Abstract:
AIMS:This joint document of the Italian Diabetes Society and the Italian Society of Nephrology reviews the natural history of diabetic kidney disease (DKD) in the light of the recent epidemiological literature and provides updated recommendations on anti-hyperglycemic treatment with non-insulin agents. DATA SYNTHESIS:Recent epidemiological studies have disclosed a wide heterogeneity of DKD. In addition to the classical albuminuric phenotype, two new albuminuria-independent phenotypes have emerged, i.e., "nonalbuminuric renal impairment" and "progressive renal decline", suggesting that DKD progression toward end-stage kidney disease (ESKD) may occur through two distinct pathways, albuminuric and nonalbuminuric. Several biomarkers have been associated with decline of estimated glomerular filtration rate (eGFR) independent of albuminuria and other clinical variables, thus possibly improving ESKD prediction. However, the pathogenesis and anatomical correlates of these phenotypes are still unclear. Also the management of hyperglycemia in patients with type 2 diabetes and impaired renal function has profoundly changed during the last two decades. New anti-hyperglycemic drugs, which do not cause hypoglycemia and weight gain and, in some cases, seem to provide cardiorenal protection, have become available for treatment of these individuals. In addition, the lowest eGFR safety thresholds for some of the old agents, particularly metformin and insulin secretagogues, have been reconsidered. CONCLUSIONS:The heterogeneity in the clinical presentation and course of DKD has important implications for the diagnosis, prognosis, and possibly treatment of this complication. The therapeutic options for patients with type 2 diabetes and impaired renal function have substantially increased, thus allowing a better management of these individuals.
journal_name
J Nephroljournal_title
Journal of nephrologyauthors
Pugliese G,Penno G,Natali A,Barutta F,Di Paolo S,Reboldi G,Gesualdo L,De Nicola L,Italian Diabetes Society and the Italian Society of Nephrology.doi
10.1007/s40620-019-00650-xsubject
Has Abstractpub_date
2020-02-01 00:00:00pages
9-35issue
1eissn
1121-8428issn
1724-6059pii
10.1007/s40620-019-00650-xjournal_volume
33pub_type
杂志文章,评审abstract:BACKGROUND:The endogenous inhibitor of nitric oxide synthase (NOS), asymmetric dimethylarginine (ADMA), is implicated in endothelial dysfunction and is a marker of renal disease progression and cardiovascular (CV) complications. Various cell species exhibit the enzymatic system that generates and degrades this methylar...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2007-09-01 00:00:00
abstract:BACKGROUND:We aimed to evaluate the relationship between abdominal aortic calcification (AAC) and renal resistive index (RRI), parameters associated with cardiovascular outcome, in non-dialysis chronic kidney disease (CKD) patients. METHODS:Seventy-seven stable patients mainly in CKD stages 3B and 4 (44 and 28%), medi...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-013-0021-4
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:The clinical benefits of on-line hemodiafiltration (HDF) versus high-flux membranes hemodialysis (hf-HD) are still debated. In fact, although a superiority of one treatment over the other, especially in terms of mortality, did not emerge from the analysis of clinical trials, improved intradialytic vascular s...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-018-00581-z
更新日期:2019-06-01 00:00:00
abstract::The Liber medicine orinalibus (codex 69 Montecassino) of Hermogenes is the first known manuscript to have a Latin translation from the original Greek work of Magnus of Emesa (or Nisibis). The particular text here translated, from the so-called Commentatio, mentions direct transliteration of Greek concepts such as chym...
journal_title:Journal of nephrology
pub_type: 历史文章,杂志文章
doi:10.5301/JN.2011.6461
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:Dialysate calcium (Ca) concentration should be viewed as part of the integrated therapeutic regimen to control renal osteodystrophy and maintain normal mineral metabolism. Thus, a correct ionized calcium mass balance (Ca++MB) during hemodialysis (HD) is crucial in the treatment of renal osteodystrophy. The G...
journal_title:Journal of nephrology
pub_type: 杂志文章,随机对照试验
doi:10.5301/JN.2011.6385
更新日期:2011-11-01 00:00:00
abstract::Osteoporosis and chronic kidney disease (CKD) have both independently important potential impact on bone health. A significant number of patients with CKD stages 3a-5D have been shown to have low bone mineral density (BMD), leading to a strikingly elevated risk of fractures (mainly hip fractures) and higher associated...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:10.1007/s40620-017-0404-z
更新日期:2017-10-01 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::The widely differing functions of vitamin D are based both on a wide diffusion of its specific receptor (VDR) and on the ability of many cells, in addition to renal tubular cells, to synthesize calcitriol for autocrine and paracrine functions. In the last few years, many published studies have added new insights into ...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:10.5301/JN.2011.7767
更新日期:2011-05-01 00:00:00
abstract::Chronic hypotension, defined by a systolic blood pressure < 100 mmHg in the interdialytic period, affects 5-10% of hemodialysis patients, and is more prevalent among patients on long-term hemodialysis. This complication requires a substantial amount of medical and nursing care before and during dialysis to control its...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:2002-07-01 00:00:00
abstract::Cardiovascular disease is the leading cause of the poor long-term survival of patients with chronic kidney disease (CKD). Anemia, which is a frequent and early complication of CKD, not only impairs patients' quality of life, but also is an independent risk factor for adverse cardiovascular outcomes. This may be due to...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:2007-11-01 00:00:00
abstract:BACKGROUND:There is growing evidence of the potential properties of nitrate-rich foods against development of hypertension (HTN) and vascular disease. In this study, we investigated the association of nitrate-containing vegetables (NCVs) with risk of HTN after 3 years of follow-up. METHODS:This prospective study was c...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-015-0229-6
更新日期:2016-06-01 00:00:00
