新型光量子对血透患者慢性炎症反应状态的干预作用

目的 :探讨新光量子疗法在干预血透患者慢性炎症反应状态中的效果。方法 :随机选择 2 0例终末期肾病 (ESRD)维持性血透患者 ,应用自行设计光量子导管与血透管路连接 ,在透析过程中对其血液直接进行紫外线的照射治疗 ,检测治疗前、治疗后 1月、治疗后 2月C反应蛋白及白介素 - 6水平。结果 :治疗 1月后C反应蛋白水平为(4 .0 0± 1.73)mg/L明显低于治疗前 (6 .12± 2 .76 )mg/L ,有统计学差异 (P <0 .0 1) ;白介素 - 6水平治疗后 (0 .2 2±0 .0 3)ng/ml,与治疗前 (0 .2 2± 0 .0 6 )ng/ml比较 ,无统计学差异 (P >0 .0 5 )。治疗 2月后白介素 - 6水平 (0 .14±0 .0 2 )ng/ml也已明显低于治疗前 ,有统计学差异 (P <0 .0 5 )。结论 :新光量子疗法是安全、方便、有效的 ,联合血透治疗可改善血透患者慢性炎症反应状态 ,有利于降低终末期肾病患者透析并发症和提高其生活质量 ,值得在临床推广应用     

终末期肾衰竭腹膜透析患者的转归及其危险因素分析

目的:探讨影响终末期慢性肾衰竭连续性不卧床腹膜透析患者死亡危险因素及其防治对策.方法:对1999年8月～2003年8月期间我院52例慢性肾衰竭腹膜透析患者的资料进行回顾性临床分析.其中死亡组22例、存活组30例,分析其死亡原因和影响因素.结果:(1)52例腹膜透析患者死亡组的22例中,死于心血管病变13例(占59.1%),腹膜炎3例(占13.6%),肺部感染2例(占9.1%),严重营养不良2例(占9.1%),其他2例(占9.1%).(2)死亡组年龄、性别分布与存活组比较无统计学差异(P＞0.05);与存活组比较,死亡组的体重、平均动脉压明显升高,血浆白蛋白明显降低,均有统计学差异(P＜0.05).(3)死亡组的透析龄、透析液总剂量、腹腔超滤量、尿量及液体总清除量与存活组比较均无统计学差异(P＞0.05);然而死亡组的水肿发生率明显高于存活组,分别为68.2%及43.3%(P＜0.05).(4)死亡组透析初始时的尿素氮、肌酐、肌酐清除率、血色素、总胆固醇、甘油三酯与存活组相比无统计学差异(P＞0.05).(5)糖尿病腹膜透析患者的水肿发生率和病死率均明显高于非糖尿病患者(P＜0.05),16例糖尿病患者有11例死亡,非糖尿病患者36例中有11例死亡(病死率分别为68.8%VS 30.6%).结论:心血管疾病是终末期肾衰竭腹膜透析患者最主要的死亡原因.容量超负荷、糖尿病、控制不良的高血压、营养不良以及透析时机过迟都是影响终末期肾衰竭患者心血管病死亡的主要危险因素.积极维持体液平衡、控制血压及糖尿病合并症,并根据患者的残余肾功能、临床症状、合并症情况和营养状态综合考虑,及时开始CAPD治疗,将有助于改善患者的预后.     

温胆汤加减联合高通量血透对糖尿病肾病的抗氧化及抗微炎症作用观察

<正>糖尿病肾病(diabetic nephropathy,DN)为糖尿病常见并发症,终末期肾病以血液透析为主要治疗手段。报道指出[1],DN血液透析患者的预期寿命普遍低于其他血液透析患者,与DN患者存在明显氧化应激及微炎症状态有关。证据显示[2],高通量血透与普通血透相比可降低心脑血管事件发生率与病死率。研究发现[3],高通量血透治疗DN收效良好,效果优于普通血液透析。燕军玲[4]的研究表明,清热化湿类中药可使DN患者受益,但目前临床有关高通量血透联合清热化湿类中药治疗DN的研究仍较为缺乏。本研究以90例DN患者作为研究对象,观察温胆汤加减联合高通量血透对氧化应激及微炎症反应的影响,现报告如下。     

终末期糖尿病肾病治疗现状

糖尿病肾病(diabetic nephropathy, DN)是糖尿病最常见的并发症,也是糖尿病患者主要死亡原因之一.DN发展到终末期糖尿病肾病(ESDN)的过程可以延缓,但不可逆.根据美国肾脏病数据统计(USRD),1996年终末期肾病(ESRD)患者中DN占36.39%;1998年日本报告ESRD患者中DN占35.7%;2000年中华医学会肾脏病分会透析移植登记工作组ESRD患者中DN占13.5%;2003年Wrenger等报告,透析患者ESDN占36%,主要为2型糖尿病.南京军区南京总医院解放军肾脏病研究所血液净化中心统计1998年新进入透析患者中ESDN占4.78%,2003年ESDN占15%.     

