Drug induced diabetes ppt

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Az előadások a következő témára: "Az idült vesebetegség progressziójának"— Előadás másolata: 1 Az idült vesebetegség progressziójának csökkentése, szövődményeinek kezelése Dr. Dialízisközpont, Győr 2 Az idült vesebetegség progressziójának csökkentése, szövődményeinek kezelése Schneider Károly dr.

BRAUN Am J Kidney Dis. Microalbuminuria is the first clinical sign of diabetic damage to the kidney and is a harbinger of progressive kidney damage. Microalbuminuria also reflects a higher risk for cardiovascular disease.

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Macroalbuminuria denotes significant diabetic nephropathy and will be followed by a decline in glomerular filtration rate GFR. Some patients develop the nephrotic syndrome, which usually heralds progressive renal insufficiency and end-stage renal disease. In diabetic nephropathy studies, where the time of onset of type 2 diabetes is known, these patients follow a time course similar to that seen in patients with type 1 diabetes.

However, the date of onset of type 2 diabetes is often unknown and usually precedes the clinical diagnosis by several years Grundy et al, By the time patients are diagnosed with type 2 diabetes, many have already developed hypertension, signs of nephropathy including microalbuminuria or even macroalbuminuria and cardiovascular disease Mogensen et al, ; The Hypertension in Diabetes Study Group, a; American Diabetes Association, Both the onset of microalbuminuria and the progression of renal disease after the onset of macroalbuminuria are accelerated by hypertension Epstein and Sowers, The majority of patients with type 2 diabetes who have macroalbuminuria also have hypertension Grundy et al, In these patients, control of hypertension slows the decline in GFR.

The main goal of any treatment for patients with type 2 diabetic nephropathy should be to prevent the natural progression from microalbuminuria to drug induced diabetes ppt to end-stage renal disease.


Effective antihypertensive treatment is the best inhibitor of diabetic nephropathy Ravid et al, Since reducing albuminuria delays progression of diabetic nephropathy, this parameter can be used as a benchmark for measuring the efficacy of therapeutic interventions Rossing et al, Note that the high risk of cardiovascular mortality in patients with type 2 diabetes, even early in their disease, may not allow for the development of nephropathy Ismail et al, Et al.

Moreover, oxLDL-induced redistribution and loss of nephrin, an adhesion molecule specific for the glomerular slit diaphragm. Nephrin reduction was preceded by inhibition of nephrin tyrosine phosphorylation and of its association with p85 phosphatidylinositol 3-kinase PI3K.

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Moreover, three different statins, mevastatin, pravastatin, and simvastatin, inhibited in a dose-dependent manner apoptosis and loss of nephrin induced by oxLDL by stimulating Akt activity. In addition, simvastatin significantly increased the expression of nephrin protein and mRNA by podocytes. The protective effects of statins were blocked by treatment of podocytes with two unrelated pharmacologic inhibitors of PI3K, LY and wortmannin, suggesting a role for PI3K, and by mevalonate, indicating dependency on HMG-CoA reductase activity.

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Statins directly stimulated Akt phosphorylation ad activity. Finally, oxLDL induced a retraction of cultured podocytes and an increase in the albumin diffusion across their monolayer that was inhibited by treatment with statins.

In conclusion, statins reduced the oxLDL-induced apoptosis and loss of nephrin in glomerular podocytes. The statin-induced Akt stevia cukorbetegség kezelésére may protect from the loss of nephrin by an inhibition of its redistribution and shedding and by a stimulation of its synthesis.

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These data provide a rationale for the anti-proteinuric effect of statins. The rapid redistribution of nephrin was associated with changes in the cytoskeleton of podocytes, characterized by a reduction of stress fibers and by peripheral accumulation of F-actin in respect to control shown. The significantly different rates of GFR decline in those diets occurred despite 1 assignment to drug induced diabetes ppt same very low protein diet 2 comparable mean achieved protein intake during follow-up and 3 comparable changes in mean protein intake form baseline values.

Thus the composition of the supplement appeared to influence GFR decline independently of the level of protein intake.

Az idült vesebetegség progressziójának

Teschan et al. Clin Nephrol, 50, 24 A vesebetegség progressziójának csökkentésére irányuló kezelés Oki kezelés: immunsuppressiv kezelés, a. Reports suggest that angiotensin-receptor blockers ARBs reduce proteinuria, but results are variable. The relative effect of ARBs and angiotensin-converting enzyme ACE inhibitors, and their combined administration, remains uncertain.

