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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.
Lesch–Nyhan disease and variants
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Allopurinol has been effective in reducing concentrations of uric acid and alleviating all of its direct clinical consequences. Doses of 200–400 mg/day lead promptly to normal plasma concentrations. Calculi and tophi are prevented or resorbed as concentrations of uric acid and in blood and urine fall. Nephropathy and arthritis are prevented. The total production of purine does not change; concentrations of xanthine and hypoxanthine increase. Some patients develop xanthine calculi. Determination of the levels of these oxypurines is very useful in providing the optimal dose of allopurinol. We aim to maximize the content of hypoxanthine without running the risk of oxypurinol lithiasis. It has become clear that doses required to accomplish this are highly individual and usually larger than employed in other diseases. An initial dose of 15–20 mg/kg is followed by assessment of concentrations of all of the oxypurines of the urine: uric acid; xanthine and hypoxanthine. Dosage is then modified, usually increased, to yield maximal concentrations of hypoxanthine which is soluble and minimal levels of xanthine, which causes the calculi in treated patients.
Practice circuit 1
Published in T. Justin Clark, Arri Coomarasamy, Justin Chu, Paul Smith, Get Through MRCOG Part 3, 2019
T. Justin Clark, Arri Coomarasamy, Justin Chu, Paul Smith
Pre-pregnancy obstetric advice – diabetic complications screening Nephropathy: U&Es (high creatinine is associated with poorer pregnancy outcomes)Urine for proteinuria estimation and creatinine clearanceRetinopathy: Refer to ophthalmologist for an eye examination conducted through dilated pupilsProliferative retinopathy predictive of foetal outcome and risk of progression (10%, if absent and 50%, if present);Retinopathy requiring treatment should be dealt with prior to pregnancyConsider the possibility of macrovascular disease (e.g. IHD, CVA) and formally investigate if it is a possibility.Early review when pregnancy confirmed.
Exogenous glutamine ameliorates diabetic nephropathy in a rat model of type 2 diabetes mellitus through its antioxidant and anti-inflammatory activities
Published in Archives of Physiology and Biochemistry, 2023
Maryam Nasri, Glavizh Adibhesami, Sina Mahdavifard, Esmaeel Babaeenezhad, Hassan Ahmadvand
Nephropathy is one of the most important diabetes complications that occur in the progressive stages of diabetes mellitus (Tavafi et al.2011). Diabetic nephropathy is manifested by specific histopathological features such as the thickening of the glomerular basement membrane (GBM) and the expansion of the mesangial matrix. Oxidative stress and inflammation resulted from hyperglycaemia contribute to the development of this complication (Schena and Gesualdo 2005, Vasavada and Agarwal 2005). The control of these has become an important strategy to mitigate diabetic nephropathy. Therefore, we aim to study the possible protective effects of Gln, as a natural antioxidant, on diabetic nephropathy in a rat model of type 2 diabetes mellitus. Based on our knowledge, this study is the first to report the possible protective effects of Gln on nephropathy in type 2 diabetes mellitus using histopathological, biochemical, and molecular evaluations. Additionally, we investigate the possible protective effects Gln on other diabetic complications, including systemic oxidative stress, hyperlipidaemia, and insulin resistance.
The occurrence of ochratoxin A in human body fluids – review
Published in Toxin Reviews, 2021
Karolina Ropejko, Magdalena Twarużek
Some studies on OTA exposure using urine as a biomarker have inevitably focused on areas where nephropathies or urinary tracts diseases are endemic. One such study investigated possible links between OTA exposure and nephropathy in Bulgaria. Urine samples were collected from suffers as well as healthy members of their families to act as controls OTA was found in 38.9% of patients suffering from endemic nephropathy and urinary tract tumors at 5–604 ng/l (Table 2). Twenty-five subjects with suspected endemic nephropathy were also examined. OTA was detected in 9 of them; values ranged from 5–32 ng/l. Healthy members of families of patients with nephropathy were tested and OTA was found in 12 out of 25 samples derived from this group OTA levels were between 5 and 33 ng/l in urine. Healthy subjects living in areas considered endemic were also tested – 11 out of 32 urine samples contained OTA at levels between 5–43 ng/l. Three healthy individuals, living in areas not considered endemic were also tested in this case, no mycotoxin was detected in any of the individuals’ urine. These results were thought to be explained by consumption of mycotoxin contaminated food by subjects (Castegnaro et al.1991).
Predictive role of laboratory markers and clinical features for recurrent Henoch-Schönlein Purpura in childhood: A study from Turkey
Published in Modern Rheumatology, 2020
Şule Gökçe, Zafer Kurugöl, Güldane Koturoğlu, Aslı Aslan
The epidemiological and demographic data including age, gender, seasonal contact time were analyzed. Previous infections, vaccinations, and insect bites were all recorded as provided they were within two weeks prior to the first symptom. Fever was considered to be present if the temperature was >37.7 °C. Renal involvement was defined as follows: Microscopic hematuria was defined when the urine test result was > 5 erythrocytes/mm3; gross hematuria was defined when blood in the urine could be seen with the naked eye. Severe nephropathy was considered to be present when the patient had 1 of the following findings: nephrotic syndrome: defined as plasma albumin level under 25g/L and either 1g of proteinuria/d per m2 of body surface area in children, with or without the presence of edema; or acute nephritic syndrome that was defined as hematuria with at least 2 of the following features; hypertension, elevated plasma urea or creatinine serum levels, and oliguria. Rash location means purpura mainly concentrated in parts of the body. The joint involvement was described as the presence of joint swelling and/or limitation of joint movement. Gastrointestinal involvement was defined as bowel angina (characterized by the presence of diffuse abdominal pain), gastrointestinal bleeding (melena or hematochezia or the child had a positive stool Guaiac test), and nausea and vomiting in the context of the clinical duration of vasculitis. Stomachache and hematemesis also support gastrointestinal involvement.