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Diabetic Nephropathy Hypertension

Diabetic Nephropathy And Treatment Of Hypertension

Diabetic Nephropathy And Treatment Of Hypertension

Diabetic Nephropathy and Treatment of Hypertension Professor of Medicine, University of California San Francisco, San Francisco, CA Diabetic nephropathy is the commonest cause of end-stage renal disease (ESRD) in the USA. The next most common cause is hypertension. The third most common cause Is glomerulionephritis. Th important subgroups of glomerulonephritis include: immunoglobulin A nephritis (IgA), membraneous glomerulonephritis (MGN) and focal sclerosing glomerulonephritis (FSGN). Among all the complications of diabetes mellitus, nephropathy is the diabetes-specific complication with the greatest mortality (1). Recently, there appears to have been an explosion in the incidence of diabetic nephropathy (DM), which is most often type II, or non-insulin dependent diabetes mellitus (NIDDM). The increased incidence of NIDDM appears linked to a virtual epidemic of obesity in the USA. According to a New York Times study, the incidence of diabetes in New York and other large cities in the USA is about 18%. Among all diabetic patients in the USA, the overall incidence of diabetic nephropathy remains small at about 20%. However, it used to be believed that most cases of diabetes mellitus occurred in individuals with insulin dependent diabetes mellitus (type I). However, recent data establishes that diabetic nephropathy now commonly occurs in patients with type II diabetes mellitus. In the 1970's, the treatment of ESRD secondary to diabetes mellitus was so disappointing that its utility was widely questioned (2). However, gradual improvements have greatly improved the quality of life (Q of L) of diabetic patients receiving chronic hemodialysis therapy. Although survival figures lag behind those of nondiabetic patients with ESRD being treated with hemodialysis, the cumulative Continue reading >>

Mechanism Of Hypertension In Diabetic Nephropathy

Mechanism Of Hypertension In Diabetic Nephropathy

Mechanism of hypertension in diabetic nephropathy Department of Nephrology, Dialysis Center, Davita, Buridah Central Hospital, Saudi Arabia *Corresponding author: Chaudhary Muhammad Junaid Nazar, [email protected] Received 2014 Apr 11; Accepted 2014 Jun 8. Published by Society of Diabetic Nephropathy Prevention. This is an open-access article distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. High prevalence of hypertension is observed in diabetic patients of both the types. Diabetic nephropathy is one of the major reason for high morbidity, mortality and financial burden in such hypertensive diabetic patients. For this review, electronic databases including PubMed/Medline, Embase, Cochrane and Google scholar were searched from 1990-2013. Multiple inter-related factors are responsible for the development of hypertension and therefore nephropathy in the chronic diabetic patients. Majority of such factors are identified to lead to extensive sodium reabsorption and peripheral vasoconstriction and thus leading to microvascular complications like nephropathy. Management of hypertension by targeting such mediators is the highly recommended therapy for controlling and treating diabetic nephropathy. Clinical trials suggests that drugs inhibiting the renin-angiotensin-aldosterone pathway should be used as the first-line agents for the management of hypertensive diabetic nephropathy patients. These agents are effective in slowing the progression of the end-stage kidney disease as well as lowering albuminuria. Researchers are also investigating the effectiveness of drug combination for better management of hypertension and diab Continue reading >>

