scholarly journals Influence of Enalapril on the progression of chronic renal failure in diabetic nephropathy and nephropathies of and other aethiology: A two-year study

2002 ◽  
Vol 130 (3-4) ◽  
pp. 87-90
Author(s):  
Jasna Trbojevic ◽  
Biljana Stojimirovic
Keyword(s):  
Blood Pressure ◽  
Renal Failure ◽  
Diabetic Nephropathy ◽  
Chronic Renal Failure ◽  
Serum Creatinine ◽  
Regression Line ◽  
Diabetic Patients ◽  
Protein Levels ◽  
Arterial Blood ◽  
The Difference

Chronic renal failure (CRF) is almost always associated with high arterial blood pressure. Adequate control of hypertension slows down the progression of the disease, Inhibitors of angiotenzin-converting enzyme (ACE inhibitors) have proved to be very efficacious in decreasing high blood pressure. The aim of this study was to assess the influence of ACE inhibitor enalapril on the progression of CRF in patients with diabetic nephropathy and nephropathies of other origin. During 1998 and 1999 thirty patients (20 males and 10 females, aged 525+1.3) have been followed-up at the Department of Nephrology, Clinical Centre of Serbia. On regular monthly controls serum creatinine, urea, calcium and protein levels, creatinine clearance, and blood pressure, were measured. All patients were suggested a low protein diet. Progression of the disease was expressed by the slope of the regression line showing reciprocal serum creatinine values. Proteinaemia was significantly higher in diabetic patients after 12 months (p<0.35) but in the next 12 months the difference between groups disappeared. The same patients had significantly lower serum urea (p<0.05) after 24 months and creatinine values (p<0.05) dur ing the whole study. Other variables changed in the same manner and with similar progression in both groups. The direction of slope lines suggested recovery of kidney function in both examined groups. However, a smaller slope in patients with diabetic nephropathy together with other results showed that enalapril had better influence on slowing down the progression of CRF in this group of patients.

The role of ramipril in the therapy of diabetic nephropathy

2014 ◽  
Vol 155 (7) ◽  
pp. 263-269 ◽  
Author(s):  
Csaba András Dézsi
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Renal Failure ◽  
Diabetic Nephropathy ◽  
Animal Experiments ◽  
International Diabetes Federation ◽  
Diabetic Patients ◽  
Converting Enzyme Inhibitors ◽  
Efficient Treatment

In the past two decades the number of diabetic patients has increased dramatically. According to the data of the International Diabetes Federation published in 2012, more than 371 million people suffer from diabetes mellitus, which is responsible for the death of 4.8 million people yearly. Diabetic nephropathy is the most frequent cause of terminal renal failure. The first stage of its development is microalbuminuria. Without an efficient treatment 20–40% of the patients with microalbuminuria suffering from type 2 diabetes mellitus develop chronic renal failure, but only 20% of them become uremic because most of them die beforehand mainly due to cardiovascular disease. The renin-angiotensin-system, which is one of the most important elements of the regulation of blood pressure and water-salt metabolism, plays an important role in the development of diabetic nephropathy. Drugs affecting the function of this system are of great significance in the treatment of hypertension. The author rewiews the results of several important studies and animal experiments to demonstrate the role of ramipril in the therapy of diabetic nephropathy. The author concludes that ramipril is one of the angiotensin-converting enzyme inhibitors with the highest number of evidence based beneficial results. Apart from its blood pressure decreasing effect, ramipril protects target organs and it proved to be effective in the treatment of diabetic nephropathy according to most international multicenter clinical trials. Orv. Hetil., 2014, 155(7), 263–269.

scholarly journals Genetics of diabetic nephropathy.

1996 ◽  
Vol 7 (12) ◽  
pp. 2509-2517
Author(s):  
H H Parving ◽  
L Tarnow ◽  
P Rossing
Keyword(s):  
Blood Pressure ◽  
Diabetic Nephropathy ◽  
Dependent Diabetes Mellitus ◽  
Minor Role ◽  
Diabetic Patients ◽  
Converting Enzyme ◽  
Deletion Polymorphism ◽  
Blood Pressure Elevation ◽  
Arterial Blood ◽  
Increased Risk

Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria, a relentless decline in GFR, raised arterial blood pressure, and increased relative mortality for cardiovascular diseases. Diabetic nephropathy is a leading cause of end-stage renal failure. The pathogenesis of diabetic nephropathy is multifactorial, with contributions from metabolic abnormalities, hemodynamic alterations, and various growth factors and genetic factors. Epidemiologic and family studies have demonstrated that only a subset of the patients develop this complication that family clustering of nephropathy is present, and that ethnicity plays an important role in the risk of developing this kidney disease. Short stature and low birth weight are both associated with increased risk of developing diabetic nephropathy, supporting the hypothesis that genetic predisposition or factors operating in utero, in early childhood, or both contribute to the development of diabetic nephropathy. Studies elucidating phenotypic markers such as parenteral hypertension and systemic blood pressure elevation have yielded conflicting results. The contribution from elevated blood pressure only plays a minor role in the majority of the patients developing diabetic nephropathy. The majority of the studies have demonstrated increased sodium/lithium countertransport activity in insulin-dependent diabetes mellitus patients with nephropathy, whereas studies of this phenotypic marker in parents of patients with and without nephropathy have yielded conflicting results. Recently, studies of genetic markers involved in the regulation of blood pressure and levels of cardiovascular risk factors have been conducted. Several studies have demonstrated that the deletion polymorphism in the angiotensin-I-converting enzyme acts as a risk factor for cardiovascular disease in diabetic patients. However, a meta-analysis does not support the suggestion that this factor plays any role for the initiation of diabetic nephropathy. Similar negative results have been obtained in relation to polymorphisms of the genes encoding for angiotensinogen and the angiotensin II Type 1 receptor. However, studies in diabetic and non-diabetic glomerulopathies have clearly demonstrated a deleterious effect of the deletion polymorphism in the angiotensin-converting enzyme on the progression of kidney function.

scholarly journals Seasonal variation of blood pressure in maintenance hemodialysis

1998 ◽  
Vol 116 (4) ◽  
pp. 1774-1777 ◽  
Author(s):  
Manuel Carlos Martins de Castro ◽  
Décio Mion Jr. ◽  
Marcello Marcondes ◽  
Emil Sabbaga
Keyword(s):  
Blood Pressure ◽  
Renal Failure ◽  
Seasonal Variation ◽  
Chronic Renal Failure ◽  
Ambient Temperature ◽  
Sao Paulo ◽  
São Paulo ◽  
Dialysis Unit ◽  
Arterial Blood ◽  
The Impact

CONTEXT: Seasonal variation in arterial blood pressure has been reported in studies with hypertensive and normotensive subjects. However, the influence of seasonal change on blood pressure of hemodialysis patients has not been reported. OBJECTIVE: To investigate the seasonal variation of blood pressure in Brazil, a tropical country, in patients on hemodialysis. DESIGN: Prospective, cohort study. SETTING: Dialysis unit of a tertiary medical center (a teaching hospital of the University of São Paulo School of Medicine, São Paulo). PATIENTS: Sixteen patients with chronic renal failure undergoing hemodialysis. OUTCOMES: Blood pressure, body weight, and ambient temperature were evaluated during 6 hemodialysis sessions carried out on 13 days during the four seasons. RESULTS: The diastolic blood pressure was lower in summer than in fall and winter (95 ± 8 vs 107 ± 10 and 101 ± 10 mmHg, respectively; p < 0.05). The same was observed with mean blood pressure (116 ± 8 vs 130 ± 11 and 124 ± 9 mmHg, respectively; p < 0.01). On the other hand, the ambient temperature was higher in summer than in fall and winter (23.0 ± 1.6 vs 19.5 ± 3.0 and 15.8 ± 1.9 ºC, respectively; p < 0.01). CONCLUSIONS: We concluded that for patients with chronic renal failure the blood pressure has a seasonal variation with higher pressures in fall and winter than in summer. Thus, further studies are needed to elucidate the impact of this observation on the adjustment of antihypertensive treatment and on morbidity and mortality in maintenance dialysis patients.

Effect of Isoosmolar volume Reduction during Hemofiltration on Plasma Antidiuretic Hormone in Patients with Chronic Renal Failure

1980 ◽  
Vol 3 (6) ◽  
pp. 322-325 ◽  
Author(s):  
N.D. Vaziri ◽  
R. Skowsky ◽  
A. Warner
Keyword(s):  
Blood Pressure ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Volume Reduction ◽  
Fluid Loss ◽  
Fluid Removal ◽  
Arterial Blood ◽  
Clear Explanation ◽  
Stage Renal Disease ◽  
End Stage

The effect of isoosmolar volume reduction on plasma ADH level was studied in 8 patients with chronic renal failure utilizing hemofiltration technique. Plasma ADH fell significantly (P < 0.001) after one hour of hemofiltration despite volume reduction which was expected to elevate the ADH level. After two hours of hemofiltration, ADH remained low in 5 patients and increased in 3. Posthemofiltration mean blood pressure was generally lower in patients whose ADH rose than those whose ADH remained low. The two groups were otherwise comparable with respect to total fluid loss, hemofiltration rate, and fluid removed expressed as percent body weight. It can thus be suggested that in these patients a rise in plasma ADH in response to fluid reduction may require a fall in the arterial blood pressure below a critical level. While the rise in plasma ADH observed with continued fluid removal in some patients can be readily explained, we have no clear explanation for the paradoxical initial fall of ADH in all patients and subsequent maintenance of low levels observed in the majority of patients. This unusual ADH response to isoosmolar volume reduction may represent some unidentified mechanism of ADH regulation in patients with end-stage renal disease.

scholarly journals Pediatric renal allograft transplantation does not normalize the increased cortisol/cortisone ratios of chronic renal failure

