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Predisposition to Hypertension and Susceptibility to Renal Disease in Insulin-Dependent Diabetes Mellitus

The New England journal of medicine, 1988-01, Vol.318 (3), p.140-145 [Tạp chí có phản biện]

1989 INIST-CNRS ;Copyright Massachusetts Medical Society Jan 21, 1988 ;ISSN: 0028-4793 ;EISSN: 1533-4406 ;DOI: 10.1056/NEJM198801213180303 ;PMID: 3336401 ;CODEN: NEJMAG

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Nhan đề:
Predisposition to Hypertension and Susceptibility to Renal Disease in Insulin-Dependent Diabetes Mellitus
Tác giả: Krolewski, Andrzej S ; Canessa, Mitzy ; Warram, James H ; Laffel, Lori M.B ; Christlieb, Richard ; Knowler, William C ; Rand, Lawrence
Chủ đề: Adult ; Associated diseases and complications ; Biological and medical sciences ; Biological Transport, Active ; Blood Glucose - metabolism ; Causes of ; Complications ; Diabetes ; Diabetes Mellitus, Type 1 - complications ; Diabetes. Impaired glucose tolerance ; Diabetic Nephropathies - etiology ; Diabetic retinopathy ; Diabetic Retinopathy - complications ; Diagnosis ; Disease Susceptibility ; Dosage and administration ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Erythrocytes - metabolism ; Family medical history ; Female ; Humans ; Hypertension ; Hypertension - blood ; Hypertension - etiology ; Hypertension - genetics ; Insulin ; Kidney diseases ; Lithium - blood ; Male ; Medical sciences ; Patients ; Risk Factors ; Sodium - blood ; Urine
Là 1 phần của: The New England journal of medicine, 1988-01, Vol.318 (3), p.140-145
Mô tả: Only one third of patients with juvenile-onset insulin-dependent diabetes seem to be susceptible to diabetic nephropathy. To test whether this susceptibility is related to a predisposition to hypertension, we investigated the association of nephropathy with markers of risk for hypertension. We randomly selected 89 patients with insulin-dependent diabetes from a roster of children and adolescents who were seen between 1968 and 1972 at about the time the diagnosis was made. These 89 patients were recalled for examination, as young adults, in 1986 and 1987. Patients with nephropathy (cases, n = 33) were compared with controls without nephropathy (n = 56). Having a parent with hypertension tripled the risk of nephropathy (odds ratio, 3.7; 95 percent confidence interval, 1.4 to 10.1). Moreover, cases had significantly higher values for maximal velocity of lithium–sodium countertransport in red cells than controls (mean maximal velocity ±SE, 0.51 ±0.04 vs. 0.38±0.02 mmol per liter of cells per hour; P<0.05). The excess risk associated with both these indicators of a predisposition to hypertension was evident principally in patients with poor glycemic control during their first decade of diabetes; the odds ratios were 4.5 (95 percent confidence interval, 1.1 to 18.7) for patients with a parental history of hypertension and 7.7 (95 percent confidence interval, 1.8 to 33.8) for patients with a maximal velocity of lithium–sodium countertransport ≥0.35 mmol per liter of cells per hour. We conclude that the risk of renal disease in patients with juvenile-onset insulin-dependent diabetes is associated with a genetic predisposition to hypertension. Predisposition to hypertension appears to increase susceptibility for renal disease principally in patients with poor glycemic control. (N Engl J Med 1988; 318:140–5.) ONLY one of three patients with juvenile-onset insulin-dependent diabetes mellitus ever acquires diabetic nephropathy. The risk of this complication peaks during the second decade of diabetes and declines thereafter. 1 , 2 Although this pattern cannot be accounted for solely by the distribution of glycemic control, it is readily explainable if susceptibility to renal complications is limited to a subset of patients with insulin-dependent diabetes. In that case, the risk of nephropathy could be low after many years simply because the pool of susceptible persons has been exhausted. 3 Hypertension in patients with insulin-dependent diabetes mellitus develops mainly in connection with the clinical emergence . . .
Nơi xuất bản: Boston, MA: Massachusetts Medical Society
Ngôn ngữ: English
Số nhận dạng: ISSN: 0028-4793
EISSN: 1533-4406
DOI: 10.1056/NEJM198801213180303
PMID: 3336401
CODEN: NEJMAG
Nguồn: ProQuest One Psychology
MEDLINE
Alma/SFX Local Collection
ProQuest Central

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Predisposition to Hypertension and Susceptibility to Renal Disease in Insulin-Dependent Diabetes Mellitus

1989 INIST-CNRS ;Copyright Massachusetts Medical Society Jan 21, 1988 ;ISSN: 0028-4793 ;EISSN: 1533-4406 ;DOI: 10.1056/NEJM198801213180303 ;PMID: 3336401 ;CODEN: NEJMAG

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