Diabetic nephropathy is one of the microvascular complications of diabetes. Its incidence is decreasing in insulin dependent patients, but extremely increasing in non-insulin dependent patients in developed countries. The development of nephropathy in an individual patient cannot be predicted in spite of new information about genetics and pathophysiology of the disease. Clinical course progresses from microalbuminuria to overt proteinuria and than to renal failure. The disease cannot be cured, but can be prevented or limited in progression. The most important measures are maintaining of normoglycaemia and blood pressure in low-normal values (best using ACE inhibitors), treatment of hypercholesterolaemia and protein restriction. Renal replacement therapy is available for all diabetic patients in our country without restriction, the best method is kidney transplantation if not contraindicated.

• MeSH
• diabetické nefropatie * diagnóza   terapie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

The epidemic increase of diabetic nephropathy stimulated also the interest in pathophysiological mechanisms that lead to the development of the disease. The main interest is concentrated on the glycosylation of proteins and lipids, activation of intracellular enzyme cascades (protein kinase C, aldosoreductase) and the effect of vasoactive compounds (NO, prostanoids, angiotensin II) and growth factors. Cytokines are also of great importance. Every new piece of information is used in search for new modes of therapy, but most of them remain at the stage of experiments.

• MeSH
• diabetické nefropatie patofyziologie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

• MeSH
• diabetické nefropatie etiologie   patologie   patofyziologie   MeSH
• ledviny patologie   patofyziologie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

The epidemiology of diabetic nephropathy (DN) should be approached from two angles: a) incidence of diabetic nephropathy in patients with diabetes, and b) epidemiology of chronic renal failure (CHRF) in diabetic patients. According to data from different sources, DN affects, in all its stages, about one third of patients irrespective of the type of diabetes they suffer from, with the peak rate of incidence after 15 years of duration of the illness. It is estimated that the rate of DN prevalence is 4-8% of patients monitored in diabetes centres. In addition, a significant portion of diabetics, especially the type 2 diabetic patients, are affected by the non-diabetic type nephropathy of primarily atherosclerotic etiology. Currently, DN is the principal cause of CHRF in advanced industrial countries (Western Europe, USA,Japan). A similar trend has been recorded in the Czech Republic which has one of the highest incidences of DN among the former Eastern Block countries. Most affected patients are type 2 diabetes patients. The cause of the above increase is the growing prevalence and incidence of type 2 diabetes, and, primarily, better care for type 2 diabetes patients who live long enough to develop severe macro and microvascular complications including DN. The principal factors influencing the risk of a diabetic patient developing DN are long-term monitoring ofglycaemia, control of hypertension, genetic (ethnic) factors, age and sex. Metabolic control has an effect on the risk of diabetic nephropathy developing in type 1 and 2 diabetes, yet it is blood pressure control which is critical for the progression of chronic renal insufficiency in DN patients. In view of the high number of diabetic patients with CHRF which, in addition, associates with their high polymorbidity and extensive demands put on medical and nursing care which is not directly associated with CHRF therapy, we have to do with a serious medical and economic problem.

• MeSH
• chronické selhání ledvin epidemiologie   etiologie   MeSH
• diabetické nefropatie epidemiologie   MeSH
• lidé MeSH
• prevalence MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• diabetické nefropatie diagnóza   MeSH
• lidé MeSH
• proteinurie diagnóza   MeSH
• těhotenství při diabetu diagnóza   MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Diabetic kidney disease (DKD), which belongs to the triad of diabetic microvascular complications, is currently the main cause of end-stage renal disease in developed countries. DKD usually simultaneously leads to a deteriorated long-term control of glucose metabolism and blood pressure, and to the development of diabetic retinopathy, neuropathy and atherosclerotic complications, which are the main causes of patients' mortality. Screening of the initial stages of DKD is to be based on the detection of increased albumin leak into the urine, microalbuminuria, and the reduction of renal function by means of estimates of glomerular filtration rate based on the serum creatinine level. The main objective of the prophylactic and treatment measures is to prevent the onset of DKD, or at least to stop its transition into an irreversible, progressive stage characterised by a permanent, often nephrotic proteinuria. The basic procedures in the prevention and treatment of DKD are maintaining the optimal metabolic control of diabetes and intensive hypertension treatment based on the inhibition of the renin-angiotensin system. Reaching the stage of progressive renal insufficiency (serum creatinine level approximately > or = 200 micromol/l) is an indication for further follow-up in the nephrology department, which will then take the necessary preparatory measures for dialysis treatment. The optimal method of kidney function replacement for patients with DKD is kidney transplantation, or combined kidney-pancreas transplantation in patients with type 1 diabetes.

• MeSH
• diabetické nefropatie * diagnóza   prevence a kontrola   terapie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

• MeSH
• diabetické nefropatie prevence a kontrola   terapie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Diabetic nephropathy is a serious microangiopathic complication of type 1 and 2 diabetes and accounts in a major way for the high morbidity and invalidity of diabetics. Although progression is inevitable when the disease is advanced, there are ways how to prevent its development and retard its progress. Because reliable prediction of diabetic nephropathy is impossible, primary prevention is essential in all diabetic patients. As soon as the diagnosis of diabetes is established, the blood sugar level should be checked systematically and permanent satisfactory compensation of diabetes should be ensured (HbA1c less than 6.5%) which is the main principle throughout the subsequent course of the disease. The principle of secondary prevention the objective of which is to prevent the development of manifest nephropathy with permanent proteinuria, is to monitor microalbuminuria and maintenance of a normal blood pressure. With regard to pathophysiological circumstances in therapy angiotensin converting enzyme inhibitors are preferred. The objective of tertiary prevention is retardation of renal insufficiency by fortified hypotensive therapy, correction of hyperlipoproteinaemia, dietary protein restriction and adequate compensation of diabetes. In case of renal failure dialyzation treatment or transplantation must not be delayed.

• MeSH
• diabetické nefropatie prevence a kontrola   terapie   MeSH
• lidé MeSH
• progrese nemoci MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Diabetic nephropathy is a serious microangiopathic complication of diabetes type I and II, which accounts for a marked proportion of the high morbidity and invalidity of diabetics. Although when the disease is fully developed, progression is inevitable, ther are ways how to prevent its development and retard its course. Because reliable prediction of diabetic nephropathy is not possible, primary prevention is essential in all diabetics. It involves, as soon as the diagnosis of diabetes is established, systematic checks of the blood sugar level and permanent satisfactory compensation of diabetes (HbA1c less than 6.5%) which is the main principle during the whole subsequent course of the disease. The principle of secondary prevention the purpose of which is to prevent the development of manifest nephropathy with permanent proteinuria is monitoring of microalbuminuria and maintenance of a normal blood pressure. With regard to pathophysiological associations, in the treatment angiotensin-converting enzymes inhibitors are preferred. The objective of tertiary prevention is to delay renal insufficiency by fortified hypotensive therapy, correction of hyperlipoproteinaemia, dietary protein restriction and satisfactory compensation of diabetes. In case of renal failure dialyzation treatment or transplantation must not be delayed.

• MeSH
• diabetické nefropatie prevence a kontrola   terapie   MeSH
• lidé MeSH
• progrese nemoci MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

• MeSH
• diabetická retinopatie epidemiologie   MeSH
• diabetické nefropatie klasifikace   epidemiologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Československo MeSH