Contrast medium induced nephropathy

Contrast medium induced nephropathy. The wide-spread use of invasive diagnostic and therapeutic procedures makes the use of contrast media more common. Acute renal failure may develop following their intravascular administration, referred as contrast medium induced nephropathy or briefly contrast nephropathy. It develops especially in patients with diabetic nephropathy, in cases of volume depletion and in chronic renal insufficiency. Contrast nephropathy is the third most common cause of acute renal failure acquired in hospital. In their present work current literature, pathogenesis, clinical characteristics and potential ways of prevention are reviewed.     

Hypoglycemia in the elderly with diabetes mellitus

Aging is associated with an increasing prevalence of chronic diseases, including type 2 diabetes mellitus and its chronic and acute complications. With changes observed in diabetes mellitus treatment goals and the lower levels of glycosylated hemoglobin recommended, the prevalence of hypoglycemia especially in patients treated with insulin has increased. Aging and changes in the physiologic reserves generate a decreased perception of symptoms associated with hypoglycemia, increasing the risk of unawareness or severe episodes. Traditionally, age was a risk factor for hypoglycemia, but in the population over 60 years, multiple comorbidities like chronic heart failure, malnutrition and renal failure are associated with increased risk of developing this acute complication. It is necessary to train doctors and nurses from all levels of care to recognize the specific clinical manifestation of low blood glucose that allow early detection and treatment, because this complication is associated with an increased hospital and 1-year after discharge mortality, with falls and cognitive impairment that directly affect the independence and functionality of older persons.     

Rhinocerebral mucormycosis: A case report

Mucormycosis is a rare and acute fungal infection which is frequently lethal, usually observed in non-controlled diabetic patients. The infection usually begins in the nose but it can invade the lung, the digestive tract, and the skin. Rhinocerebral mucormycosis accounts for 40 to 49% of mucormycosis cases. We report the case of a 53-year-old diabetic man, with chronic renal failure, presenting with rhinocerebral mucormycosis. Our patient was treated by an association of amphotericin B and surgical debridement. This observation provides on opportunity to recall clinical, histopathological, and therapeutic aspects of rhinocerebral mucormycosis.     

Acute renal failure following treatment with intravenously administered immunoglobulins

A 74-year-old woman with insulin-dependent diabetes mellitus type 2 developed severe, reversible renal failure due probably to the administration of high doses of intravenous immunoglobulins (IVIG) for Guillain-Barré syndrome. The preparation administered did not contain sucrose or mannitol as adjuvants. The risk factors for the development of acute renal failure include pre-existent diabetes mellitus, reduced renal function and advanced age. In approximately 150 case reports in the literature, acute renal failure developed mainly after the use of sucrose-containing IVIG preparations. The course of both the onset of and the recovery from the renal failure and the histopathological findings in the described patient were in accordance with these findings. Since other causes were unlikely and in view of the supportive finding of elevated colloid osmotic pressure, it was concluded that the renal failure in this case was probably mediated by the oncotic effect of the macromolecular immunoglobulin itself.     

Does Oxidative Stress Management Help Alleviation of COVID-19 Symptoms in Patients Experiencing Diabetes?

Severe acute respiratory syndrome (SARS)-CoV-2 virus causes novel coronavirus disease 2019 (COVID-19) with other comorbidities such as diabetes. Diabetes is the most common cause of diabetic nephropathy, which is attributed to hyperglycemia. COVID-19 produces severe complications in people with diabetes mellitus. This article explains how SARS-CoV-2 causes more significant kidney damage in diabetic patients. Importantly, COVID-19 and diabetes share inflammatory pathways of disease progression. SARS-CoV-2 binding with ACE-2 causes depletion of ACE-2 (angiotensin-converting enzyme 2) from blood vessels, and subsequently, angiotensin-II interacts with angiotensin receptor-1 from vascular membranes that produce NADPH (nicotinamide adenine dinucleotide hydrogen phosphate) oxidase, oxidative stress, and constriction of blood vessels. Since diabetes and COVID-19 can create oxidative stress, we hypothesize that COVID-19 with comorbidities such as diabetes can synergistically increase oxidative stress leading to end-stage renal failure and death. Antioxidants may therefore prevent renal damage-induced death by inhibiting oxidative damage and thus can help protect people from COVID-19 related comorbidities. A few clinical trials indicated how effective the antioxidant therapy is against improving COVID-19 symptoms, based on a limited number of patients who experienced COVID-19. In this review, we tried to understand how effective antioxidants (such as vitamin D and flavonoids) can act as food supplements or therapeutics against COVID-19 with diabetes as comorbidity based on recently available clinical, preclinical, or in silico studies.     

