urinary creatinine clearance were associated only in women with Type 2 DM with nephropathy (R² = 0.95); 1.5% of Type 2 DM patients without nephropathy had GFR < 60 mL/min/1.73m² and 76% had a GFR between 60 and 89 mL/min/1.73m². Glomerular filtration rate difference between Type 2 DM patients with/without nephropathy, as well as between Type 2 DM patients with nephropathy/Type 2 DM without nephropathy, and with retinopathy was not significant. CONCLUSIONS: By analysing factors associated with nephropathy in Type 2 DM Tunisian patients, this study demonstrated their susceptibility to nephropathy. In addition, retinopathy is potentially associated with incipient nephropathy in Type 2 DM Tunisian patients.


OBJETIVO: El propósito fue comparar las características de los tunesinos con diabetes mellitus tipo 2 (DMT2) y nefropatía, con aquéllos que no padecen nefropatía. Este estudio evaluó la posibilidad de saber si las características fenotípicas pueden predecir el desarrollo de una nefropatía en pacientes de DMT2. Se determinó la prevalencia de la nefropatía en los pacientes tunesinos con DMT2, y su relación con factores clínicos y bioquímicos, así como las complicaciones crónicas de la enfermedad. MÉTODOS: Se realizó un estudio transversal de pacientes con diabetes diagnosticada entre enero de 2008 y diciembre de 2010. En total, 73 voluntarios con DMT2 y 42 saludables del Grupo Básico de Salud de Sousse, fueron escogidos para el estudio. Se recogieron los datos clínicos y bioquímicos, así como las complicaciones por diabetes. El grado de mal funcionamiento renal fue determinado por la tasa de filtrado glomerular (GFR). RESULTADOS: Los pacientes diabéticos tenían más edad. Las mujeres diabéticas presentaban una mayor probabilidad de tener un índice de masa corporal más alto que los hombres (p = 0.004). Hubo mayor obesidad en las mujeres que en los hombres (60/23%). Las complicaciones - incluyendo hipertensión y dislipidemia - estuvieron co-asociadas en las mujeres. La depuración de la creatinina urinaria en los pacientes de DMT2 sin nefropatía fue significativamente más baja (p < 0.0001) que en los participantes saludables. La microalbuminuria y la depuración de la creatinina urinaria estuvieron asociadas en las mujeres con DMT2 con nefropatía (R² = 0.95); 1.5% de los pacientes con DMT2 sin nefropatía, tuvo una tasa GFR < 60 mL/min/1.73m² y 76% tuvo una GFR entre 60 y 89 mL/min/1.73m². La diferencia de la tasa de filtrado glomerular entre los pacientes de DMT2 con/sin nefropatía, así como entre los pacientes de DMT2 con nefropatía/DMT2 sin nefropatía, y con retinopatía, no fue significativa. CONCLUSIONES: Analizando factores asociados con la nefropatía en pacientes tunesinos con DMT2, este estudio demostró que estos últimos son susceptibles a la nefropatía. Además, la retinopatía se halla potencialmente asociada con la nefropatía incipiente en los pacientes tunesinos que padecen DMT2.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Developing Countries , /diagnosis , /epidemiology , Diabetic Nephropathies/diagnosis , Diabetic Nephropathies/epidemiology , Age Factors , Body Mass Index , Cross-Sectional Studies , Creatinine/blood , /physiopathology , Diabetic Nephropathies/physiopathology , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/epidemiology , Diabetic Retinopathy/physiopathology , Glomerular Filtration Rate/physiology , Risk Factors , Tunisia
15.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 22(2): 82-88, abr.-jun. 2012. tab, graf
Article in Portuguese | LILACS | ID: lil-681089

