Evaluación del compromiso retinal en diabéticos tipo 2 microalbuminúricos / Retinal involvement in type 2 diabetics with microalbuminuria

Background: In patients with type 2 diabetes, the presence of microalbuminuria, reflecting a widespread vascular damage, can be a marker of nephropathy, retinophaty and cardiovascular diseases. Aim: To study the relationship between microalbuminuria and the frequency, severity and outcome of retinopathy in patients with type 2 diabetes mellitus. Patients and methods: One hundred patients with type 2 diabetes were subjected to a clinical examination, serial monitoring of blood pressure and quarterly measurement of microalbuminuria by RIA. Annually, a fundoscopy, a color photography of the posterior pole and retinal angiofluorescence were performed. Retinophaty was classified as basal (mild to moderate), preproliferative and proliferative. Sixty four normoalbuminuric patients (urinary albumin of less than 30 mg/24 h) were included in group 1 and 36 patients with a urinary albumin over 30 mg/24 h in group 2. Fifty seven patients with normal blood pressure were randomly treated with enalapril or placebo and those with hypertension received enalapril or acebutolol to normalize blood pressure. Results: Sixty one percent of group 1 patients and 41 percent of group 2 patients has retinopathy (p < 0.05). The retinal lesions were proliferative in 41 percent of group 2 patients and in 8 percent of group 1 patient (p < 0.05). Retinopathy was present in 67 percent of hypertensive patients of group 2 and in 41 percent of hypertensive patients of group 1. An unfavorable evolution of retinopathy was observed in 22 percent of group 2 patients and in 5 percent of group 1 patient (p < 0.05). Conclusions: In type 2 diabetic patients, the presence of microalbuminuria is a prediction of a higher frequency, severity and dismal evolution of diabetic retinopathy

Excreción urinaria de albúmina en diabéticos no insulino-dependientes: efecto de un inhibidor de la enzima convertidora de angiotensina / Albumin urinary excretion in non insulin dependent diabetic patients: effects of an angiotensin converting enzyme inhibitor

Microalbuminuria in diabetic patients is diagnostic of early renal involvement and angiotensin converting enzyme inhibitors reduce albumin excretion in these subjects. To asses the effect of ACEI on urinary albumin excretion, non insulin dependent diabetic patients with normal blood pressure were randomly assigned to receive enalapril 10 mg/day or placebo and followed during 18 months. Those with high blood pressure were randomly assigned to receive enalapril or acebutolol in doses necessary to normalize blood pressure and followed during 12 months. Every 3 month, urinary albumin excretion was measured in a 4 hour urine sample by radioimmunoassay. One hundred fifty two patients were recruited for the study and 46 were lost from follow up. In 17 subjects with normal blood pressure initial urinary albumin excretion below cutoff values (30 mg/24 h) and treated with enalapril, this parameter did not change; in 20 treated with placebo, it incresed from 5.8ñ6.1 to 18.2ñ7.5 mg/24 h. In 11 patients with normal pressure and initial urinary albumin, this parameter did not change with enalapril and increased in 10 with placebo from 87.3ñ75.1 to 253.6ñ61.1 mg/24 h. In hypertensive patients with normal urinary albumin excretion, no changes in this parameter were observed in those treated with acebutolol (n=10) or enalapril (n=14). In hypertensive with high urinary albumin excretion, it decreased from 119.2ñ8.5 to 40.0ñ4.7 mg/24 h with enalapril treatment (n=12) and no change was observed in those treated with acebutolol (n=11). In Conclusion, enalapril decreases urinary albumin excretion in non insulin dependent diabetic patients

Tratamiento de la porfiria cutánea tarda con cloroquina y su efecto sobre la hepatopatía asociada: análisis retrospectivo / Porphyria cutanea tarda treatment with chloroquine and it effect on associated hepatopathy: retrospective analysis

Chloroquine may improve cutaneous symptoms and liver disease manifestations in patients with porphyria cutanea tarda. To retrospectively analyze the effects of chloroquine in patients with porphyria cutanea tarda. Five patients (1 female), aged 45 to 65 years old, were studied. The duration of the disease ranged from 2 to 15 years. All patients received chloroquine 125 mg twice weekly. Before, during and after treatment, cutaneous signs, serum bilirubin, hepatic enzymes and urine copro and uroporphyrin were assessed. Four patients were subjected to a liver biopsy before starting chloroquine. All patients had increased levels of urine porphyrins, four had abnormal serum liver enzymes. All liver biopsies showed variable hemosiderosis, 2 patients had a chronic active hepatitis (1 with cirrhosis), one a chronic persistent hepatitis and one had a mild vague alterations. During chloroquine treatment, cutaneous symptoms improved in all patients, transaminases and gamma glutamyl transferase decreased. In 3, urine uroporphyrin increased initially and normalized afterwards. Chloroquine was well tolerated. Chloroquine improved symptoms, urine uroporphyrins and serum liver enzyme levels in treated patients

Métodos cualitativos y cuantitativos en la medición de microalbuminuria / Qualitative and quantitative methods in the measuring of microalbuminuria

La nefropatía tiene, en los diabéticos, una mayor prevalencia que en la población general y la microalbuminuria (excreción urinaria entre 30 y 300 mg/24 horas) constituye un índice predictivo de su desarrollo y un elemento útil de detección precoz en etapas reversibles. Se comparan, en 36 diabéticos, los resultados de la determinación de microalbuminuria con radioinmunoensayo (método cuantitativo) y con 2 procedimientos semicuantitativos: tabletas indicadoras (microalbumintest) y sistema aglutinación látex-anticuerpo (albumintest). Los resultados obtenidos revelan alta concordancia de los métodos semicuantitativos con el RIA. Son, en consecuencia, procedimientos confiables y de gran utilidad en la pesquisa de microalbuminuria y, por ende, de nefropatía diabética en etapas iniciales y reversibles

Microalbuminuria en diabéticos insulinodependientes: prevención de la nefropatía diabética / Microalbuminuria in insulin dependent diabetics: prevention of diabetic nephropathy by angiotensin converting enzyme inhibition

We evaluated the effects of angiotensin converting enzyme inhibition upon the urinary excretion of albumin in 36 insulin dependent normotensive diabetic patients with adeuate metabolic control and no evidence of renal failure. 19 subjects had normal levels of albumin excretion (<30 mg/24h) and 17 showed microalbuminuria from 30 to 300 mg/24 h. Half of the patients were randomly selected ine ach group to receive enalapril, 5 mg/day. A progressive decrease in albumin excretion levels was observed for both enealpril treated subgroups, from 18.9 ñ 8.3 to 8.1 ñ 2.7 mg/24 h (normoalbuminurics) and from 73.1 ñ 25.0 to 40.1 ñ 26.3 mg/24 h (microalbuminurics). In contrast, an increase in albumin excretion from 19.4 ñ 6.8 to 29.4 ñ 14.2 mg/24 h was observed in non treated normoalbuminuric patients. Untreated patients with microalbuminuria remained with stable albumin excretion level (67.4 ñ 39 to 64.8 ñ 23.4 mg/24h. Enalapril treatment was associated to a significant (p < 0.05) decrease in cratinine clearance which remained within normal limits. Blood pressure, Na and K plasma levels and totral proteins remained normal throughout the study. Thus, angiotensin converting enzyme inhibition reduces the urinary excretion of albumin in insulin dependent diabetics with normo or microalbuminuria