糖化血红蛋白变异指数与2型糖尿病患者糖尿病慢性并发症的相关性研究

目的 探讨2型糖尿病(T2DM)患者糖化血红蛋白变异指数(HGI)与糖尿病慢性并发症发病的关系.方法 采用整群随机抽样的方法,从常熟市34个乡镇中随机抽出12个乡镇,选取在抽中乡镇登记并纳入国家基本公共卫生服务管理的T2DM患者为研究对象.根据HGI数值,采用三分位数法将患者分为低HGI组、中HGI组和高HGI组,探索...     

铁对链脲佐菌素糖尿病大鼠过氧化和非酶糖化作用的影响

为探讨铁在糖尿病及其并发症防治中的作用 ,以链脲佐菌素 (Streptozotocin ,STZ)腹腔注射SD大鼠建立糖尿病动物模型 ,在纯营养素饲料配方中加减元素铁 ,喂饲 5周 ,观察富铁及低铁饮食对糖尿病大鼠过氧化及非酶糖化的影响。结果表明富铁及低铁饮食对糖尿病大鼠体内糖化血红蛋白、糖化低密度脂蛋白及肾脏皮质的糖化终产物 (AGEs)含量无显著影响 ;低铁饮食对糖尿病大鼠血清和组织的脂质过氧化产物丙二醛 (MDA)含量无显著影响 ,富铁饮食可显著增高其血清及肾脏皮质的MDA含量。提示富铁及低铁饮食对糖尿病大鼠体内的非酶糖化作用无明显影响 ,但富铁饮食可以增强糖尿病大鼠体内的过氧化反应 ,从而加重糖尿病慢性并发症的发生和发展     

Possibility of early diagnosis of diabetic nephropathies

The serum and urine level of beta-2-microglobulin was examined by the authors in different stages of nephropathy of 250 patients suffering from diabetes mellitus (I type 178 pts, II type 72 pts). Beta-2-microglobulin values measured in diabetic patients without renal microangiopathy did not show any difference compared with that of the controls. In patients with freshly discovered diabetes mellitus significantly decreased beta-2-microglobulin levels were found, probably due to the increased glomerular filtration rate. Increasing beta-2-microglobulin values indicating an early glomerular lesion--were observed in incipient diabetic nephropathy. These values were significantly higher compared with that of healthy individuals and diabetic patients without renal microangiopathy. In the IV stage of disease the serum and urine beta-2-microglobulin levels were equally found to be elevated, indicating an impaired function of proximal tubuli beside the vascular lesions. The most expressed beta-2-microglobulin value elevations were observed in the stage of nephropathy. The authors emphasize the importance of determination and common evaluation of 24 hours protein excretion and serum urine beta-2-microglobulin values the earliest diagnosis of incipient renal lesion. According to their results, the introduction of this method may be very useful for early indication and follow-up of specific renal complications in diabetes mellitus patients.     

25 years of kidney replacement treatment at a general hospital

Between February 1963 and January 1988, 174 patients were treated for acute and 307 for chronic renal failure by dialysis in the St. Joseph Hospital Eindhoven, a general hospital. Sixty-two per cent of the patients treated for acute renal failure had tubular necrosis as a cause. In the patients treated for end-stage renal disease the median age of the dialysis population increased from 37 to 62 years. Vascular renal disease and diabetes mellitus were more frequent during the last ten years. Because of the inflow of older people, the outflow by death increased strongly, while the outflow by transplantation remained stable during the last 15 years. Due to an active transplantation policy together with haemodialysis at home and CAPD, 66% of the total now living patient population could be discharged from the dialysis department. Infection and cardiovascular accidents were the major causes of morbidity and mortality among the dialysis and transplant patients. Overall survival curves of all treated patients showed a 5-year survival of 60% and a 10-year survival of 42%.     

The association of low birthweight and chronic renal failure among Medicaid young adults with diabetes and/or hypertension

OBJECTIVE: The purpose of this study was to assess the effect of low birthweight on chronic renal failure among young Medicaid patients with diabetes and/or hypertension. METHODS: The study included Caucasian and African American young adults, aged 18-50, who enrolled in the Medicaid program from 1993 to 1996 in South Carolina and were diagnosed with diabetes and/or hypertension. The odds of chronic renal failure by low birthweight (< 2,500 grams) was estimated using logistic regression. RESULTS: Of the 7,505 Medicaid patients with diabetes and/or hypertension, 179 (2.4%) were diagnosed with chronic renal failure. These patients were younger (mean age of 33.9 vs. 37.6, p = 0.0024) and had a higher proportion of low birthweight (15.1% vs. 11.4%, p = 0.07) compared with the 7,326 patients without renal failure. The odds ratio of chronic renal failure for low birthweight was significantly higher compared with normal birthweight (2,500-3,999 grams) (adjusted odds ratio [OR] 1.56, 95% confidence interval [95% CI] 1.0, 2.4). The association between low birthweight and chronic renal failure was stronger among the 888 patients with both diabetes and hypertension (OR 2.6, 95% Cl 1.3, 5.7) than the 1,812 diabetes or the 4,805 hypertension patients. CONCLUSIONS: The odds of chronic renal failure by low birthweight was highest in patients with both diabetes and hypertension, suggesting that the mechanism(s) involved in the disease progression to chronic renal failure may have a fetal early life origin.     

Severe emphysematous pyelonephritis on a horseshoe kidney

Emphysematous pyelonephritis is an acute bacterial infection responsible for a high mortality. It is characterized by bacterial gas production in the renal parenchyma, occurring in diabetic patients in most case. The gold standard treatment has always been surgery associated with antibiotic therapy. We report the case of a 58 year-old woman, with undocumented diabetes, who presented with emphysematous pyelonephritis complicated with septic shock and acute renal failure. Antibiotherapy alone was successful.     

Strategies to reduce the progression of renal disease in patients with type II diabetes mellitus

The incidence of diabetes mellitus has increased dramatically in Puerto Rico. On 1996, it accounted for 56.8% of all new cases admitted for dialysis. By 1998 the number increased to 59.9%, of which, 88.5% were Type 2 diabetic patients. Strategies for the reduction or prevention of renal insufficiency of Type 2 diabetic patients should include: identification of potential chronic complications, review of risk factors related to diabetic nepropathy, and the evaluation of the arterial blood pressure and renal function. The therapeutic actions which have shown reduction of proteinuria and reduction of the progression to end stage renal disease in patients with type 2 diabetes are: strict control of the arterial pressure, the use of converting enzyme inhibitors, low salt diet and control of the protein intake. It is recommended that type 2 diabetic patients with high arterial pressure, micro or macroalbuminuria and increased serum creatinine should be referred to the nephrologist as early as possible.     

Magnesium and diabetes mellitus: their relation

The aim of this review was to elaborate a synthesis about the discussions on magnesium and diabetes mellitus, in the last 14 years. The magnesium deficiency has been associated with chronic diseases, amongst them, diabetes mellitus. Epidemiological studies had shown low levels of magnesium ingestion in the general population, as well as a relation between the ingestion of food rich in magnesium and the reduction of diabetes installation and its complications. Hypomagnesemia is frequently present in diabetic patients, however there is not an exact elucidation of the mechanism of magnesium deficiency in diabetes mellitus. On the other hand, in the presence of this illness, it is observed that inadequate metabolic control can affect the corporal concentrations of magnesium, developing hypomagnesemia, which may be still directly related with some micro and macrovascular complications observed in diabetes, as cardiovascular disease, retinopathy and neuropathy. This way, the chronic complications of diabetes can appear precociously. Based on this, the supplementation with magnesium has been suggested in patients with diabetes mellitus who have proven hypomagnesemia and the presence of its complications.     

Hypertension in the nursing home

Hypertension in a nursing home patient is a systolic blood pressure of 140 mm Hg or higher and 130 mm Hg or higher in a patient with diabetes mellitus or chronic renal insufficiency, or a diastolic blood pressure of 90 mm Hg or higher and 80 mm Hg or higher in a patient with diabetes mellitus or chronic renal insufficiency. Numerous prospective, double-blind, randomized, placebo-controlled studies have demonstrated that antihypertensive drug therapy reduces the development of new coronary events, stroke, and congestive heart failure in older persons. The goal of treatment of hypertension in elderly persons is to lower the blood pressure to less than 140/90 mm Hg and to less than 130/80 mm Hg in older persons with diabetes mellitus or chronic renal insufficiency. Elderly persons with diastolic hypertension should have their diastolic blood pressure reduced to 80 to 85 mm Hg. Diuretics should be used as initial drugs in the treatment of older persons with hypertension and no associated medical conditions. The selection of antihypertensive drug therapy in persons with associated medical conditions depends on their associated medical conditions. If the blood pressure is more than 20/10 mm Hg above the goal blood pressure, drug therapy should be initiated with 2 antihypertensive drugs, one of which should be a thiazide-type diuretic. Other coronary risk factors must be treated in patients with hypertension.     

Analyzing the content of physicians' medical practices

For many large physician groups, about 75% of all revenues come from capitation contracts. These groups may reduce the variable expenses of patient care by conducting medical outcome studies. Physician groups will obtain the most benefit for their limited research dollars by focusing outcomes research on prevalent medical conditions. The purpose of this study is to provide a comprehensive analysis of the content of physicians' medical practices. We found that 21 diagnostic clusters defined 70% or more of the episodes treated by primary care physicians. For specialists, no more than eight diagnostic clusters were needed to define the majority of their practices. Outcomes research should initially focus on abdominal pain, acute lower respiratory infections, cataracts, cholelithiasis, congestive heart failure, diabetes mellitus, external abdominal hernias, ischemic heart disease, low back pain, maternity care, menstrual disorders, otitis media, peptic diseases, prostate cancer, psychotic episodes, renal calculi, seizure disorders, and thyroid diseases.     

Management of the diabetic patient receiving nutritional support

The diabetic patient receiving TPN presents a challenge to health care personnel. Usual protocols concerning TPN administration must be reevaluated given the special considerations associated with the pathology of diabetes mellitus. These patients are susceptible to the development of complications including those associated with glucose metabolism abnormalities and electrolyte imbalances. In addition, diabetic patients receiving TPN have the added stress of an acute illness complicating a chronic illness. An understanding of the interrelationships between the pathophysiology of diabetes mellitus and the stress response will provide the nutritional support team with the background information necessary to meet the challenges imposed by TPN administration. The health care team will be able to recognize early signs and symptoms of complications and implement appropriate interventions. Individualized care plans can be formulated as an extension of the basic plan that has been presented, thus providing optimum care to the diabetic patient receiving nutritional support.     

The first case of single pancreas transplantation in Hungary

Simultaneous pancreas kidney (SPK) transplantation is the only routinely used therapeutic option which can provide insulin independence, euglycemia and good renal replacement for type I diabetes mellitus patients with end stage renal disease. Several patients have some complications of diabetes without renal failure. For these patients pancreas transplantation alone is a therapeutic option. The first pancreas transplantation alone was performed 6 years after the launch of our pancreas transplant program. The patient was a 40-years-old man. Enteric drainage was used with portal venous drainage. Anti IL-2. R antibody, daclizumab was given as prolonged induction therapy. In spite of the technical and immunological difficulties there were neither technical failures nor acute rejection. 3 years after the transplantation the patient has a good quality of life without insulin therapy with excellent renal function. Conclusion: PTA transplant is a routinely used therapeutic option with good survival rate and good quality of life for type I diabetes mellitus patients without end stage renal disease.     

The value of polypeptide analysis (beta-2-microglobulin, microalbuminuria, beta-thromboglobulin) in the diagnosis of diabetic nephropathies]

The value of polypeptide analyses in the diagnoses of diabetic nephropathy. Early diagnostic signs are rapidly gaining importance in the prevention and care of diabetic complications. The aim of this paper was to review the clinical significance of measurements of the serum and urine levels of beta-2-microglobulin, microalbuminuria and the plasma and urine levels of beta-thromboglobulin. We would like to emphasize their possible role in monitoring and prediction of the chronic sequelae of diabetes mellitus.     

Total parenteral nutrition in patients with insulin-requiring diabetes mellitus.

The clinical course of 24 patients with insulin-requiring diabetes mellitus who had received total parenteral nutrition (TPN) was retrospectively analyzed. Routine nutritional assessment disclosed significant depression of anthropometric indices and secretory protein levels in patients with chronic renal failure complicating juvenile onset diabetes mellitus (JODM). Biochemical complications including hypo- or hyperglycemia were significantly more frequent (p less than 0.001) in JODM than in maturity-onset diabetes and found to a lesser degree in patients with renal failure. The catheter infection rate was substantially higher (17%) than usually encountered in TPN therapy. Positive nitrogen balance was achieved in the majority of patients with an average 84% and 92% of estimated protein and caloric requirements being provided. Close monitoring and a protocol of infusion plus supplemental subcutaneous regular insulin was useful in providing adequate TPN safely to these high-risk patients.     

Total parenteral nutrition in patients with insulin-requiring diabetes mellitus

The clinical course of 24 patients with insulin-requiring diabetes mellitus who had received total parenteral nutrition (TPN) was retrospectively analyzed. Routine nutritional assessment disclosed significant depression of anthropometric indices and secretory protein levels in patients with chronic renal failure complicating juvenile onset diabetes mellitus (JODM). Biochemical complications including hypo- or hyperglycemia were significantly more frequent (p less than 0.001) in JODM than in maturity-onset diabetes and found to a lesser degree in patients with renal failure. The catheter infection rate was substantially higher (17%) than usually encountered in TPN therapy. Positive nitrogen balance was achieved in the majority of patients with an average 84% and 92% of estimated protein and caloric requirements being provided. Close monitoring and a protocol of infusion plus supplemental subcutaneous regular insulin was useful in providing adequate TPN safely to these high-risk patients.