Showing papers by "Carl Erik Mogensen published in 1999"

Validity of rapid estimation of glomerular filtration rate in type 2 diabetic patients with normal renal function.

Abstract: Background. Rapid estimation of the renal function is widely used in clinical practice. renal function; serum creatinine Methods. The validity of rapid estimation of renal function as well as long-term changes in renal function from the Cockcroft‐Gault formula for estimation of Introduction creatinine clearance or from serum creatinine measurements was evaluated against the 51Cr-EDTA plasma Estimation of glomerular filtration rate (GFR) from clearance technique in 36 type 2 diabetic patients with measurements of serum creatinine concentration or renal normal renal function followed for 5.2 (2.7‐7.5) (mean creatinine clearance (C cr ) is widely used for rapid assess(range) years. ment of renal function in humans. However, due to lack Results. Compared with 51Cr-EDTA plasma clearance of accuracy compared with standard methods, such as the Cockcroft‐Gault formula significantly underesti- inulin clearance or radioisotope clearance techniques, mated glomerular filtration rate by 21%. The degree the validity of such rapid estimates in terms of reliable of underestimation was observed over the whole range appraisal of renal function is a concern [1‐3]. In more of glomerular filtration rate studied and increased with advanced stages of nephropathy, assessment of GFR as increasing levels of isotopically measured glomerular well as prognostic estimates of renal function from filtration rates. Serum creatinine was not significantly measurements of renal C cr is usually thought inadvisable associated with glomerular filtration rate. The average because of the progressive contribution of renal tubular long-term change in renal function was significantly secretion of creatinine to whole-body creatinine clearoverestimated by the Cockcroft‐Gault formula ance, which, especially in patients with moderate impair(’2.8±2.3 ml/min/year) compared with the measured ment of renal function, tends to mask the severity of the rate (’1.5±2.5 ml/min/year) (P=0.002). The diVer- GFR reduction [2,3]. Similarly, in patients with normal ence in change rate between the two methods was renal function renal C cr measurements may overestimate highest when the measured fall rates were small and GFR by as much as 10‐40% [2]. The sensitivity of serum tended to disappear in patients with faster fall rates. creatinine as a marker of the degree of renal disease is Changes in serum creatinine correlated significantly, undermined not only by renal tubular secretion of creatibut imprecisely, with the rate of decline of measured nine but also by the inverse relationship between serum glomerular filtration rate (r=’0.48, P=0.003). The creatinine concentrations and GFR [3], which allows variability of the estimated fall rate of renal function GFR to fall quite markedly before significantly elevated was unacceptably high for all approaches. laboratory values of serum creatinine become apparent. Conclusion. Valid estimates of glomerular filtration Prediction of C cr using the Cockcroft‐Gault formula [4] rate as well as the rate of change in glomerular filtration has been shown to give more valid estimates of GFR in rate cannot be obtained by estimation of creatinine some studies [5‐7], but not all [3,8‐11]. It is still controclearance from the Cockcroft‐Gault formula or from versial whether longitudinal changes in renal function serum creatinine concentration measurements in type can be reliably assessed using rapid estimations of GFR 2 diabetic patients with normal renal function. from such equations or from measurements of serum creatinine concentrations in patients with normal GFR. The present studies were undertaken to address these questions in a group of type 2 diabetic patients with normal renal function. In addition to a comparison of Correspondence and oVprint requests to: Soren Nielsen MD, Medical the level of GFR, special attention was directed

Drug treatment for hypertensive patients in special situations: diabetes and hypertension.

Abstract: Diabetes mellitus and hypertension is often associated, but with a different type of development in type 1 and type 2 diabetes. Type 1 diabetes, renal disease, starting with microalbuminuria, is associated with increasing blood pressure or hypertension, whereas the patient without renal disease is most often normotensive. Poor metabolic control is a predictor of microalbuminuria or incipient nephropathy, but with microalbuminuria hypertension is an important risk factor for progression along with poor glycemic control. The same is the case for overt renal disease, and metabolic control is important in all stages of renal disease in type 1 diabetes. It has also been shown that good metabolic control as well as antihypertensive treatment, especially with ACE-inhibitors, often combined with other agents is quite effective in preventing progression in renal disease in all its stages. In type 2 diabetes, blood pressure elevation is often found as early as at the actual diagnosis, and blood pressure significantly increases according to the degree of albuminuria, normo-microalbuminuria and clinical proteinuria (macroalbuminuria). Elevated blood pressure is an important risk for renal disease but more importantly so also for cardiovascular disease. Several studies document that antihypertensive treatment in particular with ACE-inhibitors is important in preventing microalbuminuria, in treating microalbuminuria and thus preventing progression, also in overt renal disease. Near-normalization of blood pressure is vital. Regarding cardiovascular disease, a series of studies now document that antihypertensive treatment with various antihypertensive agents is able to significantly reduce a number of major cardiovascular complications in diabetes, such as cardiac disease, stroke, and also microvacular disease, including retinopathy. Several studies show that antihypertensive treatment should be started at a level higher than 140-150/90. The blood pressure to be achieved during treatment is probably around 140/85 mmHg or even 130/80 mmHg as a pragmatic goal. However, there is no sign of a J-shaped curve in any of the studies, and therefore even lower blood pressure could be advantageous. Even mortality, at least from diabetes-related causes can be effected by antihypertensive treatment. With more advanced renal disease, normalization of blood pressure is increasingly difficult, especially systolic blood pressure, and therefore it is recommendable to screen patients much earlier on with focus on blood pressure recordings and measurements of albuminuria, including microalbuminuria, and to treat early.