ABSTRACT

A hipertensão arterial é o maior fator de risco para doença cardiovascular e renal. Inversamente, a doença renal crônica é a forma mais comum de hipertensão secundária e várias evidências sugerem que é um fator de risco independente para mortalidade e morbidade cardiovascular. Balanço de sal positivo é o fator dominante, mas não único na gênese da hipertensão na doença renal crônica. As evidências experimentais demonstraram , claramente que a hipertensão devido à retenção de sal e água é mantida pelos aumento da resistência periférica.O diagnóstico da hipertensão é criticamente dependente das medidas adequadas da pressão arterial, principalmente em pacientes com doença renal crônica, cujo tratamento anti-hipertensivo precoce é mandatório para a prevenção de eventos cardiovasculares. A monitorização ambulatorial da pressão arterial permitiu identificar pacientes hipertensos de risco elevado. O tratamento da hipertensão em pacientes com doença renal crônica deve levar em consideração a natureza da doença renal subjacente. Pacientes com nefropatia diabética ou doença renal não diabética proteinúrica se beneficiam do tratamento com inibidores da enzima de conversãoda angiotensina ou bloqueadores do receptor de angiotensina II para a meta de pressão arterial < 130/80 mmHG, se tolerado. A meta abaixo de 140/90 mmHg é aceitável para muitos pacientes com outras formas de doença renal. Bloqueio duplo ou triplo do sistema renina angiotensina deve ser evitado.


Hypertension is a major risk factor for cardiovascular and renal disease. Conversely, chronic kidney disease is the most common form of secondary hypertension and mounting evidence suggest it is independent risk factor for cardiovascular morbidity and mortality. positive salt balance is the dominant but not the sole factor in the genesis of hypertension in chronic kidney disease. The experimental evidences have clearly demonstrated that hypertension due to retention of salt and water is maintained by increased peripheral resistance. The diagnosis of hypertension is critically dependent on accurate blood pressure measurement, especially in patients with chronic kidney disease, in whom early antihypertensive treatment is imperative to prevent cardiovascular events. Ambulatory blood pressure monitoring has successfully identified hypertensive patients at increased risk. The treatment of hypertension in chronic kidney disease patients should take into consideration the nature of the underlying kidney disease. Patients with diabetic nephropathy or proteinuric nondiabetic kidney disease benefit from treatment with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers to a goal blood pressure of < 140/90 mmHg is acceptable for most patients with other forms of chronic kidney disease. Dual or triple blockade of the renin-angiotensin system should generally be avoided.


Subject(s)
Humans , Antihypertensive Agents/administration & dosage , Hypertension/complications , Diabetic Nephropathies/complications , Diabetic Nephropathies/diagnosis , Kidney Diseases/complications , Renin-Angiotensin System/physiology , Cardiovascular Diseases , Risk Factors
16.
Article in English | WPRIM | ID: wpr-210928

ABSTRACT

Spot urinary albumin to creatinine ratio (ACR) measurement has been suggested as a surrogate to 24-hr urine collection for the assessment of microalbuminuria, and cystatin C (cysC) is known as an advantageous marker for renal function. The aim of this study was to evaluate the clinical values of spot urinary ACR and serum cysC for the assessment of diabetic nephropathy instead of 24-hr urine microalbumin in children and adolescents with diabetes. A total of 113 children and adolescents (age 12-19 yr, M:F = 47:66) with type 1 or 2 diabetes were enrolled. We evaluated the validity of spot urine ACR and serum cysC, and then compared them to 24-hr urine microalbumin and creatinine clearance. Spot urine ACR was correlated with 24-hr urine albumin excretion (R2 = 0.828, P = 0.001) and creatinine clearance (R2 = 0.249, P = 0.017). The ROC curve analysis of serum cysC demonstrated higher diagnostic accuracy than that of serum creatinine (AUC 0.732 vs 0.615). Both the measurements of spot urine ACR and serum cysC might better predict the presence of diabetic nephropathy than 24-hr urine microalbumin in childhood diabetic patients.


