Diabetic nephropathy and arterial hypertension

Parving, Hans‐Henrik; Andersen, Andreas; Smidt, Ulla M; Oxenbøll, B; Edsberg, Berit; Christiansen, John

doi:10.1007/bf00275939

Cited by 149 publications

(50 citation statements)

References 13 publications

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“…17 We also noted a high frequency of significantly elevated blood pressure in persons with juvenile-onset type I diabetes at the time of diagnosis of diabetic nephropathy when the serum creatinine was still normal. This confirms the findings of Parving et al , 10 who found a similar blood pressure of 146/96 mm Hg in type I diabetic patients with persistent proteinuria and normal serum creatinine.…”

Section: Discussionsupporting

confidence: 92%

“…6 " 9 Generally, hypertension has been acknowledged to be a late symptom of diabetic nephropathy, but it was recently demonstrated that elevated blood pressure is also present in patients during early stages of nephropathy, that is, normal level of serum creatinine. 10 It has also been shown that elevated arterial blood pressure has an enormous impact on the progression of diabetic nephropathy.…”

mentioning

confidence: 99%

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Hypertension in diabetes as related to nephropathy. Early blood pressure changes.

Feldt‐Rasmussen¹,

Borch‐Johnsen²,

Mathiesen³

1985

Hypertension

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SUMMARY We measured the blood pressure under standardized conditions in three groups of patients with type I (insulin-dependent) diabetes: group 1, patients with Albustix-negative urine and normal urinary albumin excretion rate below 20 /xg/min; group 2, patients with Albustix-negative urine and elevated urinary albumin excretion rate 20 to 200 /xg/min; and group 3, patients with Albustix-positive urine at the time of diagnosis of diabetic nephropathy, that is, proteinuria greater than 0.5 g/24 hr on four consecutive visits with an interval of more than 1 month. We also studied blood pressure data at the time of diagnosis of diabetes in patients with type I diabetes who later died with severe nephropathy (n = 84), and in those who survived their disease for more than 40 years (n = 256). Patients subsequently developing diabetic nephropathy could not be identified on the basis of systolic and/or diastolic blood pressure during the first 2 to 10 years of diabetes. Our study also demonstrated that the blood pressure in group 3 (147/93 mm Hg) was significantly higher than that in group 2 (135/86 mm Hg), which again was higher than that in group 1 (128/79 mm Hg). We concluded that arterial hypertension is an early feature in the developing of diabetic nephropathy, with blood pressure rising before the presence of clinical proteinuria. (Hypertension 7 [Suppl II]: II-18-H-20, 1985) KEY WORDS • type I diabetes * urinary albumin excretion rate * blood pressure D IABETIC nephropathy is the most serious complication of type I (insulin-dependent) diabetes mellitus (IDDM), 1 with a grave prognosis after the onset of proteinuria. "5 It is characterized by glomerular arteriolohyalinosis, glomerulosclerosis, persistent proteinuria, decreasing glomerular filtration rate (GFR), and increasing blood pressure. The etiology of diabetic nephropathy is unknown, and the role of arterial blood pressure in the pathogenesis of clinical nephropathy has been discussed.

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

Hypertension in diabetes as related to nephropathy. Early blood pressure changes.

Feldt‐Rasmussen¹,

Borch‐Johnsen²,

Mathiesen³

1985

Hypertension

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show abstract

“…However, recent data suggest that mild or subclinical hypertension may play an important role in accelerating the progression to renal failure in patients with diabetes. Blood pressure is frequently elevated in IDDM patients with proteinuria before the appearance of clinically overt deterioration in renal function (26,27). Even in patients with microalbuminuria, blood pressure is related to the degree of urinary protein excretion (28).…”

Section: Natural History and Complicationsmentioning

confidence: 99%

Etiology and Prevalence of Hypertension in Diabetic Patients

Simonson

1988

Diabetes Care

127

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Data from several epidemiologic studies have suggested that the prevalence of hypertension in patients with diabetes mellitus is -1.5-2.0 times greater than in an appropriately matched nondiabetic population. In patients with insulin-dependent diabetes mellitus (IDDM), hypertension is generally not present at the time of diagnosis. As renal insufficiency develops, blood pressure rises and may exacerbate the progression to end-stage renal failure. In non-insulin-dependent diabetes mellitus (NIDDM), many patients are hypertensive at the time of diagnosis. The incidence of hypertension in NIDDM is related to the degree of obesity, advanced age, and extensive atherosclerosis that is typically present, and it probably includes many patients with essential hypertension. Several other pathophysiologic mechanisms also contribute to the genesis and maintenance of hypertension in the patient with diabetes. Hyperglycemia and increases in totalbody exchangeable sodium may lead to extracellular fluid accumulation and expansion of the plasma volume. In some patients, alterations in the function of the renin-angiotensin-aldosterone system and vascular sensitivity to vasoactive hormones may also play a role. It has recently been suggested that hyperinsulinemia and insulin resistance may also contribute to the maintenance of an elevated blood pressure because insulin is known to promote sodium retention and enhance sympathetic nervous system activity. The evidence for these hypotheses and their respective contributions to the etiology of hypertension in IDDM and NIDDM are discussed. Diabetes Care 11:821-27, 1988

