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At least 19 recordsLinked to original sources
PubMed1988

Renal failure in diabetics in the UK: deficient provision of care in 1985. Joint Working Party on Diabetic Renal Failure of the British Diabetic Association, the Renal Association, and the Research Unit of the Royal College of Physicians.

Two surveys of diabetic renal failure were conducted in 1985. The first survey was designed to identify all diabetic patients having advanced renal failure (serum creatinine greater than 500 mumol/l and/or blood urea greater than 25 mmol/l in six selected health regions of the UK. The study identified 181 such patients indicating that approximately 10 people in every million of the population were affected. It is calculated that there were about 580 patients having diabetic renal failure in the whole of the UK. The majority of the patients (78%) were considered by their physicians to be suitable for renal support treatment. Those who were excluded were considered unsuitable chiefly on account of old age or cardiac problems. In the second survey all 66 renal units in the UK reported the number of diabetic patients starting renal support treatment in 1985. There were 273 patients, suggesting that there may be a shortfall when compared with the number of diabetics likely to need treatment. The Working Party recommends that diabetics who develop renal failure should always be considered for treatment by dialysis or transplantation, and that appropriate resources should be made available for them.

Adult↗
PubMed1983

Predictors of renal function in diabetic and non-diabetic renal disease.

Forty-two patients with renal disease due to diabetic nephropathy (14 patients), tubulointerstitial disease (14 patients) and glomerular disease (14 patients) underwent measurement of glomerular filtration rate (GFR) by the 51Cr-EDTA 'one-shot' method and simultaneous serum beta 2-microglobulin, serum creatinine and creatinine clearance estimation. Serum creatinine was a significantly better predictor of GFR than serum beta 2-microglobulin in patients with diabetic nephropathy, whereas both methods were equally useful predictors of GFR in non-diabetic renal disease. Serum creatinine measurement remains the best method for detecting early reduction of GFR on a serum sample.

Adult↗
PubMed1989

Treatment of and mortality from diabetic renal failure in patients identified in the 1985 United Kingdom survey. Joint Working Party on Diabetic Renal Failure of the British Diabetic Association, Renal Association, and the Research Unit of the Royal College of Physicians.

The aim of the study was to determine the outcome in 181 diabetic patients with advanced, previously untreated renal impairment who had been identified in a survey conducted in six health regions in the United Kingdom in 1985. Late in 1987 questionnaires were sent to the consultant physicians, geriatricians, and nephrologists who had reported on the 181 patients, asking whether the patient had started receiving dialysis, had received a transplant, or had died. In all, 176 of the patients were traced, 164 having either died or received renal support treatment by the end of 1986. Nearly two thirds (107) of the patients received renal support treatment, which was renal transplantation in five and dialysis in 102. This is an increase on previous years. A third of the patients (57) died without having received renal support treatment. In 15 patients death was unavoidable and mainly from acute myocardial infarction (10 patients), but 28 patients (half of those who died untreated) died from renal failure, sometimes with fluid retention that was ascribed to heart failure (18 patients). Most of the patients would have benefited from renal support treatment. This neglect should no longer occur.

Adult↗
PubMed2002

Prevalence of non-diabetic renal disease in type 2 diabetic patients in a diabetes centre in Southern India.

OBJECTIVE: The Aim of Study is to determine the prevalence of non-diabetic renal disease among South Indian type 2 diabetic subjects based on renal biopsy. METHODS: Three thousand five hundred and ninety subjects with complete records were included for the study. One hundred and forty subjects who had proteinuria but no evidence of retinopathy undertook a 24 hour proteinuric estimation. Of these 140 subjects, 28 subjects had proteinuria > 1,000 mg/day and were subjected to renal imaging. Seven subjects were excluded due to renal calculi, cysts or contracted kidneys. Of the remaining 21 diabetic subjects, one subject was excluded as he had a mild diabetic retinopathy on fundus fluorescein angiography. Of the 20 subjects included 18 participated in the renal biopsy study (response rate--90%). Renal pathology of these subjects were studied. RESULTS: Of the 18 renal biopsies, two were excluded due to different reasons. Out of 16 patients, eight (50%) had pathological changes suggestive of diabetic etiology, five (33.3%) had classical membranous nephropathy, one (6.2%) had tubulo-interstitial disease and two (12.5%) were categorized as others with minimal changes. The subjects with non-diabetic renal disease had significantly higher creatinine clearance (p = 0.024), serum cholesterol (p = 0.036), triglyceride levels (p = 0.045) and LDL cholesterol (p = 0.048) compared to subjects with diabetic nephropathy. CONCLUSION: This study suggests that even in subjects clinically suspected to have non-diabetic renal disease many may turn out to have diabetic nephropathy on renal biopsy.

Adult↗
PubMed1989

Diabetic renal disease in Pima Indians.

Diabetic renal disease is a major source of morbidity and mortality in Pima Indians. Excess mortality in NIDDM occurs principally in those with proteinuria regardless of whether death is due to cardiovascular or renal disease. Diabetes duration is a strong predictor of diabetic renal disease. Additional predictors include blood pressure, severity of diabetes, and, most likely, genetic or shared environmental determinants. The incidence rate of diabetic renal disease in Pima Indians with NIDDM is similar to that reported for subjects with IDDM with equivalent durations of diabetes. These observations suggest that clinical proteinuria and renal failure may occur in patients with NIDDM just as frequently as in those with IDDM. This finding has important implications and suggests that the variations in the frequency and age of onset of NIDDM among different populations and ethnic groups may be primarily responsible for the apparent variations in the frequency of ESRD associated with diabetes in different populations. Furthermore, diabetic renal disease appears to account for virtually all of the excess mortality associated with diabetes among Pima Indians and may perhaps do so in other populations. Improved survival of persons with NIDDM, an increasing incidence of this disease, and a relatively early age of onset in many populations could lead to a dramatic increase in the incidence of ESRD in the future. On the other hand, if diabetic renal disease and its consequences could be prevented, a profound improvement in the longevity and quality of life of those afflicted with diabetes might be possible.

Albuminuria↗
PubMed1991

Diabetic renal disease in type 1 diabetes: aetiology and prevention.

Diabetic renal disease affects a subset of about 35% of patients with Type 1 diabetes and is characterized by a triad comprising increased albuminuria, arterial pressure, and volume fraction of the mesangium. This leads to a decline in the glomerular filtration rate and ultimately end-stage renal failure or premature cardiovascular mortality. Individuals at risk can be detected before the development of persistent proteinuria by screening for microalbuminuria which has proved predictive of clinical nephropathy in about 80% of cases. Microalbuminuria is often accompanied by subclinical increases in arterial blood pressure and plasma lipid levels and is usually not apparent until 5 years after stabilization of newly diagnosed diabetes. This latter finding suggests that microalbuminuria is an indicator of early disease rather than a marker of susceptibility to it. Recent evidence suggests that diabetic renal disease may be linked to a familial, possibly genetically determined, predisposition to arterial hypertension or to some factor closely related to the risk of hypertension. This underlying predisposition may be one of the mechanisms leading to severe glomerular damage and may help to explain why clinical renal disease only occurs in a subset of diabetic patients. A number of therapeutic interventions, ranging from strict blood glucose control to low-protein diet and angiotensin-converting enzyme inhibition are effective in reducing or preventing further increases in microalbuminuria. If current long-term trials confirm that treatment of microalbuminuric diabetic patients prevents the onset of heavier persistent proteinuria secondary prevention of diabetic renal failure may become possible. The current criteria for diagnosis of diabetic nephropathy will then require revision.

Albuminuria↗
PubMed1997

Diabetic nephropathy: an observational study on patients attending a joint diabetes renal clinic.

Diabetic nephropathy is a major cause of renal failure, accounting for 20% of patients starting dialysis. In clinical trials, effective blood-pressure control, especially by angiotensin-converting-enzyme inhibitors (ACEIs), retards the rate of progression of renal failure substantially. We examined these effects in clinical practice by surveying patients at a joint diabetes renal clinic at Glasgow Royal Infirmary from 1989 to 1995. We examined the relationship between progression of diabetic nephropathy, mean arterial pressure (MAP), and the use of ACEIs. The average MAP of the whole group of patients fell by 7%, the urine albumin:creatinine ratio fell by 29%, and the rate of progression as measured by the slope of reciprocal of serum creatinine with time (l/mumol/day) was slowed, from -4.59 to -2.76. This is equal to delaying the necessity for dialysis by about 2 years. The joint clinic met its aim and was cost-effective.

Albuminuria↗
PubMed2001

Projected number of diabetic renal disease patients among insulin-dependent diabetes mellitus children in Japan using a Markov model with probabilistic sensitivity analysis.

BACKGROUND: To plan prevention programmes for the diabetic renal disease among insulin-dependent diabetes mellitus (IDDM) children, projections of future trends for the disease is crucial. We projected future trends in the number of diabetic renal disease patients among IDDM children and assessed an impact of treatment dissemination in Japan. METHODS: We used a Markov model to describe the clinical courses of diabetic renal disease. Future trends in the number of patients with diabetic nephropathy (DN) and end-stage renal disease (ESRD) were projected from the year 1995 to 2015. We made three scenarios for assessing an impact of the dissemination of new treatment. We performed a probabilistic sensitivity analysis for the uncertainty of transition probabilities. RESULTS: The results showed that the number of patients with DN was 790.5 (5th to 95th percentile: 652.5-955.1), ESRD was 253.3 (5th to 95th percentile: 207.3-310.0) in year 2015 on basic scenario. Considering the dissemination of intensive insulin therapy, under the scenario of the gradual increase of the treatment, the result showed that the number of patients with DN was 713.1 (5th to 95th percentile: 546.2-930.6), ESRD was 231.0 (5th to 95th percentile: 176.6-296.2). Under the scenario of the immediate change of the treatment, the results showed that the number of patients with DN in 2015 was 418.9 (5th percentile; 345.4; 95th percentile; 506.1) and with ESRD was 133.4 (5th percentile; 109.0; 95th percentile; 163.8). CONCLUSIONS: The results of the projection showed a gradual increase in the number of patients with DMN and ESRD. Examination of three possible scenarios showed that the programme of dissemination of intensive insulin therapy prevented the progression of diabetic renal disease.

Adolescent↗