糖尿病对腹腔镜胆囊切除术的影响

目的　讨论糖尿病对腹腔镜胆囊切除术 (LC)的影响。方法　比较 49例糖尿病和 1 4 99例非糖尿病患者LC手术并发症 ,并进行统计学分析。结果　糖尿病组与非糖尿病组相比 ,在平均手术时间、中转开腹率、心率失常、胆漏、胆管损伤、腹腔感染等方面差异有显著性意义 (P <0 .0 1 ) ,而在水、电解质失衡方面 ,两组间差异无显著性意义 (P >0 .0 5)。结论　糖尿病组手术风险性增高是由于糖尿病的并发症造成的。糖尿病患者抗感染能力低、神经病变、血管病变、代谢紊乱是引起糖尿病并发症的重要因素。术前应加强综合治疗 ,控制血糖     

非糖尿病终末期肾病患者血液透析期间血糖变化

目的 探讨非糖尿病终末期肾病患者血液透析过程中血糖变化并分析其原因.方法 选取我院非糖尿病终末期肾病血液透析患者20例,其中非进食组11例,进食组9例(于透析1.5～2h进食).测定患者血液透析0、0.5、1.0、2.0、4.Oh时血糖浓度.收集患者透析废液,检测其中葡萄糖含量.结果 20例患者均未出现低血糖反应,其中非进食组2例患者出现无症状低血糖.进食组血糖呈逐渐增高趋势,而非进食组血糖呈逐渐降低趋势.进食组透析废液中葡萄糖丢失量为(17.70±6.33)g,非进食组透析废液葡萄糖丢失量为(15.43±8.52)g,两组比较差异无统计学意义.结论 非糖尿病肾病血液透析期间有低血糖发生风险,血液透析中葡萄糖丢失是其主要原因,建议非糖尿肾病血液透析患者使用含糖透析液,以减少低血糖发生风险.     

糖尿病肾病透析性低血压相关因素分析

目的:探讨导致糖尿病肾病(DN)尿毒症透析性低血压的相关因素及防治措施.方法:25例维持性血液透析的DN患者,分透析性低血压组和无低血压组(对照组),观察透析间期空腹血糖(Glu)、糖基化血红蛋白(HbAlc)、血红蛋白(Hb)、血肌酐(Scr)、血尿素氮(BUN)、血钠(Na )、血浆白蛋白(Alb)、总胆固醇(TC)、甘油三酯(TG),计算干体重、透析间期体重增长率、超滤量、超滤率的变化.结果:低血压组首次血透时Scr、BUN明显高于对照组,Ccr明显低于对照组,两组比较有统计学差异(P均＜0.05);透析间期体重增长率(透析间期体重/干体重)、超滤量、超滤率均较高两组间有统计学差异(P＜0.01);透析期间Glu、HbAlc明显高于对照组有统计学差异(P＜0.05);Hb、Alb、Na 明显低于对照组有统计学差异(P＜0.05),而Scr、BUN、TG、TC之间无统计学差异(P＞0.05).结论:糖尿病肾病透析性低血压与首次血透时肾功能、透析间期体重增长率、超滤量、超滤率、高血糖、营养不良、贫血、血钠浓度等有关,应提倡个体化透析.     

维生素D受体基因BsmI多态性与2型糖尿病肾病的关系

目的 研究维生素D受体(VDR)基因BsmI位点多态性与汉族人群2型糖尿病肾病(DN)的关系.方法 应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术检测304例2型糖尿病患者(DM组)及100例健康体检者(NC组)VDR Bsml位点基因型和等位基因频率.根据尿白蛋白情况将DM组分为非糖尿病肾病组(DN0组,122例)、微量白蛋白尿组(DN1组,87例)、大量白蛋白尿组(DN2组,95例).83例病程5年以上仍未出现肾病的DM患者纳入L-NDN组;64例起病1年内即出现肾病的DM患者纳入EDN组.结果 DM组BB+Bb基因型和B等位基因频率均高于NC组(x2=7.088,P=0.008;x2=5.865,P=0.015).DN2组BB+Bb基因型和B等位基因频率高于NC组(x2=14.287,P=0.000; x2=12.621,P=0.000)及DN0组(x2=8.063,P=0.005;x2=8.173,P=0.004).其余组间差异均无统计学意义.EDN组BB+Bb基因型和B等位基因频率均显著高于L-NDN组(x2=7.228,P=0.007;x2=5.853,P=0.016).B等位基因阳性DN患者的尿白蛋白排泄率显著高于B等位基因阴性DN患者,差异有统计学意义(P＜0.01).BsmI位点基因型与DN发生密切相关.B等位基因阳性是DN发生及早发的危险因素(OR=2.004;0R=2.394).结论 VDRBsmI基因多态性与DN易感性相关.B等位基因阳性患者更易出现大量白蛋白尿及早期发生肾病.     

老年糖尿病肾病患者血液透析中的低血压原因分析

目的:探讨老年糖尿病肾病(diabeticnephropathy,DN)患者血液透析发生相关性低血压的原因.方法:选择维持性血液透析的老年糖尿病肾病患者30例,根据低血压发生情况分为低血压组和无低血压组(对照组),观察两组透析间期空腹血糖(Glu)、血红蛋白(Hb)、血肌酐(Scr)、血尿素氮(BUN)、血钠(Na )、血浆白蛋白(Alb)、总胆固醇(TC)、甘油三酯(TG),计算干体重、透析间期体重增长率、超滤量、超滤率的变化.结果:低血压组首次血透时Scr、BUN高于对照组,Ccr明显低于对照组(P＜0.05);透析间期体重增长率(透析间期体重/干体重)、超滤量、超滤率均高于对照组(P＜0.05);透析期间空腹血糖Glu高于对照组(P＜0.05);Hb、Na 低于对照组(P＜0.05),而长期透析患者Scr、BUN、TG、TC之间无统计学差异(P＞0.05).结论:老年糖尿病肾病透析性低血压与首次血透时肾功能、透析间期体重增长率、超滤量、超滤率、高血糖、营养不良、贫血、血钠浓度等有关,应综合防治.     

糖尿病肾病血液透析病人的护理

目的:探讨糖尿病终末期肾病(DN)患者在维持性血液透析中的特殊护理.方法:对糖尿病终末期肾病患者在维持性血液透析中进行心理、饮食、专科特殊护理.结果:以糖尿病为原发病的终末期肾衰患者患心脑血管疾病和感染性疾病发生率较高,其中脑出血死亡3例,心肌梗塞1例.继续维持性血液透析22例.结论:以糖尿病为原发病的终末期肾衰发病率逐年上升,其死亡率明显高于非糖尿病患者,因此,如何提高糖尿病肾病患者的透析质量,减少透析并发症,提高其生存率,是糖尿患者血良透析护理工作的难点及重点.     

Increased urinary excretion of monocyte chemoattractant protein-1 in proteinuric renal diseases

Monocyte chemoattractant protein-1 (MCP-1) is a chemokine that is produced mainly by tubular epithelial cells in kidney and contributes to renal interstitial inflammation and fibrosis. More recently, we have demonstrated that urinary MCP-1 excretion is increased in proportion to the degree of albuminuria (proteinuria) and positively correlated with urinary N-acetylglucosaminidase (NAG) levels in type 2 diabetic patients. Based on these findings, we have suggested that heavy proteinuria, itself, probably aggravates renal tubular damage and accelerates the disease progression in diabetic nephropathy by increasing the MCP-1 expression in renal tubuli. In the present study, to evaluate whether urinary MCP-1 excretion is increased in the proteinuric states not only in diabetic nephropathy but also in other renal diseases, we examined urinary MCP-1 levels in IgA nephropathy patients with macroalbuminuria (IgAN group; n = 6), and compared the results with the data obtained from type 2 diabetic patients with overt diabetic nephropathy (DN group; n = 23) and those without diabetic nephropathy (non-DN group; n = 27). Urinary MCP-1 excretion levels in non-DN, DN, IgAN groups were 157.2 (52.8-378.5), 346.1 (147.0-1276.7), and 274.4 (162.2-994.5) ng/g creatinine, median (range), respectively. Expectedly, urinary MCP-1 and NAG excretion levels in DN and IgAN groups were significantly elevated as compared with non-DN group. Therefore, we suggest that MCP-1 expression in renal tubuli is enhanced in proteinuric states,irrespective of the types of renal disease, and that increased MCP-1 expression probably contributes to renal tubular damage in proteinuric states.     

西藏地区糖尿病肾病临床特点分析

目的 分析西藏地区2型糖尿病肾病(DN)的临床特点。 方法 回顾分析2001年5月至2006年10月间在我科住院的306例2型糖尿病（DM）患者的临床资料。 结果 306例DM患者包括151例DN和155例非DN患者，根据尿白蛋白及Scr水平，DN组患者再分为微量白蛋白尿组、临床蛋白尿组和肾功能不全组。DN组尿微量白蛋白、Scr和血、尿β2微球蛋白(MG)均较非DN组显著增高（均P < 0.01）；且尿微量白蛋白与收缩压、血β2-MG呈正相关（r = 0.187， P < 0.05； r = 0.297， P < 0.01），而与GFR呈负相关（r = －0.287，P < 0.01）。DN组高血压发生率高（60.27％），血压显著高于非DN组（P < 0.01），且以收缩压更显著。DN组发生尿毒症者14例（9.27％），死亡8例（5.30％），其中5例死于尿毒症；并发糖尿病视网膜病变20例(13.25%)；发生心脑血管意外者6例(3.97%)。 结论 西藏地区2型糖尿病肾病早期即有明显的蛋白尿、血压及血、尿β2-MG增高，后期GFR急剧下降且并发症多而严重。     

Effect of age, gender, and diabetes on excess death in end-stage renal failure

Life expectancy is short in elderly individuals with end-stage renal failure (ESRF). This study aimed to compare mortality in patients with ESRF versus the general population (GP) to assess the evolution of excess mortality by age, gender, nephropathy, and dialysis modality after first dialysis. All incident adult dialysis patients from January 1,1999, to December 31, 2003, who lived in Rh?ne-Alpes Region (France) were included and followed up to death or December 31, 2005. Standardized mortality ratios (SMR) in comparison with GP were computed in the first to the fifth years after first dialysis. In the whole cohort (3025 incident patients), SMR decreased during these 5 yr from 7.4 to 5.2 (P = 0.002). In the 18- to 44-, 45- to 64-, 65- to 74-, 75- to 84-, and > or =85-yr-old groups, SMR decreased from 26.7 to 6.2 (P = 0.01), from 12.8 to 8.1 (P = 0.03), from 8.6 to 5.6 (P = 0.051), from 7.1 to 4.5 (P = 0.02), and from 3.5 to 1.2 (P = 0.14), respectively. Among age categories, differences were significant in the first 3 yr (P < 0.05). SMR were higher 1.5-fold in women than in men in the first 4 yr (P < 0.05). In patients with diabetic nephropathy (DN), SMR increased during the first 3 yr (P = 0.045) and were higher than in patients without DN in the second, third, and fourth years (P < 0.05). SMR were higher in the peritoneal dialysis than in the hemodialysis group in the fourth year (P < 0.01). Patients with ESRF have a high excess mortality compared with the GP. Older patients with ESRF experienced less excess mortality. ESRF cancels out women's survival advantage noted in the GP. SMR evolution in patients with DN was different from that in patients without DN.     

Increased Urinary Excretion of Monocyte Chemoattractant Protein-1 in Proteinuric Renal Diseases

Monocyte chemoattractant protein-1 (MCP-1) is a chemokine that is produced mainly by tubular epithelial cells in kidney and contributes to renal interstitial inflammation and fibrosis. More recently, we have demonstrated that urinary MCP-1 excretion is increased in proportion to the degree of albuminuria (proteinuria) and positively correlated with urinary N-acetylglucosaminidase (NAG) levels in type 2 diabetic patients. Based on these findings, we have suggested that heavy proteinuria, itself, probably aggravates renal tubular damage and accelerates the disease progression in diabetic nephropathy by increasing the MCP-1 expression in renal tubuli. In the present study, to evaluate whether urinary MCP-1 excretion is increased in the proteinuric states not only in diabetic nephropathy but also in other renal diseases, we examined urinary MCP-1 levels in IgA nephropathy patients with macroalbuminuria (IgAN group; n = 6), and compared the results with the data obtained from type 2 diabetic patients with overt diabetic nephropathy (DN group; n = 23) and those without diabetic nephropathy (non-DN group; n = 27). Urinary MCP-1 excretion levels in non-DN, DN, IgAN groups were 157.2 (52.8–378.5), 346.1 (147.0–1276.7), and 274.4 (162.2–994.5) ng/g creatinine, median (range), respectively. Expectedly, urinary MCP-1 and NAG excretion levels in DN and IgAN groups were significantly elevated as compared with non-DN group. Therefore, we suggest that MCP-1 expression in renal tubuli is enhanced in proteinuric states, irrespective of the types of renal disease, and that increased MCP-1 expression probably contributes to renal tubular damage in proteinuric states.     

Determination of oxidative stress and cellular inflammation in patients with diabetic nephropathy and non-diabetic nephropathy being administered hemodialysis treatment due to chronic renal failure

Objectives: We aimed to evaluate oxidative stress [8-hydroxydeoxyguanosine (8-OHdG), malondialdehyde (MDA)] endothelial damage [asymmetric dimethylarginine (ADMA)] and markers of cellular inflammation [interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), neopterin (NP) and high-sensitivity C-reactive protein (hsCRP)] in patients with diabetic nephropathy (DN) and non-diabetic nephropathy who were being administered hemodialysis treatment because of chronic renal failure. Methods: In determining 8-OHdG, IL-6 and TNF-α levels, Enzyme-Linked Immuno-Sorbent Assay method was used. Serum MDA, ADMA and NP levels were determined by using high performance liquid chromatography (HPLC). And hs-CRP values were measured with nephelometric method. Results: Serum 8-OHdG and MDA levels were found statistically to have increased when compared with those of the control group in patients groups after dialysis. However, serum ADMA and neopterin levels were observed statistically to have decreased when compared with those of the control group in patients groups after dialysis. But, decreases on ADMA and neopterin levels are still much higher than those of control. IL-6 and TNF-α levels were found to have increased when compared with those of control group in patients groups before dialysis. Conclusion: The oxidative stress in patients with DN, who were being treated with hemodialysis due to chronic renal failure, was higher than that of non-DN patients who were being treated with hemodialysis. In contrast with this, inflammation occurring in non-DN patients was found to have been higher than that of in patients with DN.     

糖尿病肾病患者24h动态血压临床特点分析

目的:分析比较由糖尿病(DN)肾病和非糖尿病导致的慢性肾脏病患者的动态血压变化情况,探讨糖尿病肾病患者动态血压变化的特点。方法:选择62例符合慢性肾脏病诊断标准的DN患者,均无肾脏替代治疗。观察其24 h动态血压监测结果,并与152例年龄、性别、肾功能等匹配的非糖尿病的CKD患者的动态血压结果相比较。结果:在对62例DN患者和152例非糖尿病CKD患者动态血压的分析中,我们发现:(1)DN组的24 h平均收缩压、日间平均收缩压、夜间平均收缩压均显著高于非DN组。(2)两组患者血压变异性差异无统计学意义;夜间血压下降率普遍较小,但差异无统计学意义。(3)DN组收缩压负荷均显著高于非DN组。(4)DN组非杓型节律的发生率为90.3%,非DN组为81.6%,两组血压节律类型差异无统计学意义。(5)非DN组和DN组24 h尿蛋白量与夜间收缩压均具有显著正相关。结论:中晚期DN患者收缩压控制较非糖尿病的CKD患者更差,血压非杓型节律现象比较普遍。夜间收缩压与24 h尿蛋白排泄量密切相关。     

糖尿病肾病治疗的循证医学新进展

随着糖尿病(DM)发病率的逐年上升,糖尿病肾病(DN)已成为引起我国乃至全球终末期肾病的一个主要原因,因此其治疗问题也成为临床肾脏病学界的一个重要焦点。近年来,DN治疗的循证医学研究取得了一些新的进展,如合理地控制血糖、血压,调节血脂,降低蛋白尿,保护肾功能等治疗措施的更新,在一定程度上改变了人们以往对DN治疗的认识。对防治DN并发症,延缓DN进展,降低患者心血管疾病及死亡发生率具有重要的临床价值。该文结合文献资料及我们以往的工作对DN治疗循证医学新进展予以综述。     

Improved prognosis in type 1 diabetic patients with nephropathy: a prospective follow-up study