Hypertension And Diabetic Nephropathy

Hypertension And Diabetic Nephropathy

Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark Stettler C, Christ E, Diem P (eds): Novelties in Diabetes. Endocr Dev. Basel, Karger 2016, vol 31, pp 97-107 I have read the Karger Terms and Conditions and agree. I have read the Karger Terms and Conditions and agree. Buy a Karger Article Bundle (KAB) and profit from a discount! If you would like to redeem your KAB credit, please log in . Save over 20% compared to the individual article price. Buy Cloud Access for unlimited viewing via different devices Immediate access to all parts of this book * The final prices may differ from the prices shown due to specifics of VAT rules. Diabetic nephropathy (DN) is a major complication of both type 1 and type 2 diabetes. DN is the most common cause of end-stage renal disease, and it markedly enhances the risk of cardiovascular events. An elevated urinary albumin excretion rate, increased blood pressure (BP), and a continual loss of renal function are characteristics of DN. Screening for microalbuminuria is central to diabetes care, and antihypertensive agents are used for the primary prevention and treatment of DN. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers play central roles and have protective properties beyond their BP-lowering effects. BP control in relation to DN is the main focus of this review, but tight control of the glucose level is equally important. There is an unmet need for new treatment options, and while a few promising candidates exist, their roles in clinical practice have not yet been determined. Kimmelstiel P, Wilson C: Intercapillary lesions in the glomeruli of the kidney. Am J Pathol 1936;12:83-98. Collins AJ, Foley RN, Herzog C, Chavers B, Gilbertson D, Herzog C, Ishani A, Joha Continue reading >>

Doxazosin Effects On Abpm In Hypertensive Patients With Diabetic Nephropathy

Doxazosin Effects On Abpm In Hypertensive Patients With Diabetic Nephropathy

You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Doxazosin Effects on ABPM in Hypertensive Patients With Diabetic Nephropathy The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT00295555 Top of Page Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information Few studies have reported the effect of alpha1-adrenergic antagonists on 24-h blood pressure and regulation of sympathetic nervous activity in hypertensive patients with diabetic nephropathy. Using ambulatory blood pressure monitoring devices equipped with spectral analysis of heart rate variability, we assess the effects of doxazosin on blood pressure in diabetic nephropathy patients and compare the results with those in patients with essential hypertension, patients with diabetes mellitus and patients with chronic nephropathy. Diabetes Mellitus Essential Hypertension Renal Failure Drug: Effects of doxazosin on morning surge in diabetic patients The study is an open-labeled parallel prospective trial comparing the effects of doxazosin (2-8 mg/day) on 24-h blood pressure and autonomic nervous activity. Hypertensive patients with non-insulin-dependent diabetic nephropathy, patients with essential hypertension, patients with diabetes mellitus and patients with chronic nephropathy undergo ambulatory blood pressure monitoring before and after treatment with doxazosin. Simultaneously, spectral analysis is performed to calculate the high frequency components as a marker of parasym Continue reading >>

Hypertension In Diabetic Nephropathy: Epidemiology, Mechanisms, And Management

Hypertension In Diabetic Nephropathy: Epidemiology, Mechanisms, And Management

Hypertension in Diabetic Nephropathy: Epidemiology, Mechanisms, and Management University of Texas Southwestern Medical Center at Dallas, Department of Internal Medicine-Division of Nephrology Corresponding Author: Robert Toto 5323 Harry Hines Boulevard Dallas, TX 75390-8523 214-645-8268 (Phone) 214-645-8903 (Fax) [email protected] The publisher's final edited version of this article is available at Adv Chronic Kidney Dis See other articles in PMC that cite the published article. Hypertension is common among patients with chronic kidney disease (CKD) and diabetes mellitus. In this population hypertension increases risk for kidney disease onset and progression and cardiovascular (CV) morbidity and mortality. Diabetic nephropathy is the most common cause of CKD in those with diabetes and is the leading attributable cause for incident end stage renal disease (ESRD) in the United States (US). The mechanism of hypertension in diabetic nephropathy is complex, incompletely understood, and includes excess sodium retention, sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS) activation, endothelial cell dysfunction (ECD), and increased oxidative stress. Both non-pharmacological and pharmacological interventions, including RAAS antagonists, are critically important in the management of hypertension in diabetic nephropathy. The purpose of this article is to examine the pathophysiology of hypertension in diabetic nephropathy and the clinical trials that support the implementation of strategies aimed at these pathophysiologic mechanisms. Evidence from prior and very recent clinical trials in patients not on dialysis is reviewed. Management of hypertension in patients on dialysis is an important topic that is beyond the scope of this review, Continue reading >>

Blood Pressure, Diabetes And Diabetic Nephropathy - Em|consulte

Blood Pressure, Diabetes And Diabetic Nephropathy - Em|consulte

Blood pressure, diabetes and diabetic nephropathy F. Chantrel[1], B. Moulin[1], T. Hannedouche[1] [1]Department of Nephrology, Hpital Universitaire de Strasbourg, Strasbourg, France. Despite multiple evidence-based data that diabetic nephropathy is largely preventable and its progression slowed by currently available interventions diabetic patients are often undertreated, especially for the lowering of blood pressure. Recent studies, (HOT Syst-Eur, SHEP, UKPDS, CAPPP, ABCD, HOPE) have confirmed the efficiency of intensively treated blood pressure in reducing morbidity-mortality in this group of patients at high risk. Low blood pressure targets are mandatory, but may not be that easy to achieve, especially in the presence of renal failure. Early prescription of a combination of antihypertensive drugs is often neccessary. Thus, the clinical question relates to the best combination of drugs. Most studies in hypertensive diabetic patients have dealt with 3 classes of antihypertensives drugs: diuretics, beta-blockers and ACE-inhibitors. Diuretics are one of the most efficient hypotensive drugs available for treatment of hypertension in diabetic patients. Their use must be encouraged early in the stepped approach since diabetes is usually associated with mid-volume expansion due to hyperinsulinism and hyperadrenergic state. In spite of the proven benefit of beta-blockers in diabetic patients, these drugs are largely underused. The indications for selective beta-blockers should probably be broadened for most diabetic patients in primary prevention. Beta-blockers are essential in secondary prevention for patients with coronary artery disease and hypertension. ACE-inhibitors are now more and more widely prescribed in diabetic patients at all stages of hypertension and nephropat Continue reading >>

Hypertension In Diabetic Nephropathy: Epidemiology, Mechanisms, And Management - Sciencedirect

Hypertension In Diabetic Nephropathy: Epidemiology, Mechanisms, And Management - Sciencedirect

Volume 18, Issue 1 , January 2011, Pages 28-41 Author links open overlay panel Peter N.Van Buren RobertToto Get rights and content Hypertension is highly prevalent in patients with diabetic nephropathy. Diabetic nephropathy is the leading cause of CKD and end-stage kidney disease in the United States. The etiology of hypertension in diabetic nephropathy involves mechanisms with multiple inter-related mediators that result in renal sodium reabsorption and peripheral vasoconstriction. The management of hypertension in these patients is focused on treatments that target these mediators. Clinical trials have established that drugs that inhibit the renin-angiotensin-aldosterone system should be used as first-line agents on the basis of their ability to slow down progression of kidney disease and lower albuminuria. There is further interest into how the combination of drugs that inhibit this pathway at multiple steps will contribute further to the management of hypertension and diabetic nephropathy. This article presents an updated review of the mechanisms involved in hypertension in patients with diabetic nephropathy. It also reviews the past clinical trials using single agents as therapeutics and the more recent trials involving novel drugs or drug combinations used to treat these patients. Retrospective analyses of multiple studies are included to better examine the significance of the currently proposed blood pressure targets for patients with diabetic nephropathy. Continue reading >>

Diabetic Nephropathytreatment & Management

Diabetic Nephropathytreatment & Management

Diabetic NephropathyTreatment & Management Author: Vecihi Batuman, MD, FASN; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Several issues are key in the medical care of patients with diabetic nephropathy. [ 20 , 21 ] These include glycemic control, management of hypertension, and reducing dietary salt intake and phosphorus and potassium restriction in advanced cases. A meta-analysis from the Cochrane Database shows a large fall in blood pressure with salt restriction, similar to that of single-drug therapy. [ 22 ] All diabetic patientsshould consider reducing salt intake at least to less than 5-6 g/d, in keeping with current recommendations for the general population, and may benefit from lowering salt intake to even lower levels. Reducing dietary salt intake may help slow progression of diabetic kidney disease. Renal replacement therapy may be necessary in patients with end-stage renal disease (ESRD). A 2012 post-hoc analysis of the data merged from the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial and the Irbesartan Diabetic Nephropathy Trial (IDNT) in 1177 patients demonstrated that a low-sodium diet (24-h urinary sodium/creatinine ratio (mmol/g) < 121) enhanced the renoprotective and cardioprotective effect of angiotensin receptor blockers (losartan or irbesartan) in type 2 diabetic patients with nephropathy. Compared with higher sodium intake groups, the patients in the low-sodium group had better renal (by 43%) and cardiovascular (by 37%) outcomes. These improved outcomes in the low-sodium group underscore the importance of recent calls for population-wide intervention to reduce dietary salt intake, particularly in patients with diabetes and nephropathy treated with angiotensin receptor blockers. [ 23 ] In perso Continue reading >>

Management Of Hypertension In Diabetic Nephropathy: How Low Should We Go?

Management Of Hypertension In Diabetic Nephropathy: How Low Should We Go?

Management of Hypertension in Diabetic Nephropathy: How Low Should We Go? Hypertension is a frequent comorbidity often following the development of diabetic nephropathy among individuals with type 1 diabetes and affecting most patients with type 2 diabetes at the time of diagnosis. Multiple prospective randomized placebo-controlled trials demonstrate that tight blood pressure control among patients with diabetic nephropathy reduces the rates of macrovascular and microvascular complications. While randomized trials exist and support a blood pressure goal of <140/90 mm Hg for patients with nondiabetic kidney disease, there are no prospective data regarding a specific blood pressure goal on progression of diabetic nephropathy. Retrospective data analyses from trials show a linear relationship between either baseline or achieved study blood pressure and progression of nephropathy. Very high albuminuria is a hallmark of diabetic nephropathy with reductions by either angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blocker (ARB) monotherapy associated with slowed nephropathy progression. However, combination antihypertensive therapy, while decreasing proteinuria, augments the risk of hyperkalemia, hypotension, and kidney dysfunction. Given the lack of trial data for a BP goal among patients with diabetic nephropathy, prospective trials are needed to define the optimal blood pressure necessary to preserve kidney function. At present, guideline blood pressure goals of less than 140/90 mm Hg and the use of ACEi or ARB therapy for those with more than 300 mg of albuminuria are mandated. Epidemiology of Hypertension in Diabetic Nephropathy Hypertension is twice as prevalent in patients with diabetes compared to the general population with mean blood pressur Continue reading >>

Mechanism Of Hypertension In Diabetic Nephropathy

Mechanism Of Hypertension In Diabetic Nephropathy

Mechanism of hypertension in diabetic nephropathy 1 Department of Nephrology, Dialysis Center, Davita, Buridah Central Hospital, Saudi Arabia *Corresponding author: Chaudhary Muhammad Junaid Nazar, Email: [email protected] High prevalence of hypertension is observed in diabetic patients of both the types. Diabetic nephropathy is one of the major reason for high morbidity, mortality and financial burden in such hypertensive diabetic patients. For this review, electronic databases including PubMed/Medline, Embase, Cochrane and Google scholar were searched from 1990-2013. Multiple inter-related factors are responsible for the development of hypertension and therefore nephropathy in the chronic diabetic patients. Majority of such factors are identified to lead to extensive sodium reabsorption and peripheral vasoconstriction and thus leading to microvascular complications like nephropathy. Management of hypertension by targeting such mediators is the highly recommended therapy for controlling and treating diabetic nephropathy. Clinical trials suggests that drugs inhibiting the renin-angiotensin-aldosterone pathway should be used as the first-line agents for the management of hypertensive diabetic nephropathy patients. These agents are effective in slowing the progression of the end-stage kidney disease as well as lowering albuminuria. Researchers are also investigating the effectiveness of drug combination for better management of hypertension and diabetic nephropathy. The present article is a review of the evidences which explains the underlying pathological changes which leads to the development of nephropathy in a hypertensive diabetic patients. The review also observes the clinical trials for different anti-hypertensive drugs which are recommended for the treatment Continue reading >>