abstract::Lupus is now regarded as a syndrome which results from several related auto-immune processes, although the exact mechanisms of how the disease arises in susceptible individuals remain obscure. When the San Carlo meetings began in 1968, much less was known about the pathogenesis of autoimmunity, but the presence of aut...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:1999-07-01 00:00:00
abstract::Over the last two decades, several studies have reported a high prevalence of cardiovascular disease in patients with end-stage renal disease (ESRD). This population usually presents both the traditional and non-traditional risk factors for atherosclerosis. Inflammation as well as impaired nitric oxide production are ...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:2003-01-01 00:00:00
abstract::Von Hippel-Lindau (VHL) disease is a rare autosomal dominant disorder characterized by multifocal and bilateral renal cell carcinoma and cysts, retinal angiomas, hemangioblastoma of the central nervous system, pheochromocytoma, epididymis cystoadenoma, pancreatic cysts and/or islet cell tumors. However, phenotypic man...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2005-03-01 00:00:00
abstract::The role of the kidney in controlling and maintaining plasma potassium levels in the normal range requires the presence and activity of renal potassium channels, and their importance has been highlighted in patients with Bartter syndrome harboring mutations in the ROMK (Kir1.1, KCJN1) channel and hyperkalemia. However...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Chronic kidney disease (CKD) is associated with increased morbidity and mortality in cardiovascular disease (CVD). Apart from traditional risk factors, chronic inflammation, oxidative stress, malnutrition and endothelial dysfunction are important in CVD development in renal patients. Our aim was to investiga...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2005-11-01 00:00:00
abstract:BACKGROUND:Serum adiponectin is inversely linked to obesity, impaired glucose homeostasis, dyslipidemia and hypertension and has been suggested as a possible marker of cardiovascular (CV) disease in the general population. However, its role in chronic kidney disease and following renal transplantation is not well estab...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Since dialysis has brought long-term survival to uremic patients, we can now speculate on more subtle problems derived from imbalance or sub-optimal regulation of some elements such as trace metals. We focused on the rubidium (Rb) status in dialysis patients (HD), as concerns about its possible deficiency ha...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2001-05-01 00:00:00
abstract:BACKGROUND:Contrast-induced nephropathy (CI-AKI) is a complication of diagnostic/therapeutic hemodynamic procedures in cardiology, which may also cause renal cholesterolinic atheroembolism. Despite the severe clinical impact of these complications, there is no optimal therapy for preventing and treating them. We sugge...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.5301/jn.5000266
更新日期:2013-05-01 00:00:00
abstract::Klaus Hierholzer (1929-2007) dissected various functions influenced by steroids in the distal tubule and showed that aldosterone in low doses reversed the sodium and potassium transport defect in adrenalectomized rats, through a rapid activation of Na+,K+-ATPase. Subsequent studies addressed the role of 11-beta-hydrox...
journal_title:Journal of nephrology
pub_type: 传,历史文章,杂志文章
doi:
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND:Malnutrition is common and associated with poor outcomes in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Recently, the geriatric nutritional risk index (GNRI) was reported as a novel tool for evaluating nutritional status. However, the association between GNRI and renal outc...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-019-00676-1
更新日期:2020-08-01 00:00:00
abstract::The hallmark of IgA nephropathy (IgAN) is macroscopic hematuria coinciding with, or immediately following, a mucosal infection, usually of the upper respiratory airways. The role of mucosal pathogens has been proven in different experimental models. Mucosal (or innate) immunity acts through the recognition of pathogen...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:2010-11-01 00:00:00
abstract::Cyclosporine (CsA) is among the most widely used immunosuppressants for preventing graft rejection and autoimmune diseases. However, its clinical use is hampered by its significant nephrotoxicity and effects as a cause of hypertension. The proximal tubular Na+-H+ exchanger (NHE3) is responsible for transcellular reabs...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:2010-11-01 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
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journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2006-09-01 00:00:00
abstract::Recent molecular cloning experiments have identified the existence of four NBC isoforms (NBC1, 2, 3 and 4) and two NBC-related proteins AE4 and NCBE (Anion Exchanger 4 and Sodium-dependent Chloride-Bicarbonate Exchanger). Except for AE4 which does not transport Na, all are presumed to mediate the cotransport of Na+ an...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:2002-03-01 00:00:00
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journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:2004-07-01 00:00:00
abstract::With increasingly accurate non-invasive tests, the clinician frequently discovers obstruction of the renal arteries by atherosclerosis. The decision to reverse this obstruction is not straightforward, particularly when blood pressure can be easily controlled with medications. Proper management of this problem requires...
journal_title:Journal of nephrology
pub_type: 杂志文章,评审
doi:
更新日期:1998-05-01 00:00:00
abstract:BACKGROUND:Until now, the survival of iliac vein tunneled cuffed catheters (TCCs) used in elderly patients has not been fully investigated. Accordingly, we evaluated their use in elderly hemodialysis patients with no other venous access options. METHODS:A total of 70 elderly patients with iliac vein TCCs undergoing ch...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:10.1007/s40620-015-0198-9
更新日期:2016-02-01 00:00:00
abstract::Given the alarming predictions of the potentially devastating future epidemic of end-stage renal disease (ESRD), further knowledge is still urgently needed on this topic. The real dimensions of the problem are still unclear. It is difficult to compare Europe and the USA because different criteria are used in data coll...
journal_title:Journal of nephrology
pub_type: 杂志文章
doi:
更新日期:2005-03-01 00:00:00