Subject(s)
Adolescent , Albuminuria/urine , Child , Creatinine/urine , Cystatin C/blood , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 2/diagnosis , Diabetic Nephropathies/diagnosis , Female , Glomerular Filtration Rate , Glycated Hemoglobin A/analysis , Humans , Kidney Function Tests , Male , Predictive Value of Tests , ROC Curve
17.
Braz. j. med. biol. res ; 43(7): 687-693, July 2010. graf, tab
Article in English | LILACS | ID: lil-550740

ABSTRACT

The objective of this study was to evaluate the effect of metabolic syndrome (MetS) and its individual components on the renal function of patients with type 2 diabetes mellitus (DM). A cross-sectional study was performed in 842 type 2 DM patients. A clinical and laboratory evaluation, including estimated glomerular filtration rate (eGFR) calculated by the modification of diet in renal disease formula, was performed. MetS was defined according to National Cholesterol Education Program - Adult Treatment Panel III criteria. Mean patient age was 57.9 ± 10.1 years and 313 (37.2 percent) patients were males. MetS was detected in 662 (78.6 percent) patients. A progressive reduction in eGFR was observed as the number of individual MetS components increased (one: 98.2 ± 30.8; two: 92.9 ± 28.1; three: 84.0 ± 25.1; four: 83.8 ± 28.5, and five: 79.0 ± 23.0; P < 0.001). MetS increased the risk for low eGFR (<60 mL·min-1·1.73 (m²)-1) 2.82-fold (95 percentCI = 1.55-5.12, P < 0.001). Hypertension (OR = 2.2, 95 percentCI = 1.39-3.49, P = 0.001) and hypertriglyceridemia (OR = 1.62, 95 percentCI = 1.19-2.20, P = 0.002) were the individual components with the strongest associations with low eGFR. In conclusion, there is an association between MetS and the reduction of eGFR in patients with type 2 DM, with hypertension and hypertriglyceridemia being the most important contributors in this sample. Interventional studies should be conducted to determine if treatment of MetS can prevent renal failure in type 2 DM patients.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , /complications , Diabetic Nephropathies/etiology , Metabolic Syndrome/complications , Renal Insufficiency, Chronic/etiology , Cross-Sectional Studies , Diabetic Nephropathies/diagnosis , Glomerular Filtration Rate , Renal Insufficiency, Chronic/diagnosis , Severity of Illness Index
18.
Rev. Méd. Clín. Condes ; 21(4): 579-583, jul. 2010. ilus, tab
Article in Spanish | LILACS | ID: biblio-869501

ABSTRACT

La nefropatía diabética constituye una patología con elevada morbimortalidad y es la principal causa de ingreso a tratamiento de diálisis. Esta revisión tiene por objeto describir en forma concisa y práctica aquellos aspectos más relevantes en la evaluación y tratamiento de la nefropatía diabética, sin dejar de lado los aspectos preventivos cuyo respaldo de evidencia es robusto. Si bien está escrito desde la óptica del nefrólogo no debe perderse de vista una concepción y manejo integral del enfermo.


Diabetic nephropathy is the main cause of end stage renal failure. This review, intended to the general practitioner, aims to describe in a concise form the most relevant issues in the management of diabetic nephropathy. Although written from the stand point of view of the nephrologist, a multidisciplinary approach is warranted.


Subject(s)
Humans , Diabetic Nephropathies/diagnosis , Diabetic Nephropathies/drug therapy , Albuminuria , Arterial Pressure , Antihypertensive Agents/therapeutic use , Blood Glucose , Creatinine/urine , Glomerular Filtration Rate , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Nutritional Status , Diabetic Nephropathies/physiopathology
19.
Article in Portuguese | LILACS | ID: biblio-834372