Diabetic Nephropathy Clinic

Diabetic Nephropathy Clinic

The Diabetic Nephropathy Clinic in the Division of Nephrology and Hypertension at Mayo Clinic Rochester was created in 2004 to provide comprehensive diagnosis and treatment for patients with diabetic nephropathy , also known as diabetic kidney disease. This clinic brings together a dedicated group of nephrologists, hypertension nurses and dietitians who use a specialized treatment program developed at Mayo Clinic to customize therapy for each patient. The Diabetic Nephropathy Clinic offers patients who have diabetes the opportunity for early screening to identify diabetic nephropathy and begin treatment to slow down disease progression. Frequently, patients may not know that they have diabetic nephropathy because they may exhibit no symptoms in the early stages of the disease. Because diabetic nephropathy can lead to increased risk for kidney failure and heart disease, medical evaluation is important to diagnose the condition promptly and to properly maintain kidney and heart function. Physicians within the Diabetic Nephropathy Clinic work closely with specialists in the Division of Endocrinology and local physicians in coordinating treatment and follow-up care. Early diagnosis of diabetic nephropathy using state-of-the-art diagnostic tools including blood tests, urinalysis, renal imaging, kidney biopsy and urologic evaluation. Appropriate treatment of diabetic nephropathy guided by a specialized treatment plan developed at Mayo Clinic to monitor progress and adjust therapy when needed. Research to increase understanding of the causes of diabetic nephropathy in order to advance and develop novel therapies for the disease. In 2007, the Diabetic Nephropathy Clinic completed a clinical trial testing the use of pirfenidone as a treatment for diabetic nephropathy. New trial Continue reading >>

Hypertensive Kidney Disease

Hypertensive Kidney Disease

Hypertensive nephrosclerosis (HN or HNS), hypertensive kidney disease, hypertensive nephropathy (HN) Micrograph showing renal arterial hyalinosis pink ring right-of-centre. PAS stain . Hypertensive kidney disease is a medical condition referring to damage to the kidney due to chronic high blood pressure . HN can be divided into two types: benign and malignant. Benign nephrosclerosis is common in individuals over the age of 60 while malignant nephrosclerosis is uncommon and affects 1-5% of individuals with high blood pressure, that have diastolic blood pressure passing 130mm Hg. [1] It should be distinguished from renovascular hypertension , which is a form of secondary hypertension . In addition, HN can be referred to as hypertensive nephrosclerosis, benign nephrosclerosis, and nephroangiosclerosis. [2] Signs and symptoms of chronic kidney disease , including loss of appetite, nausea , vomiting , itching , sleepiness or confusion, weight loss, and an unpleasant taste in the mouth, may develop. [3] "Hypertensive" refers to high blood pressure and "nephropathy" means damage to the kidney; hence this condition is where chronic high blood pressure causes damages to kidney tissue; this includes the small blood vessels, glomeruli, kidney tubules and interstitial tissues. The tissue hardens and thickens which is known as nephrosclerosis. [4] The narrowing of the blood vessels means less blood is going to the tissue and so less oxygen is reaching the tissue resulting in tissue death (ischemia). [5] Risk factors for HN include poorly-controlled, moderate-to-high blood pressure, older age, other kidney disorders, and Afro-Caribbean background, whose exact cause is unclear, as it may be due to either genetic susceptibility or poor health management among people of Afro-Caribbean Continue reading >>

