1/6. enalapril and hydroxyurea therapy for children with sickle nephropathy.proteinuria in children with sickle cell anemia (SCA) is an early sign of sickle nephropathy, and portends the development of nephrotic syndrome and chronic renal failure. enalapril has been shown to reduce proteinuria in adult patients with SCA, but the potential benefits of hydroxyurea in this clinical setting have not been reported. A single institution retrospective analysis was performed. Children with sickle nephropathy were identified, and the laboratory effects of enalapril and hydroxyurea therapy were evaluated in children with substantial proteinuria. Three children developed proteinuria at 8 /- 1 years of age. Pre-treatment laboratory studies included a low serum albumin (2.8 /- 0.8 g/dl) and a highly elevated urine protein/creatinine ratio (6.9 /- 3.7, normal <0.2). enalapril treatment for 3.0 /- 1.3 years normalized serum albumin (3.9 /- 0.3 g/dl) without significant changes in serum potassium, serum creatinine, or systolic blood pressure. However, urine protein/creatinine remained elevated in the nephrotic range (1.6 /- 0.7). The addition of hydroxyurea therapy for 3.5 /- 1.2 years increased fetal hemoglobin levels (7.0 /- 3.6% to 21.0 /- 3.2%) and was associated with a near-normal urine protein/creatinine ratio (0.5 /- 0.1). enalapril therapy for children with sickle nephropathy reduces urinary protein excretion and normalizes serum albumin. hydroxyurea therapy may further normalize the urine protein/creatinine ratio. Combination therapy should be tested prospectively in children with sickle nephropathy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/6. diabetes mellitus and the kidney in adolescents.Diabetic nephropathy continues to be a major complication of both types I and II diabetes; renal disease in the two types of diabetes exhibits no major differences with regard to initiation, progression, or treatment. The increasing prevalence of type II diabetes among adolescents means that understanding diabetic nephropathy and its prevention and treatment strategies is increasingly important for physicians caring for this population. The most important prevention and treatment modalities for diabetic nephropathy are improved glycemic control and aggressive blood pressure control, beginning as soon as possible after the diagnosis of diabetes.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/6. antihypertensive agents in patients with diabetes: trade-off between renal and cardiovascular protection.PURPOSE: Management of hypertension in patients with diabetes should address both renal and cardiovascular protection. The use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin ii receptor blockers (ARBs) for control of hypertension in patients with diabetic nephropathy is widely advocated by various international guidelines. Use of any agent that provides tight control of blood pressure is indicated in patients with diabetes but without nephropathy. methods: In this article, the authors present a clinical case scenario and review current clinical evidence supporting the use of ACE inhibitors and ARBs in patients with diabetic nephropathy. In addition, the use of ACE and ARBs in patients with diabetes but without nephropathy will be discussed. RESULTS: Available trial evidence confirms the survival benefits of patients taking ACE inhibitors with diabetic nephropathy. However, the efficacy of ARB inhibitors on survival is unknown. In patients with diabetes without nephropathy, only ACE inhibitors have been found to reduce the risk of onset of microalbuminuria, while all agents affect survival provided a tight control of blood pressure is monitored. CONCLUSIONS: Dose of ACE inhibitors should be titrated appropriately to obtain proven benefits. In summary, current evidence supports the use of ACE inhibitors in patients with and without nephropathy because of renal and cardiovascular benefits.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
4/6. Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients.The impact of microalbuminuria on mortality as well as other risk factors was investigated in a 10-year follow-up study of 503 predominantly non-insulin-dependent diabetic patients of whom 265 had died. Using Cox's regression analysis the prognostic influence of age, sex, age at diagnosis, known diabetes duration, blood pressure, fasting plasma glucose, relative weight, serum creatinine, retinopathy, and treatment was evaluated as well as morning urine albumin concentration (UAC) in four categories, i.e. UAC less than or equal to 15 micrograms/ml (normal), 15 micrograms/ml less than UAC less than or equal to 40 micrograms/ml, 40 micrograms/ml less than UAC less than or equal to 200 micrograms/ml and UAC greater than 200 micrograms/ml. Age, UAC, known duration, and serum creatinine were the only significant risk factors. After correction for the other three independent risk factors, the hazard ratios in the elevated UAC categories relative to the group with UAC less than or equal to 15 micrograms/ml were 1.53 (p = 0.007), 2.28 (p = 0.000002), and 1.82 (p = 0.02). The statistically significant correlations with UAC were: age (r = 0.09, p less than 0.05), duration (r = 0.14, p less than 0.01), systolic blood pressure (r = 0.12, p less than 0.01), serum creatinine (r = 0.33, p less than 0.001), and fasting plasma glucose (r = 0.12, p less than 0.01). Increased UAC was associated also with retinopathy (p = 0.01). Fifty-eight per cent of the deaths were caused by cardiovascular disease or stroke; only 3% died from uraemia. A reinvestigation including blood pressure, fasting plasma glucose, and UAC was made on 208 survivors.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
5/6. Non-insulin-dependent diabetes mellitus (NIDDM) in Asians in the UK.South Asian subjects in the United Kingdom have a substantially increased risk of both diabetes and cardiovascular disease. The excess risk of cardiovascular disease is not explained by risk factors such as smoking, blood pressure or dyslipidaemia. It has been proposed that the insulin resistance syndrome, perhaps consequent upon central obesity, may underlie the risk of both glucose intolerance and cardiovascular disease. In non-diabetic south Asian subjects we have found higher concentrations of insulin and of proinsulin-like molecules, higher blood pressure, and lower concentrations of high density lipoprotein cholesterol, but no elevation of activity of plasminogen activator inhibitor. Newly diagnosed diabetic subjects from the south Asian population are younger and thinner than newly diagnosed europid subjects, but are more centrally obese and hyperinsulinaemic. It is possible that the coexistence of diabetes and cardiovascular disease represents the consequence of a common antecedent.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
6/6. Medical nephrectomy. The use of metallic salts for the control of massive proteinuria in the nephrotic syndrome.Two patients with intractable massive proteinuria and uremia were followed and treated with standard mecial therapy and dialysis. After a period of study and demonstration of clinical deterioration both patients were given solutions containing sodium mercaptomerin. Within days there was a decline in urine protein excretion and a variable increase in serum protein concentration. The patients demonstrated an increase in blood pressure, which made hemodialysis treatment possible. No deleterious effects from the mercury salts were noted. These observations suggest that in selected cases nephrotoxic agents may be of value in decreasing massive proteinuria, and improving protein homeostasis in uremic patients. Table I: Possible advantages of medical nephrectomy. 1. Reversal of hypotension and shock 2. Ability to perform hemodialysis 3. No anesthesia or surgical risk 4. No angiography related complications 5. Preservation of endocrine function of kidney. Possible advantages of medical nephrectomy (Table I), are: 1) Correction of proteinuria and hypotension; 2) Ability to perform hemodialysis; 3) No anesthesia or surgical risk; 4) No angiography related complications; and 5) Preservation of remaining endocrine function of the kidney, including erythropoietic and vitamin d action. The ideal agent should be non-toxic to other organs and produce selective renal ablation. Obviously mercury is not the ideal agent, although in these cases it did not produce observable side effects. It appears that this agent should be used with caution and only in patients with irreversible renal failure.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |