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Diabetes Mellitus, Obesity, Lipoprotein Disorders and other Metabolic Diseases
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Hypertension is more common in patients with DM; approximately 50% are hypertensive. Many secondary causes of diabetes are associated with hypertension (see Table 11.1). People with DM gain greater benefit from treatment of hypertension due to their increased risk of macrovascular disease. Strict blood pressure control reduces the chance of stroke, heart failure and the progression of diabetic retinopathy in patients with type 2 DM. Blood pressure targets in type 1 DM are currently <130/<80 mmHg and in type 2 DM are <140/80 mmHg or <130/<80 if the albumin : creatinine ratio is >70 mg/mmol or there is chronic kidney disease. Control of hypertension is an important part of diabetic nephropathy management.
Diabetic Nephropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Diabetic nephropathy is a primary cause of chronic kidney disease. There is thickening of the glomerular basement membrane, glomerular sclerosis, and mesangial expansion. Diabetic nephropathy is one of the major complications of diabetes mellitus that results in kidney failure and death without treatment. The changes that occur lead to glomerular hypertension and a steady decline in the glomerular filtration rate. If there is systemic hypertension present, the progression of diabetic nephropathy may occur more quickly. It is usually asymptomatic until the development of nephrotic syndrome or renal failure. The detection of urinary albumin prompts the diagnosis of diabetic nephropathy. Once the presence of diabetes is diagnosed, urinary albumin should be monitored regularly, at least once per year, by measuring the albumin: creatinine ratio. Diabetic nephropathy is managed with strict blood glucose and blood pressure control.
Cardiovascular and Related Complications of Diabetes
Published in Robert Fried, Richard M. Carlton, Type 2 Diabetes, 2018
Robert Fried, Richard M. Carlton
Combining the patients with chronic kidney disease and/or the presence of albuminuria, 34.7% seemed to suffer from significant chronic kidney disease. The proportion of patients with albuminuria increased with a decrease in GFR. Historically, diabetic nephropathy had been diagnosed in 24.3% of the patients.
Kirenol alleviates diabetic nephropathy via regulating TGF-β/Smads and the NF-κB signal pathway
Published in Pharmaceutical Biology, 2022
Jialin Li, Jiawen Zhang, Meng Yang, Xiaocui Huang, Meng Zhang, Xiansong Fang, Suzhen Wu
Diabetes is also an inflammatory disease. Diabetic nephropathy is accompanied by inflammation. NF-κB is a transcriptional factor of IL-6 and TNF-α, the phosphorylation and translocation of NF-κB will drive the expression of inflammatory factors such as IL-6 and TNF-α. Our study found that kirenol could inhibit the HG-induced phosphorylation of NF-κB. Moreover, IκBα, which is a negative regulator of NF-κB signalling pathway, was significantly increased by kirenol treatment (Figure 3(A–C)). We designed an NF-κB probe that binds to nuclear proteins and then performed EMSA to investigate their binding activities. The EMSA results showed that the binding activity of the NF-κB probes to the nuclear protein in HG-induced mesangial cells was remarkably suppressed by kirenol treatment (Figure 3(D)). These results indicated that kirenol treatment markedly inhibited the HG-induced NF-κB signalling pathway in mesangial cells.
Emerging drugs for the treatment of diabetic nephropathy
Published in Expert Opinion on Emerging Drugs, 2022
Yoon Kook Kim, Xinyuan Ning, Kashif M. Munir, Stephen N. Davis
In addition to drugs, there are investigations underway in search for other therapeutic options. Given the important role of hypertension (and more specifically the hemodynamics of the kidneys) in overall renal health, antihypertensive therapy with renal denervation devices or baroreflex activation therapy is also being investigated [21–23]. These advances and continued efforts testify to the significant strides made in the management of diabetic nephropathy; however, the overall burden of diabetic nephropathy is still large. Given our current understanding of the heterogeneous nature of the pathophysiology of diabetic nephropathy, there are other likely therapeutic targets that address uncharted pathways of diabetic nephropathy, and investigations to find these novel drugs continue. With some of these emerging drugs and ongoing research, one may aim to not only slow the progression of diabetic nephropathy but potentially also reverse or halt it.
Three cases of retained cuff related infection after manual pull removal of peritoneal dialysis catheter
Published in Renal Failure, 2021
Suojian Zhang, Xu Zhang, Haitao Li, Zhiqiang Wei, Juan Cao
A 36-year-old man was initiated on PD 2 years ago. He had a history of type I diabetes for >10 years and underwent kidney biopsy at our department 4 years ago. The pathological diagnosis was diabetic nephropathy. Owing to poor adequacy, he discontinued PD treatment and the PD catheter was removed by the ‘pull technique’ 1 year ago. After 4 months, secretions were found at the exit site of the original PD catheter, accompanied by pain and discomfort. Blood test results revealed the following: hemoglobin 121 g/L, blood cell count 8.32 × 109/L, neutrophil percentage 73.4%, platelet count 153 × 109/L, C-reactive protein 1.47 mg/L, and procalcitonin 0.37 ng/mL. Bacterial culture of the secretions revealed the presence of Serratia marcescens. B-mode ultrasound imaging revealed a heterogeneous mass in the left lower abdominal wall (Figure 1). We removed the mass by open surgery and administered piperacillin–sulbactam 2.5 g intravenously (IV) twice a day (BID) for 10 days. Subsequently, the patient was cured.