Study Selection: Randomized trials of ARBs versus placebo, ACE inhibitors, calcium-channel blockers, or the combination of ARBs and ACE inhibitors in patients with or without diabetes and with microalbuminuria or proteinuria for whom data were available on urinary protein excretion at baseline and at 1 to drug induced diabetes ppt months.

Data Extraction: Two investigators independently searched and abstracted studies. Data Synthesis: Forty-nine drug induced diabetes ppt involving participants reported results of 72 comparisons with 1 to 4 months of follow-up and 38 comparisons with 5 to 12 months of follow-up.

Cardiovascularis kockázatcsökkentés a diabetológus szemével

The ARBs reduced proteinuria compared with placebo or calcium-channel blockers over 1 to 4 months ratio of means, 0. The antiproteinuric effect was consistent across subgroups. Limitations: Most studies were small, varied in quality, and did not provide reliable data on adverse drug reactions. Proteinuria reduction is only a surrogate for important progression of renal failure.

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Conclusion: The ARBs reduce proteinuria, independent of the degree of proteinuria and of underlying disease. The magnitude of effect is similar regardless of whether the comparator is placebo or calcium-channel blocker. Reduction in proteinuria from ARBs and ACE inhibitors is similar, but their combination is more effective than either drug alone.

Uncertainty concerning adverse effects and outcomes that are important to patients limits applicability of findings to clinical practice. Ann Intern Med. Excessive prepubertal salt intake permanently increases blood pressure BP. We examined the role that the mineralocorticoid receptor MR plays in the salt-induced hypertension and renal damage of prepubertal Dahl salt-sensitive SS rats. Prepubertal 6 weeks old and adult 10 weeks old Dahl SS rats fed a high 8.

The effect of treatment between the ages of 4 and 10 weeks with the MR antagonist eplerenone 0.

Excessive salt intake starting in prepuberty was associated with a higher BP increase and greater proteinuria than if it started in adulthood. Eplerenone moderately reduced BP and markedly improved renal injury during its administration in prepubertal rats.

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These effects continued after drug discontinuation. Hydralazine greatly decreased BP and reduced proteinuria, but these effects were completely lost after drug discontinuation. Eplerenone, but not hydralazine, attenuated these salt-induced inflammatory reactions.

Tempol improved drug induced diabetes ppt hypertension and renal injury, even after its discontinuation. Dahl SS rats exposed to excessive salt in prepubescence show a permanent increase in susceptibility to salt-induced hypertension and proteinuria.

MR activation may promote these effects at least in part by inducing oxidation and inflammation. Kawarazaki H. NDT 1 of 11 33 Sóterhelésének okozta MR aktiváció szelektív gátlásával kivédhető a proteinuria növekedés és kreatinin szint emelkedés MR gátlás — eplerenone-al MR antagonista RR csökkentés — hydralazin direkt asodilatator Antioxidans — tempol superoxid dismutase mimeticum Kawarazaki H.

NDT 1 of 11 34 Különböző korú prepubertas patkányok sóterhelésének hatása a glomerulus, drug induced diabetes ppt és vasculatura szerkezetére Kawarazaki H.

NDT 1 of 11 35 A vesebetegség progressziójának csökkentésére irányuló kezelés Oki kezelés: immunsuppressiv kezelés, a.

Az előadások a következő témára: "Cardiovascularis kockázatcsökkentés a diabetológus szemével"— Előadás másolata: 1 Cardiovascularis kockázatcsökkentés a diabetológus szemével Balatonaliga, május The Verona Diabetes Complications Study showed that, in diabetic and non-diabetic subjects, insulin resistance is associated with several cardiovascular risk factors, including hyperglycaemia, dyslipidaemia and hypertension. The study identified insulin resistance as an independent risk factor for cardiovascular disease. HDL cholesterol concentrations are increased and there is a preponderence of small dense, atherogenic, LDL particles in patients. PAI-1 plasminogen activator inhibitor-1 : PAI-1 is a major regulator of plasminogen activation and plays an important role in blood clotting.

More recently, data suggest that the benefit of statins is greater than lipid lowering alone. The pleiotropic effects of statins may derive from inhibition of other downstream targets isoprenoids of the mevalonic acid pathway that are separate from cholesterol synthesis.

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