2006 ◽  
Vol 154 (4) ◽  
pp. 555-561 ◽  
Author(s):  
Michael Schroth ◽  
Christian Plank ◽  
Manfred Rauh ◽  
Helmuth-Günther Dörr ◽  
Wolfgang Rascher ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Blood Pressure ◽  
Renal Failure ◽  
Renal Transplantation ◽  
Chronic Renal Failure ◽  
Tandem Mass Spectrometry ◽  
Renal Allograft ◽  
Tandem Mass ◽  
Allograft Transplantation ◽  
Arterial Blood

Objective: The conversion of cortisol (F) to cortisone (E) is catalyzed by 11beta-hydroxysteroid dehydrogenase type 2 (11β-HSD2). Children suffering from chronic renal failure (CRF) have a decreased activity of 11β-HSD2 contributing to increased arterial blood pressure. The objective was to investigate whether a normal conversion of F to E is achieved after renal transplantation (TX) in children. Methods: Fifteen children with CRF, 17 children with steroid-free immunosuppression after TX, and 18 healthy controls (CO) were enrolled. The activity of 11β-HSD2 in plasma was calculated using the ratio of F/E determined by tandem mass spectrometry, the ratio of tetrahydrocortisol (THF) +5α-tetrahydrocortisol (5αTHF) in urine determined by gas chromatography/mass spectrometry, and the ratio of (THF +5αTHF)/tetrahydrocortisone (THE) in urine determined by tandem mass spectrometry. Results: The F/E ratio (mean ± s.d./s.e.m.) was significantly higher in CRF and TX (5.6 ± 1.9/0.6, 7.12 ± 3.1/0.9) than in CO (1.18 ± 0.2/0.03, P < 0.0001) groups. The (THF + 5αTHF)/THE ratio in CRF (1.19 ± 1.1/0.5) and TX (1.19 ± 0.1/0.5) groups was significantly higher than in controls (0.21 ± 0.05/0.18, P < 0.0001). Positive correlations between plasma and urinary ratios (P = 0.0004. R2 = 0.73 in CRF, P = 0.0013, R2 = 0.56 in TX, P < 0.0001, R2 = 0.66 in CO) were found, whereas significant correlations between F/E or (THF + 5αTHF)/THE ratios and blood pressure, the number of antihypertensive drugs taken or creatinine clearance could not be found. Conclusions: In all children with chronic renal failure plasma and urinary cortisol/cortisone ratios are elevated and do not return to normal levels after renal allograft transplantation. This suggests that renal transplantation does not normalize 11β-HSD2 activity.

Effect of haemodialysis on plasma levels of brain natriuretic peptide in patients with chronic renal failure

1992 ◽  
Vol 82 (2) ◽  
pp. 127-131 ◽  
Author(s):  
Chim C. Lang ◽  
Anna Maria ◽  
J. Choy ◽  
Iain S. Henderson ◽  
Wendy J. Coutie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Serum Creatinine ◽  
Brain Natriuretic Peptide ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Natriuretic Peptide ◽  
Before And After ◽  
Healthy Control

1. Plasma human brain natriuretic peptide-like immunoreactivity (hBNP-li) was measured in ten patients with chronic renal failure before and after 4 h of haemodialysis. 2. Plasma hBNP-li was elevated in all patients before dialysis (mean ± sem 21.0 ± 3.8 pmol/l) compared with healthy control subjects (1.3 ± 0.2 pmol/l, n = 11), but showed considerable inter-patient variability. Before dialysis plasma hBNP-li bore no relationship to the serum creatinine level or to the mean blood pressure. 3. Plasma hBNP-li fell significantly (P = 0.04) during 4 h of haemodialysis. The fall in plasma hBNP-li correlated significantly with the degree of postural blood pressure drop (r2 = 0.44, P = 0.05) and with the fall in body weight (r2 = 0.64, P<0.01) after haemodialysis. In all patients, plasma hBNP-li at the end of treatment remained above that in healthy subjects. 4. There was no significant correlation between the fall in plasma hBNP-li and the fall in serum creatinine level, and between the fall in plasma hBNP-li and the fall in supine systolic or diastolic blood pressure, during haemodialysis. 5. We have shown that plasma hBNP-li is elevated in patients with chronic renal failure and is decreased during haemodialysis. The fact that the plasma hBNP-li was not reduced to normal by haemodialysis despite restoration to normovolaemia gives tentative support to the view that, in addition to hypervolaemia, another factor may also be responsible for the elevated plasma hBNP-li seen in these patients.

scholarly journals Effect of sanhuanghuoxue decoction on the treatment of chronic renal failure

2016 ◽  
Vol 11 ◽  
pp. S131-S135
Author(s):  
Qiang Wu ◽  
Pu Wang ◽  
Changhong Wang ◽  
Xiangrong Liu ◽  
Xue Zhang
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Serum Creatinine ◽  
Control Group ◽  
Rat Models ◽  
The Difference

The aim of this study was to investigate the efficacy of sanhuanghuoxue decoction in the treatment of chronic renal failure by examining the changes in serum creatinine and blood urine nitrogen using rat models. Compared with the control group, which was treated by coated aldehyde oxystarch, the group treated by sanhuanghuoxue showed remarkable decrease in serum creatinine and blood urine nitrogen. The difference was found statistically significant. 

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