ABSTRACT

A nefropatia diabética (ND) é uma complicação crônica grave do diabetes melito (DM); é a principal causa de insuficiência renal terminal. A ND é classificada em 3 estágios conforme a excreção urinária de albumina (EUA): normoalbuminúria (EUA <17 mg/l), microalbuminúria (EUA 17-174 mg/l) e macroalbuminúria (>174 mg/l). Da fase de microalbuminúria pode ocorrer regressão para normoalbuminúria (30% casos) ou progressão para a macroalbuminúria, quando ocorre maior risco de evolução para a doença renal crônica (DRC) terminal. O diagnóstico da ND é realizado através da medida da albumina na urina e pela avaliação da taxa de filtração glomerular (TFG). Recomenda-se a medida da albumina em amostra isolada de urina (primeira da manhã ou amostra casual), podendo-se medir o índice albumina-creatinina ou a concentração de albumina. Valores elevados de albuminúria devem ser confirmados em pelo menos 2 de 3 coletas de urina, em um intervalo de 3 a 6 meses. Na impossibilidade da medida da albuminúria, a medida de proteínas totais (proteinúria @430 mg/l em amostra ou >500 mg/24 h), pode ser utilizada para diagnóstico de fases mais avançadas de ND. Em pacientes com DM tipo 2 o rastreamento deve iniciar ao diagnóstico de DM, e nos pacientes com DM tipo 1 deve ser após os 10 anos de idade; logo após o início da puberdade; ou quando a duração do DM for >5 anos. Se negativo repetir anualmente; e, se positivo, recomenda-se a monitoração mais frequente da albumina urinária. A estimativa da TFG é realizada através de fórmulas que empregam a creatinina sérica, ajustadas para idade, gênero e etnia. São recomendadas as equações do estudo Modification of Diet in Renal Disease (MDRD) e Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Deve ser levado em conta que, em pacientes com DM, essas equações tendem a subestimar a TFG. A ND deve ser identificada o mais precocemente possível e para isto tanto os profissionais de saúde como os pacientes com DM devem ser conscientizados.


Diabetic nephropathy (DN) is an important chronic complication of diabetes mellitus (DM) and is the leading cause of end-staage renal disease. DN is classified into stages according to the urinary albumin excretion (UAE): normoalbuminuria (UAE <17 mg/l), microalbuminuria (UAE 17-174 mg/l), and macroalbuminuria (UAE >174 mg/l. From microalbuminuria there might be regression to normoalbuminuria (30% cases) or progression to macroalbuminuria, in which case there is higher risk of progression to advanced chronic kidney disease (CKD). DN has a high cardiovascular morbidity and mortality rate that is possibly more significant than the progression to terminal CKD. DN diagnosis is established by the measurement of albumin in the urine and assessment of glomerular filtration rate (GFR). The measurement of albumin in an isolated urine sample (first morning urine or random sample) is recommended, with the possibility of measuring albumin-creatinine ratio or albumin concentration. High levels of albuminuria should be confirmed by at least 2 out of 3 urine samples within a time interval of 3 to 6 months. If albuminuria cannot be measured, total protein level (proteinuria @ 430 mg/l in a sample or > 500 mg/24 h) can be used to diagnose advanced stages of DN. In patients with type 2 DM, screening should start upon diagnosis of DM, and in patients with type 1 DM, it should be started after the patient turns 10 years old; soon after the onset of puberty; or when the duration of DM is >5 years. In case of negative results, screening should be repeated annually and, if the result is positive, more frequent monitoring of urinary albumin is recommended. GFR estimation is calculated using formulas that employ serum creatinine adjusted for age, gender, and ethnicity. Modification of Diet in Renal Disease (MDRD) study and CKD-EPI (Chronic Kidney Disease - Epidemiology Collaboration) equations are the recommended. In patients with DM, this equation shows a tendency to underestimate GFR.


Subject(s)
Humans , Diabetes Complications , Diabetic Nephropathies/diagnosis , Albuminuria , Diabetes Mellitus/urine , Monitoring, Physiologic , Diabetic Nephropathies/classification , Diabetic Nephropathies/epidemiology , Kidney Diseases/diagnosis , Glomerular Filtration Rate/physiology
20.
Rev. Assoc. Med. Bras. (1992) ; 56(1): 67-73, 2010. tab
Article in Portuguese | LILACS | ID: lil-541165

ABSTRACT

OBJETIVO: Avaliar a prevalência de complicações crônicas vasculares e fatores associados em pacientes com diabetes mellitus (DM) tipo 1. MÉTODOS: Estudo transversal com pacientes DM tipo 1 atendidos no Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre. Os pacientes foram avaliados quanto à presença de complicações crônicas vasculares. RESULTADOS: Avaliamos 573 pacientes, idade média de 33 anos. A presença de retinopatia diabética (RD) foi observada em 43,3 por cento, o tempo de DM [RC: 1,07; IC95 por cento 1,03-1,11; P < 0,001], presença de nefropatia diabética (ND) [RC 3,40; IC95 por cento 1,89 - 6,13; P <0,001] e presença de hipertensão (HAS) [RC:2,12; IC95 por cento 1,16 - 3,87; P = 0,014] foram associados com RD. A ND esteve presente em 34,5 por cento e foi associada à presença de HAS [RC: 1.93; IC95 por cento (1,16-3,21); P = 0,001] e colesterol total [RC: 1,0; IC 95 por cento (1,0-1,01); P = 0,05]. Sete pacientes apresentaram doença macrovascular. Apenas 22 por cento atingiram níveis de HbA1c <7,0 por cento. A prevalência de HAS foi 33 por cento, sendo que 48 por cento estavam com a PA <130/80 mm Hg e 45 por cento dos pacientes apresentaram valores de LDL >100 mg/dl. CONCLUSÃO: Observamos elevadas prevalências de complicações microvasculares e de HAS. A duração do DM, HAS e presença de ND foram associados à RD. HAS e dislipidemia foram associados à ND. A maioria dos pacientes encontrava-se fora dos alvos desejados de controle glicêmico, pressórico e lipídico. Maiores esforços são necessários para intensificar o controle metabólico e pressórico de pacientes com DM tipo 1.


OBJECTIVE: To evaluate the prevalence of chronic vascular complications and associated factors in patients with type 1 diabetes mellitus (DM). METHODS: Cross sectional study with type 1 DM patients attending the Endocrine Division, Hospital de Clinicas de Porto Alegre. Patients were evaluated for presence of chronic vascular complications. RESULTS: We evaluated 573 patients, mean age of 33 years. The presence of diabetic retinopathy (DR) was observed in 43.3 percent, diabetes duration [OR: 1.07, 95 percent CI: 1.03 to 1.11, P <0001], the presence of diabetic nephropathy (DN) [OR: 3.40; CI 95 percent: 1.89 to 6.13, P <0001] and hypertension (HPT) [OR: 2.12, 95 percent CI: 1.16 to 3.87, P = 0014] were associated with DR. The DN was present in 34.5 percent and was associated with HPT [OR: 1.93, 95 percent CI: 1.16 to 3.21, P = 0001] and total cholesterol [OR: 1.0, 95 percent CI: 1.0-1.01, P = 0.05]. Seven patients had macrovascular disease. Only 22 percent achieved an A1c of <7.0 percent. HPT was 33 percent and 48 percent had levels <130/80 mm Hg and 45 percent of patients had values for LDL> 100 mg/dl. CONCLUSION: We observed a high prevalence of microvascular complications and HPT. Duration of DM, HPT and presence of DN were associated with DR. HPT and dyslipidemia were associated with DN. Most patients did not meet the desired glycemic control, blood pressure and lipid targets. Greater efforts are needed to intensify the pressure and metabolic control of patients with type 1 DM.


Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Diabetes Mellitus, Type 1/epidemiology , Diabetic Nephropathies/epidemiology , Diabetic Retinopathy/epidemiology , Brazil/epidemiology , Chronic Disease , Cross-Sectional Studies , Diabetic Nephropathies/diagnosis , Diabetic Retinopathy/diagnosis , Prevalence , Risk Factors , Severity of Illness Index
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