ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Diabetes mellitus is the leading underlying cause of end-stage renal disease in the USA. To develop preventive strategies aimed at combatting diabetic end-stage renal disease, three steps are required: first, the delineation of the natural history of diabetic nephropathy; second, the identification of modifiable risk factors for the development and progression of diabetic nephropathy; and third, the demonstration that manipulation of these factors does indeed reduce risk. A review of the literature regarding the epidemiology and prevention of diabetic renal disease in humans published during the past year revealed a wealth of data which may guide preventive efforts. Prospective cohort studies confirmed that microalbuminuria is a strong predictor of nephropathy and that blood pressure is an important modifiable risk factor for the progression of diabetic renal disease. In addition, observational studies identified several novel factors which might also increase risk. Randomized controlled trials provided convincing evidence that strict glycemic control reduces the risk of progression to diabetic nephropathy by 50%. Data from trials also demonstrated that angiotensin-converting enzyme inhibitors slow the progression of renal disease beyond their effect on blood pressure alone. Future research should further evaluate novel modifiable risk factors, define optimal treatment strategies for the use of angiotensin-converting enzyme inhibitors and antihypertensive agents, and develop methods to translate these findings into practice for the general population.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Three etiologies of renal disease account for more than 80% of Medicare-supported (U.S. Federal Government sponsored) end-stage renal disease (ESRD) cases: diabetes mellitus, hypertension and chronic glomerulonephritis. Surprisingly, despite improvements in medical care, their incidence is increasing rapidly in many parts of the world. With the exception of autosomal dominant adult polycystic kidney disease, the DNA polymorphisms causing progressive renal failure in individuals with common diseases have not yet been identified. Although hypertension and diabetes mellitus are associated with ESRD, the majority of patients with these disorders never develop nephropathy. There is abundant evidence that both inherited factors and the environment affect the development of ESRD. Predisposition to nephropathy may be inherited independently from the environmental and hereditary components that produce the associated systemic disease. This review examines the evidence that ESRD results, in part, from inherited factors. It discusses the racially variable risk of renal disease, the familial clustering of ESRD and molecular genetic data in animals and humans with renal failure.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Publications within the past year have added to our understanding of the relationships between race, socioeconomic status, hypertension, and renal disease. The catalog of racial differences in hypertension and renal disease has been enriched on several accounts. Some of these differences can be explained by specific intervening variables, but others remain attributed to race itself. Unfortunately, what 'race' actually represents is still subject to debate. This debate should be encouraged, because the lack of a clear concept of race hinders research in this area. The main new finding of the year may be a confirmation by several studies that low socioeconomic status is an independent risk factor for end-stage renal disease, regardless of race. Research explaining the mechanisms by which poverty affects the risk of kidney failure is urgently needed, as some of these mechanisms may lend themselves to preventive intervention. Interventions aimed at improving the serious socioeconomic consequences of treated end-stage renal disease are also receiving increasing attention, and have been shown to improve patient outcomes.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Large-scale clinical trials of antihypertensive drugs that have shown a reduction in morbidity and mortality used the classic step-care treatment design, initiating treatment with a diuretic. Long-term morbidity and mortality reports comparing the newer classes of agents with the traditional antihypertensive agents have not been completed. A recent meta-analysis of 13 randomized, controlled clinical trials of hypertension showed that 18 elderly people, but two to four times as many younger people, needed to be treated for 5 years to prevent one cerebrovascular or cardiac event. Any head-to-head comparisons of one class of antihypertensive agent with another in the prevention of vascular complications will require very large cohorts, even of elderly people, to show a difference. Such trials are ongoing or being planned, but their results will not be available before the next century.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

There is substantial evidence to suggest that regular physical activity reduces the risk of heart disease. Less clear is the extent to which this is caused by blood pressure reduction. This review considers effects of exercise on blood pressure and overall cardiovascular risk in normotensive and hypertensive individuals.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID