Abstract:
UNLABELLED:The prognosis of renal survival in both type 1 and type 2 diabetes mellitus is not benign. Several factors characterize the increase in the risk of developing renal damage in diabetic patients, distinguished in diabetes-related factors, genetic factors and other factors. DIAGNOSIS:Diagnosis requires standard annual urinalysis and dipstick for albumin. In patients with negative urine dipstick, the routine approach is to evaluate the albumin/creatinine ratio (ACR) in the first voided urine. The degree of renal impairment is assessed by an annual evaluation of the glomerular filtration rate (GFR) by the Cockroft/Gault formula in normoalbuminuric patients. In patients with overt nephropathy this evaluation needs to be more frequent. THERAPY:A thorough therapeutic approach, in both the early and later stages of diabetic nephropathy, is fundamental because of the increased risk of morbidity and mortality. Renal damage (and the natural history of the disease) is approached on three different levels. Primary prevention, in patients with no clinical and biochemical signs of renal damage, is a strict glycemic control by oral antidiabetic agents or insulin, as required, together with the maintenance of blood pressure (BP) levels < 130/85 mmHg, preferably using ACE-inhibitors. Secondary prevention aims to prevent or slow the progresssion from micro- to macroalbuminuria. BP control is the first-line approach, along with a strict glycemic control. At this stage, it is necessary to use other anti-hypertensive agents besides ACE-inhibitors to achieve optimal BP levels of 130/85 mmHg. Tertiary prevention addresses the reduction in the rate of renal failure progression by optimal BP control, a slightly hypoproteic diet and the control of dyslipidemia, in the presence of a (non-fundamental) euglycemic state. PROMISING NEW TRENDS IN DIABETIC NEPHROPATHY TREATMENT:a pharmacological blockade of endothelin and/or sympathetic system, an amelioration of hypoxia by correcting reduced hemoglobin levels, an interference with the formation and accumulation of advanced glycosilation end-products (AGE). Finally, the manipulation of the sex hormone balance, genetic screening for a predisposition to progressive renal dysfunction and, eventually, gene therapy complete the scenario for future approaches to this major complication of diabetic disease.
journal_name
J Nephroljournal_title
Journal of nephrologyauthors
Strippoli GF,Di Paolo S,Cincione R,Di Palma AM,Teutonico A,Grandaliano G,Schena FP,Gesualdo Lsubject
Has Abstractpub_date
2003-07-01 00:00:00pages
487-99issue
4eissn
1121-8428issn
1724-6059journal_volume
16pub_type
杂志文章,评审abstract:BACKGROUND:Cell-free DNA (cfDNA) is present in the peritoneal effluent of stable peritoneal dialysis (PD) patients, but there are no data on cfDNA in PD patients with peritonitis. We investigated the variation of peritoneal cfDNA levels subsequent to peritonitis in PD patients. METHODS:We enrolled 53 PD patients: 30 w...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-015-0212-2
更新日期:2016-02-01 00:00:00
abstract::Recently, two independent teams detected presumed hepatitis agents, which were designated HGV and hepatitis GB virus C; they represent a new genus in the family Flaviviridae. The most accurate way to assess the epidemiology of GBV-C/HGV infection remains the combination of RT-PCR and anti-GBV-C/HGV E2 techniques, to d...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:1999-05-01 00:00:00
abstract:BACKGROUND:Cardiovascular (CV) diseases are the main cause of death in maintenance hemodialysis (MHD) patients. Muscle wasting and physical function decline are common in MHD patients, and significantly impair their quality of life. These can result from abnormalities in cardiac function, which can be further worsened ...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-015-0188-y
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:The ongoing necessity for systemic heparinization is a well-known disadvantage of continuous renal replacement therapies (CRRT), and alternative methods of anticoagulation may be required. Our aim was to evaluate, in patients with a high risk of bleeding, the possibility of an acceptable filter life with non...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2003-07-01 00:00:00
abstract::The term thin glomerular basement membrane disease (TBMD) refers to a condition characterised by thinning of the GBM at electron microscopy examination and, clinically, by isolated hematuria, frequently occurring in other family members, with no extra-renal manifestations. Progression towards chronic renal failure (CR...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Renal tubular epithelial cells (TECs) function as antigen-presenting cells because they constitutively express MHC class II molecules and have the ability to present peptide antigen to CD4+T cells. However, the costimulatory signals provided by TECs for optimal T-cell activation have not been fully character...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2006-07-01 00:00:00
abstract::Minoxidil is frequently used in patients with advanced renal disease who have been unresponsive to other antihypertensive agents. We describe a case of a 50-year-old man with chronic renal failure who was hospitalized complaining of a 2-week history of sore throat that had progressed to severe oral lesions and multipl...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2007-01-01 00:00:00
abstract::During peritoneal dialysis (PD), peritoneal mesothelial cells undergo a transition from an epithelial phenotype to a mesenchymal phenotype that, together with the inflammatory process, promotes tissue fibrosis and a failure of peritoneal membrane function. To date, there is no definitive treatment for the progressive ...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-016-0368-4
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Chronic renal failure (CRF) is associated with a tendency to atherosclerosis due to the enhanced oxidative stress and insufficient antioxidant enzyme activities such as superoxide dismutase (SOD), catalase (CAT) and paraoxonase (PON 1), together with abnormalities in lipid parameters. We determined the in vi...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2002-03-01 00:00:00
abstract:BACKGROUND:Uremic pruritus as a symptom that affects hemodialysis (HD) patients can decrease the quality of life and increase morbidity in these patients. The aim of this study was to evaluate the effects of turmeric on uremic pruritus in HD patients. SUBJECTS AND METHODS:This was a double-blind placebo-controlled tri...
journal_title:Journal of nephrology
pub_type: 杂志文章,随机对照试验
doi:10.1007/s40620-014-0039-2
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:Because urinary low molecular weight protein (LMWP) measurement shows changes in renal integrity at an early stage, beta2-microglobulin (B2m), retinol-binding protein (RBP) and alpha1-microglobulin (A1m) were evaluated in 24-hour urine collection of 65 patients with pure monoclonal light chain (MLC) proteinu...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2007-11-01 00:00:00
abstract:BACKGROUND:Phosphate control is a crucial treatment goal in end-stage renal disease, but poor patient adherence to phosphate binder therapy remains a challenge. This study aimed to estimate the extent of phosphate binder adherence in hemodialysis patients and to identify potential determinants. METHODS:Phosphate binde...
journal_title:Journal of nephrology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s40620-014-0062-3
更新日期:2014-12-01 00:00:00
abstract::Some antihypertensive drugs may have a renoprotective effect, that is partially independent of their ability to reduce blood pressure. ACE-inhibitors are safe and effective agents that are capable of reducing proteinuria and preventing CRF progression. The results of the AIPRI extension study suggest that they may als...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:1998-11-01 00:00:00
abstract:BACKGROUND:Chronic kidney disease (CKD) progression is associated with significant comorbidities and costs. In Italy, limited evidence of healthcare resource consumption and costs is available. We therefore aimed to investigate the direct healthcare costs in charge to the Lombardy Regional Health Service (RHS) for the ...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-016-0291-8
更新日期:2017-04-01 00:00:00
abstract::Late-presenting end-stage renal disease is a significant problem worldwide. Up to 70% of patients start dialysis in an unplanned manner without a definitive dialysis access in place. Haemodialysis via a central venous catheter is the default modality for the majority of such patients, and peritoneal dialysis is usuall...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:10.1007/s40620-018-0485-3
更新日期:2019-02-01 00:00:00
abstract::A 64-year-old man was hospitalized in 2002 with symptoms of stupor, weakness, and renal colic. The clinical examination indicated borderline hypertension, small masses in the glutei, and polyuria. Laboratory tests evidenced high serum concentrations of creatinine, calcium, and phosphate. Imaging assessments disclosed ...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-015-0228-7
更新日期:2016-02-01 00:00:00
abstract:BACKGROUND:Benefits and risks of angiotensin converting enzyme inhibitors (ACE-I) in advanced chronic kidney disease (CKD) are controversial. We tested the role of ACE-I in slowing the progression of renal damage in a real-world elderly population with CKD stage 5. METHODS:We evaluated all patients consecutively refer...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-016-0290-9
更新日期:2016-12-01 00:00:00
abstract::Some patients with essential hypertension manifest increased urinary albumin excretion (UAE). Hypertensive patients with microalbuminuria manifest abnormal circadian variation of blood pressure, increased serum levels of LDL-cholesterol and lipoprotein(a), a greater rise of serum insulin in response to an oral glucose...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:1997-07-01 00:00:00
abstract::The combination of hypomagnesemia and hypocalciuria is the phenotypic signature of two distinct genetic renal tubular transport disorders: Gitelman's syndrome and autosomal dominant isolated renal magnesium wasting. In the past 5 years the genetic defects underlying these disorders have been elucidated through positio...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:2003-03-01 00:00:00
abstract::Jaundice and pancreatitis are serious complications in post renal transplantations; hepatotropic viruses and drugs are commonly implicated. We describe ascaris infestation causing pancreatitis and obstructive jaundice in a renal transplant patient. ...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2004-05-01 00:00:00
abstract:BACKGROUND:The effect of interleukin-11 (IL-11) on transforming growth factor-ß (TGF-ß) is controversial and has not been examined in renal diseases. In this study, we (i) characterised the up-regulation of TGF-ß1, phospho-p38 MAPK (p-p38 MAPK) and extracellular matrix during pathogenesis of glomerulonephritis and (ii)...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.5301/jn.2010.5094
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Early initiation of therapy is warranted for patients with idiopathic membranous nephropathy (IMN) who have severe proteinuria. Therapy with tacrolimus (TAC) or intravenous cyclophosphamide (CYC) may be an option in treating such patients. METHODS:This prospective cohort study included patients with IMN who...
journal_title:Journal of nephrology
pub_type: 临床试验,杂志文章
doi:
更新日期:2008-07-01 00:00:00
abstract::The aging process results in remarkable changes in the kidney. These changes are both anatomical and functional and have been considered the cause of the increased propensity of the elderly to acute or chronic renal failure. However, the majority of the early studies on aging enrolled institutionalized elderly patient...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:2010-09-01 00:00:00
abstract::Urine samples can be readily obtained from patients in everyday clinical practice. Therefore, the availability of urine allows physicians to obtain relevant clinical information in a timely manner. Since the measurement of urinary protein levels is essential in diagnosing and treating a host of diseases, the potential...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:10.1007/s40620-020-00735-y
更新日期:2020-04-23 00:00:00
abstract::The presence of circulating permeability factors (cPFs) has been hypothesized to be associated with recurrence of focal segmental glomerulosclerosis (rFSGS) in renal allografts. The available methods to detect cPFs are complex, not easily repeatable and inappropriate to represent the anatomical characteristics of the ...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-019-00683-2
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Accumulating experimental and clinical evidence reveals beneficial effects of n-3 polyunsaturated fatty acids (PUFAs) in kidney disease by modulating inflammation and fibrosis mechanisms that lead to renal failure. METHODS:EPA, DHA (n-3 PUFAs) and AA (n-6 PUFA) effects, compared to those of AngII, on renal ...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.5301/jn.5000193
更新日期:2013-07-01 00:00:00
abstract:BACKGROUND:Functional failure of the peritoneal membrane is the most serious problem in long-term continuous ambulatory peritoneal dialysis (CAPD). Transforming growth factor-beta (TGF-ss) is one of the key mediators of fibrosis in some organs, and is thought to be involved in peritoneal alterations. In this study, we ...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2003-01-01 00:00:00
abstract:INTRODUCTION:Lack of adherence may influence the efficiency of phosphate binders. Our clinical hypothesis was that if lanthanum carbonate (LC) might offer some advantage over sevelamer (S), that that would be in those patients in whom serum phosphate (P) levels were not controlled by S or in those requiring high doses ...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2010-11-01 00:00:00
abstract:BACKGROUND:Different mitogens are involved in the pathogenesis of kidney damage after subtotal nephrectomy. One of them, TGF-beta, controls mesangial cell proliferation and interstitial fibrosclerosis. The transduction of the TGF-beta signal is controlled by intracellular signalling molecules such as Ras G monomeric pr...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2002-09-01 00:00:00
abstract:BACKGROUND:Atypical haemolytic uremic syndrome (aHUS) is at high risk of relapse at any time, therefore patients require lifelong monitoring. The most appropriate way to monitor patients is not yet clear. Patients could be monitored for relapse by urine dipstick testing for haemoglobinuria based on the hypothesis that ...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-021-00965-8
更新日期:2021-01-18 00:00:00