Diabetes and Aging
Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu in Medical Management of Diabetes Mellitus, 2000
In patients with type 2 diabetes, both adequate systemic blood pressure control (38,39) and use of ACE inhibitors (44,45) reduce the rate of progression of early renal disease. Testing for microalbuminuria is an appropriate screen for early renal disease and decreases progression ot sucn disease in type i aiaoetes. Little information is available specifically in older diabetic patients, although, based on the weight of evidence in other population groups, it is reasonable to check urinary microalbuminuria, use ACE inhibitors when possible, and obtain renal evaluation if there is evidence of renal disease. In older diabetic patients, it is important to remember that there are many other causes of microalbuminuria, such as urinary tract infections, hematuria owing to prostate disease, and intercurrent illness. In addition, there is a higher prevalence of other causes of renal insufficiency, including most commonly, hypertensive renal disease or reaction to medications.
Nutrition, Chronic Kidney Disease, and Kidney Failure
David Heber, Zhaoping Li in Primary Care Nutrition, 2017
The most common cause of chronic renal insufficiency is diabetes (Vallon and Thomson 2012). After 10–20 years of diabetes mellitus, approximately 20% of patients with either type 1 or type 2 diabetes mellitus develop diabetic nephropathy, making diabetes mellitus the leading cause of ESRD. Both genetic and environmental factors determine which patients eventually develop diabetic nephropathy, and there remains a need for research to better understand the pathophysiology and molecular pathways that lead from the onset of hyperglycemia to renal failure. Changes in the vasculature and the glomerulus, including those to mesangial cells, the filtration barrier, and podocytes, play important roles in the pathophysiology of the diabetic kidney.
Diabetic Nephropathy: Present and Future Challenges
Meguid El Nahas in Kidney Diseases in the Developing World and Ethnic Minorities, 2005
In diabetic patients, renal transplantation reduced the risk of acute coronary syndromes in comparison to dialysis treatment, although the risk is substantially higher than the risk of the nondiabetic population (21). In summary, diabetic nephropathy is a high-risk condition for cardiovascular and non-cardiovascular morbidity and mortality. Indeed, renal insufficiency by any cause has a significant impact on cardiovascular disease outcome. Among many others, it is worth mentioning two recently published papers. Investigators of the Valsartan in Acute Myoscardial Infarction Trial (VALIANT) identified 14,527 patients with complicated myocardial infarction who had a measured serum creatinine (22). They calculated the glomerular filtration rate (GFR) with the modification of diet in renal disease (MDRD) formula, and patients were grouped according to their estimated GFR. In these patients, the risk of death from cardiovascular causes increased with declining GFR. The authors concluded that even mild renal disease should be considered a major risk factor for cardiovascular complication after a myocardial infarction. The study of Go and co-workers (23) was conducted in a large population of more than 1 million adults within an integrated system of health care. In these people, serum creatinine had been measured, and GFR could be estimated by MDRD formula. After adjustment, the risk of death increased as GFR declined below 60 mL/min/1.73 m2. A similar independent graded association was noted between reduced GFR and cardiovascular events. The concern that kidney disease could be underestimated as a risk factor for development of cardiovascular disease has been voiced by the American Heart Association, which has issued a scientific statement to recommend that patients with chronic kidney diseases are considered at the highest risk group for cardiovascular disease (24).
Analysis of the clinical characteristics of tigecycline-induced hypofibrinogenemia
Published in Journal of Chemotherapy, 2023
Haibo Lei, Xiang Liu, Zuojun Li, Chunjiang Wang
Acute or chronic renal insufficiency often occurs at the same time in some patients. Joan et al. found that 30% of tigecycline accumulated in patients with severe renal insufficiency [26]. Renal impairment has been suggested to be a risk factor for tigecycline-induced hypofibrinogenemia. Zhang et al. found that renal failure (whether requiring dialysis or not requiring dialysis) was a risk factor for tigecycline-induced hypofibrinogenemia (OR [95% CI]: 2.450 [1.335-4.496]) [23]. David et al. found that renal impairment was not related to a higher risk of FIB decreases in a real-world setting [22]. However, they still consider renal insufficiency to be a possible risk factor due to its clinical relevance. Based on reports of tigecycline-induced hypofibrinogenemia, we found that renal insufficiency may be a risk factor for hypofibrinogenemia induced by tigecycline. Further study is needed to verify the relationship between tigecycline-induced hypofibrinogenemia and renal function.
Role of point-of-care arterial blood potassium in diagnosing pseudohyperkalemia
Published in Baylor University Medical Center Proceedings, 2022
Ghulam Mujtaba Ghumman, Abdul Baqi, Abid Nawaz Khan Adil, Vinod Khatri
We highlight the use of POC potassium in diagnosing pseudohyperkalemia. The use of arterial blood in heparinized arterial blood gas syringes with immediate POC analysis can prevent cell lysis and reflect true in vivo potassium levels. This occurs due to lack of tourniquet use with arterial sampling, no vacutainer use, absence of pneumatic tube transport, early analysis, and thus less chance of leukocyte destruction. This phenomenon has been described by Ruddy et al, who reported a discrepancy between arterial and venous potassium levels due to pseudohyperkalemia. In their case, the arterial blood was also sent to the laboratory for analysis immediately after collection to target the minimum sample-to-analysis time.7 It is important to look for other causes of hyperkalemia in these patients, as tumor lysis syndrome can also occur and lead to hyperkalemia. Renal insufficiency is another cause in these patients. The presence of normal levels of uric acid, calcium, phosphate, and creatinine ruled out these causes.
Tigecycline-induced life-threatening coagulopathy in a patient with a Mycobacterium abscess: a case report and step-by-step diagnostic approach
Published in Acta Clinica Belgica, 2021
Sara Akalay, Thomas Vanassche, Paul De Munter
Some risk factors for developing this side effect have been mentioned. First, if we review the literature on tigecycline-associated coagulopathy it appears that all the reported cases had renal impairment [2–7]. In our case, the patient had a history of kidney transplantation 13 years ago with an actual estimated glomerular filtration rate (eGFR) of 30 ml/min/1.73 m2. Therefore, it has been suggested that renal insufficiency might be a risk factor for this side effect. However, two studies found no significant change in the tigecycline pharmacokinetics in patients with impaired renal function and tigecycline is not cleared by dialysis [11,12]. Therefore, current recommendations do not recommend adjusting the drug dose in patients with impaired renal function or in patients undergoing hemodialysis treatment. Possibly, the presence of a metabolite of tigecycline that accumulates in renal insufficiency might be causing the coagulopathy. Secondly, a retrospective analysis by Zhang et al. [9] found that patients with severe infections treated with tigecycline experienced a reduction in fibrinogen levels that was proportional to the dose. Their results suggest that dose increase and/or regimen prolongation may cause greater decreases in fibrinogen levels. There was no difference in fibrinogen decrease according to age.
Related Knowledge Centers
- Anemia
- Confusion
- Edema
- Renal Osteodystrophy
- Vomiting
- Cardiovascular Disease
- Hypertension
- Kidney Disease
- Assessment of Kidney Function
- Renin–Angiotensin System