BACKGROUND: In early studies, a median survival time of 5 to 7 years from onset of diabetic nephropathy was observed. Furthermore, end-stage renal disease (ESRD) was the main cause of death. We prospectively assessed the impact of reno- and cardiovascular protective treatment on prognosis in type 1 diabetic patients with diabetic nephropathy. METHODS: We prospectively followed 199 type 1 diabetic patients with diabetic nephropathy and 192 patients with normoalbuminuria for 10 years. Aggressive antihypertensive treatment was initiated in patients with diabetic nephropathy in mid 1980s, whereas statins and aspirin were not prescribed routinely until April 2002. The primary end point was cardiovascular mortality and morbidity. Secondary end points were all-cause mortality and ESRD. RESULTS: During follow-up, 79 patients (40%) with nephropathy reached the primary end point versus 19 (10%) of normoalbuminuric patients, log rank test P < 0.0001. Predictors of the primary end point were: nephropathy (hazard ratio 3.26; 95% confidence interval 1.89 to 5.62), previous event (3.19; 2.04 to 4.97), age (1.27; 1.04 to 1.55), and systolic blood pressure (1.13; 1.03 to 1.24). In the nephropathy group, 60 patients (30%) died; hereof, 25 deaths (42%) were ascribed to cardiovascular causes while 30 patients (50%) with nephropathy died with ESRD. The estimate of median survival time from onset of diabetic nephropathy was 21.7 years, SE 3.3 years. CONCLUSION: The survival of patients with diabetic nephropathy has improved most likely due to aggressive antihypertensive treatment and improved glycaemic control.     

Improved survival in patients with type 1 diabetes mellitus after renal transplantation compared with hemodialysis: a case-control study

BACKGROUND: Diabetes mellitus is the leading cause of renal failure worldwide. The question of which treatment modality-hemodialysis versus renal transplantation-is associated with the lowest risk of cardiovascular morbidity and mortality in the diabetic end-stage renal disease (ESRD) population has not yet been investigated in a controlled trial. METHODS: We therefore conducted a case-control study of patients with ESRD caused by type 1 diabetes mellitus. The case patients were diabetics who received a renal graft between 1978 and 1997, whereas the controls were registered for renal transplantation but stayed on maintenance hemodialysis without ever undergoing transplantation. The groups were matched for age, sex, duration of diabetes, length of hemodialysis (up to the registration), and date of registration for renal transplantation. RESULTS: Kaplan-Meier life table analysis, based on 46 case patients and 46 controls, demonstrated a highly significant (P=0.0001) poorer survival in the control group compared with the case group. Logistic regression showed that hemodialysis was a significant risk factor for death (P=0.0002) and cardiovascular morbidity (P=0.0023). Patients with cardiovascular complications such as coronary artery and peripheral vascular events were significantly more frequent in the control group. Additionally tested risk factors for cardiovascular complications (serum cholesterol, arterial blood pressure, number of antihypertensive drugs, serum calcium, serum phosphate, and glucose control [hemoglobin A(1c)]) showed no significant correlation to survival or morbidity in either group by logistic regression. CONCLUSIONS: Renal transplantation is associated with a significantly improved survival compared with hemodialysis in patients with ESRD caused by type 1 diabetes mellitus. This seems to be a result of a reduced incidence of cardiovascular complications after renal transplantation.     

Long-term outcome after percutaneous transluminal coronary angioplasty in patients with chronic renal failure with and without diabetic nephropathy

OBJECTIVE: Percutaneous transluminal coronary angioplasty (PTCA) in patients on maintenance hemodialysis leads to high rates of restenosis and postinterventional complications. The additional influence of diabetes mellitus on the results of PTCA in patients with diabetic nephropathy and reduced but sufficient renal function has not been investigated before. METHODS: In a retrospective case-control study, 51 patients with reduced renal function were compared to 71 matched controls. Patients with elevated creatinine values were divided in two subgroups: diabetic nephropathy (diabetes, n = 15) and stable renal insufficiency (renal failure, n = 36). RESULTS: The control group had normal renal function (creatinine: 1.0 +/- 0.01) and a mean survival time of 3.6 +/- 0.8 years. Patients with renal failure showed a mean survival time of 2.7 +/- 0.3 years (p < 0.001), creatinine values of 2.0 +/- 0.2 and elevated fibrinogen values of 401 +/- 28 (p < 0.01). Patients with diabetes (creatinine: 2.2 +/- 0.2) had a significantly higher mortality rate with a reduced mean survival time of 1.25 +/- 0.3 years (p < 0.001), postinterventional acute renal failure (n = 2, p < 0.01) and Re-PTCA (n = 2, p < 0.05). DISCUSSION: Patients with reduced but stable renal function showed a higher mortality than comparable patients from the control group. The group of patients with diabetic nephropathy has a poor prognosis after PTCA even though renal function was only moderately reduced.