Diabetic nephropathy and multiorgan protection. Part I.

Diabetic nephropathy, one of the most important complications of diabetes mellitus, requires during its evolution protective measures defined as renoprotective. Since the complications of diabetes mellitus are not limited to diabetic nephropathy and as this is frequently associated with heart complications that require protective measures defined as cardioprotective, neurologic measures that require neuroprotection of the retina, of the large vessels etc., much more complex protective measures are necessary. The metabolic complications that are usually at the basis of the other complications at the level of the cell also impose measures of protection. Such an approach can have important practical consequences. It is a well-known fact that most patients with chronic kidney disease--CKD--do not reach final stages as in the meantime they decease because of cardiovascular diseases. Consequently, cardioprotective measures have to be associated with renoprotective ones, as well as protective measures that address other organs, in close connection with protective measures at metabolic level. The protective measures must also address to microcirculation, diabetic nephropathy being a disease that primarily affects microcirculation. Diabetes mellitus also frequently affects the large vessels, the circulatory system being usually affected in its complexity. The paper represents a synthesis of multiorganprotective measures in diabetic nephropathy, in diabetes mellitus, respectively, the concept of multiorgan protection finding in this disease an ideal domain of expression. The first part gives the main multiorgan measures: monitoring of blood pressure and, mainly, protection by means of the renine aldosterone (RAAS) system, multiorgan by intensive monitoring of glycaemia and by treatment of proteinuria. The second part presents the other protective measures used in diabetic nephropathy.

Elements of renal injury in patients with varicose ulcer. Preliminary study.

The kidney may be affected in the processes of microbial, viral, parasitic infections. Knowledge of renal disease during chronic infection, with a different location than the throat, is of particular importance for the practicing physician for the detection and prevention of impaired renal function. Chronic kidney disease recovered in the early stages can prevent the progression of renal function decline. We studied a total of 85 patients with varicose ulcers with a mean age of 66.78 +/- 12.09 years, hospitalized in the Clinic of Dermatology and a control group consisting of 110 apparently healthy individuals. Urinary abnormalities have been detected in 26 (30%) of patients studied. GFR < 60 ml/min have been detected in 14 (17%) of patients studied. CRF stage II have been detected in 36 (42%) of patients studied. We detected recurrent varicose ulcer in 2 (2%) of patients studied. In two (2%) of patients during hospitalization we found a decrease in GFR by 15 and 12 ml/min, accompanied by an increase in serum creatinine from 0.7 mg % to 1 mg % in one patient and in another patient from 1.5 mg % to 2 mg %. Urinary abnormalities detected in patients with both acute and recurrent erysipelas warn about renal impairment and the need for monitoring of the renal patients with varicose ulcers.