Importance of glycemic control on the course of glomerular filtration rate in type 2 diabetes with hypertension and microalbuminuria under tight blood pressure control

2008 ◽  
Vol 18 (9) ◽  
pp. 632-638 ◽  
Author(s):  
Karl Thomaseth ◽  
Giovanni Pacini ◽  
Patrizia Morelli ◽  
Giancarlo Tonolo ◽  
Romano Nosadini
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Glomerular Filtration Rate ◽  
Glycemic Control ◽  
Glomerular Filtration ◽  
Blood Pressure Control ◽  
Filtration Rate ◽  
Pressure Control ◽  
Tight Blood Pressure Control

Diabetes mellitus and the kidney

2020 ◽  
pp. 4975-4987
Author(s):  
Rudolf Bilous
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Glomerular Filtration Rate ◽  
Glycaemic Control ◽  
Blood Pressure Control ◽  
Ace Inhibitors ◽  
Filtration Rate ◽  
Pressure Control

Diabetic nephropathy is the commonest cause of endstage renal disease in the developed world. Aetiology and pathology—causation is related to glycaemic control, hypertension, inflammation, genetic factors, and dietary and other environmental factors. Pathological hallmarks in the glomerulus are thickening of the glomerular basement membrane and mesangial expansion, with or without nodule formation, secondary to an accumulation of extracellular matrix. Many patients have a varying severity of tubulointerstitial inflammation and fibrosis. Staging and natural history—is classically described in terms of urinary albumin excretion rate (UAER). Clinical features—most patients (>60%) will have a normal UAER throughout their diabetic life, but 1 to 2% of the remainder develop persistent moderately increased albuminuria each year. Once UAER exceeds 200 µg/min, there tends to be a relentless increase in proteinuria and glomerular filtration rate declines progressively at a rate that largely depends upon blood pressure control. Prevention—tight glycaemic control can prevent moderately increased albuminuria in both type 1 and type 2 diabetes. Whether intensive blood pressure control using angiotensin-converting enzyme (ACE) inhibitors can also prevent this remains controversial. In both type 1 and type 2 diabetes, intensive blood pressure control using ACE inhibitors or angiotensin II receptor blockers (ARBs) slows progression from moderately to severely increased albuminuria and also slows the rate of decline in glomerular filtration rate in those with severely increased albuminuria. Management—aims for (1) control of glycaemia, (2) control of hypertension (<130/80 mmHg) using an ACE inhibitor or an ARB as first line; and (3) other interventions, including some or all of serum lipid lowering, smoking cessation, and reduction of dietary protein and salt.

scholarly journals A Profile of Renal Function in Northern Cameroonians with Essential Hypertension

2017 ◽  
Vol 7 (4) ◽  
pp. 324-333 ◽  
Author(s):  
Marcel Tangyi Tamanji ◽  
Divine Amagho Ngwakum ◽  
Olivier Pancha Mbouemboue
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Blood Pressure Control ◽  
Filtration Rate ◽  
Pressure Control ◽  
Systematic Evaluation ◽  
Hypertensive Patients ◽  
The Mean

Background/Aim: The two-way cause and effect relationship existing between high blood pressure and kidney dysfunction is currently a well-documented phenomenon with patients in either category being almost equally predisposed to the other pathology. Our goal was to assess the renal function capacity of hypertensive patients in our setting. Methods: This cross-sectional descriptive study involved the determination of blood pressure levels and the collection of blood and urine samples for the measurement of renal function markers. Hypertensive patients who came for medical follow-up constituted the study participants, and were enrolled consecutively into the study from February to May 2015. Data analysis was performed using the SPSS 20.0 software, and significant differences were determined at p < 0.05. Results: The prevalence of elevated creatinine and urea levels were 35 and 27%. Eighty percent of the participants had a decreased glomerular filtration rate (≤90 mL/min/1.73 m3), with at least 36% recording less than 60 mL/min/1.73 m3. Proteinuria and glucosuria were recorded in 15% and 8% of the participants, respectively. The mean diastolic pressure was observed to be significantly higher in participants with proteinuria (p = 0.016), and participants' weight directly correlated with systolic blood pressure (p = 0.015). Furthermore, the mean estimated glomerular filtration rate was relatively lower in participants >60 years compared to those <60 years (p < 0.001). Conclusion: Renal function is often perturbed in hypertensive patients, and good blood pressure control may reduce the progression of renal impairment. Thus, a systematic evaluation of renal function in addition to blood pressure control in hypertensive patients is indispensable towards effectively reducing the occurrence of renal events and preventing end-stage renal disease.

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