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“…Em um estudo epidemiológico multicêntrico realizado com indivíduos não diabéticos (38), foi evidenciado que os pacientes com microalbu - Não houve diferença significativa, em nosso estudo, em relação aos níveis tanto da PAS como da PAD. São muitos os dados na literatura em relação à associação da PA sistêmica e microalbuminúria e, apesar de um grande número de estudos ter demonstrado essa associação, principalmente com a PAS (13,22,28,(39)(40)(41)(42), outros estudos não observaram este fato, sugerindo que técnicas mais elaboradas e exatas para aferição da pressão arterial, como a monitorização ambulatorial da pressão arterial, talvez se façam necessárias para melhor acurácia no diagnóstico da hipertensão no paciente diabético (28,43).…”

Section: Microalbuminúria Em Pacientes Com Dm1unclassified

Microalbuminúria em pacientes diabéticos tipo 1: prevalência e fatores associados

Piccirillo

Cunha

Gonçalves

et al. 2002

Arq Bras Endocrinol Metab

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Arq Bras Endocrinol Metabvol 46 nº 6 Dezembro 2002 640 RESUMOPara avaliar a freqüência da microalbuminúria e fatores clínicos e metabólicos associados, estudamos 72 pacientes com diabetes tipo 1 [DM1, 38F/34M, sendo 6 crianças, 17 adolescentes e 49 adultos, com 22,7±9,5 anos e 7 anos (0,1-37,5) de duração da doença]. A taxa de excreção de albumina (EUA) foi determinada em amostra noturna de urina de 10h. Microalbuminúria foi definida como EUA ≥20 e <200 µg/min em pelo menos 2 de 3 amostras de urina, 25% mostraram-se microalbuminúricos (16 adultos e 2 adolescentes) e tinham maiores médias de idade (27,3±5,8 vs 20,9±10,1 anos, p<0,001), duração do DM [11,0 (0,1-17,0) vs 5,9 (1,0-37,5) anos, p<0,05], índice de massa corporal (22,7±2,6 vs 20,7±3,1, p<0,05), uréia (32,4±7,8 vs 28,3±5,9mg/dl, p<0,05), creatinina [0,7 (0,6-1,2) vs 0,6 (0,4-1,1) mg/dl, p<0,05] e maior freqüência de retinopatia (33% vs 9,4%, p<0,05) quando comparados aos normoalbuminúricos. Na regressão linear múltipla em stepwise , tendo a EUA como variável dependente, a única variável independente associada e preditora foi a idade (r 2 = 0,13, p<0,05). Concluímos que a idade foi um fator determinante no surgimento da microalbuminúria. Apesar de não termos observado microalbuminúria em crianças sugerimos que a triagem nesta faixa etária deve ser discutida no contexto específico de cada serviço de atendimento ao diabetes. To evaluate the frequency of microalbuminuria and associated clinical and metabolic features, we studied 72 type 1 diabetic subjects [DM1, 38F/34M; 6 children, 17 adolescents and 49 adults; aged 22.7±9.5 years and with DM duration of 7 years (0.1-37.5)]. Urinary albumin excretion rate (AER) was determined in timed overnight urine samples by RIA. Microalbuminuria was defined when 2 out of 3 urine samples had AER in the range of 20-200 µg/min. Microalbuminuria was present in 25% of our patients (16 adults and 2 adolescents), who were older (27.3±5.8 vs 20.9±10.1 years, p<0.001), had a longer DM duration [11.0 (0.1-17.0) vs 5.9 (1.0-37.5) years, p<0.05], higher body mass index (22.7±2.6 vs 20.8±3.1, p<0.05), urea (32.4±7.8 vs 28.3±5.9mg/dl, p<0.05) and creatinine [0.7 (0.6-1.2) vs 0.6 (0.4-1.1) mg/dl, p<0.05] than normoalbuminuric. Microalbuminuria was associated with retinopathy (p<0.05). Stepwise multiple regression analysis showed that age was the only independent predictive variable of AER (r 2 = 0.13, p<0.05). In conclusion, age was an independent factor associated with AER. Even though microalbuminuria was not observed in children in our sample, screening in this age group should be decided by each diabetes center according to their objectives. (Arq Bras Endocrinol Metab 2002;46/6:640-647)

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Diabetic nephropathy and arterial hypertension

Cited by 149 publications

References 13 publications

Hypertension in diabetes as related to nephropathy. Early blood pressure changes.

Hypertension in diabetes as related to nephropathy. Early blood pressure changes.

Etiology and Prevalence of Hypertension in Diabetic Patients

Microalbuminúria em pacientes diabéticos tipo 1: prevalência e fatores associados

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