Diabetic Nephropathy

Diabetic Nephropathy

The Division of Nephrology and Hypertension is pleased to announce the establishment of the Mayo Clinic Diabetic Nephropathy Clinic (DNC). Diabetic nephropathy presently accounts for fifty percent of all new cases of End Stage Renal Disease (ESRD) each year. The majority of ESRD cases arise in patients with Type 2 diabetes who initially present with microalbuminuria and hypertension. Of note, however, at least 30% of patients with both Type 2 diabetes and renal insufficiency have neither proteinuria nor diabetic retinopathy. In these patients, other causes of renal insufficiency such as ischemic renovascular disease, atheroembolism, nephrotoxin exposures, or other glomerular diseases need to considered. Several studies have demonstrated that aggressive blood pressure control using angiotensin converting enzyme-inhibitors and/or angiotensin receptor blockers can prevent or delay the progression of diabetic nephropathy. Other risk factor interventions such as blood glucose control and treatment of dyslipidemia are also helpful. Towards achieving this goal, a collaborative effort between the Divisions of Endocrinology/Metabolism and Nephrology/Hypertension has been undertaken. The mission of the DNC is to identify early and aggressively manage renal disease in the diabetic patient (and to exclude other causes of renal disease). Another important mission of this collaboration is to foster clinical and basic research in the area of diabetic nephropathy. Any diabetic patient with proteinuria, regardless of blood pressure status Any diabetic patient with renal insufficiency regardless of the presence or absence of hypertension or proteinuria Continue reading >>

Diabetic Nephropathy And Antihypertensive Treatment: What Are The Lessons From Clinical Trials?:

Diabetic Nephropathy And Antihypertensive Treatment: What Are The Lessons From Clinical Trials?:

Diabetic nephropathy is the most serious problem among current issues in nephrology, as 40% of the cases of end-stage renal disease are due to this entity. The close relationship between type 2 diabetes and hypertension makes the problem even more severe. The knowledge of the intrarenal effects of angiotensin II and the greater effect of angiotensin converting enzyme inhibitors (ACEI) on reducing albuminuria suggested in the past a trend toward preferable use of these drugs in diabetic nephropathy. The first relevant clinical trials yielded rather poor conclusions because of lack of blind randomization and short duration. Subsequent double-blind studies with adequate numbers of patients and sufficient duration underlined the importance of blood pressure (BP) control as well as the rather poor response of diabetic nephropathy to any treatment. In most of these studies, the changes in albuminuria or microalbuminuria were a substitute end point for the renal function. Three clinical trials using angiotensin II receptor blockers (ARB), planned specifically to monitor the progression of renal damage, have been recently published. They showed better renal protection by ARB, as compared with placebo or calcium channel blockers (CCB), beyond or independently of the BP reduction. Nevertheless, these recent trials, like the previous ones with similar results, invariably demonstrate slightly better control of BP in the groups of the active drug. Another issue is that the vast majority of the patients need so many nonstudy drugs to keep their pressure under control, that the isolation of advantageous effects of certain drugs seems unrealistic. Diabetic nephropathy , albuminuria , clinical trials , antihypertensive treatment Diabetes mellitus (DM) is one of the strongest independen Continue reading >>

Diabetic Nephropathy In African Americans

Diabetic Nephropathy In African Americans

Diabetic nephropathy (DN) is the number one cause of end-stage renal disease in United States and is highly prevalent in African Americans. We have found that among African Americans in Mississippi diabetic nephropathy appears to affect females more than males, which may be related to increased rates of obesity and diabetes in African American women. Glycemic control and control of blood pressure is essential to prolong renal survival and to protect against cardiovascular events. Angiotensin-converting enzyme inhibitors reduce cardiovascular mortality in diabetics and are tolerated in advanced renal disease. The impact of glycemic control, appropriate antihypertensives, and the optimal level of blood pressure control in African Americans with advanced DN require further study. This article reviews the impact, clinical characteristics, risk factors, and treatment of diabetic nephropathy in African Americans. Am J Hypertens 2001;14:132S138S 2001 American Journal of Hypertension, Ltd. African American , diabetic nephropathy , angiotensin-converting enzyme inhibitors , end-stage renal disease , hypertension Type 2 diabetes mellitus is 1.4 to 2.2 times more prevalent in African Americans compared with whites. 1 The financial impact of the disease is enormous and becomes all the more staggering when one considers days lost from work for those with the disease and their caretakers. This effect of diabetes predominantly results from the microvascular complications that are also more severe in minority populations. 1 African Americans have consistently suffered from over 3.5-fold higher rates of end-stage renal disease (ESRD) compared with whites. The rates of ESRD from hypertension, diabetes, and glomerulopathic causes are all substantially higher in African Americans compared Continue reading >>

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