XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

tion’, implying that most patients ‘should’ receive a particular action. In contrast, level 2 guidelines are essentially ‘suggestions’ and are deemed to be ‘weak’ or discretionary, recognising that management decisions may vary in different clinical contexts. Each recommendation was further graded from A to D by the quality of evidence underpinning them, with grade A referring to a high quality of evidence whilst grade D recognised a ‘very low’ evidence base. The overall strength and quality of the supporting evidence is summarised in table 1 . The guidelines focused on 4 key domains: (1) AKI definition, (2) prevention and treatment of AKI, (3) contrastinduced AKI (CI-AKI) and (4) dialysis interventions for the treatment of AKI. The full summary of clinical practice statements is available at www.kdigo.org, but a few key recommendation statements will be highlighted here.

/pdf/kdigo-clinical-practice-guidelines-for-acute-kidney-injury-27tybolw7l.pdf

KDIGO clinical practice guidelines for acute kidney injury.

2018 ESC/ESH Guidelines for the management of arterial hypertension.

Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

We report a case of infective endocarditis developing after pedicure in a 36-y-old female. Methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis was diagnosed. Even aggressive therapy was ineffective. To our knowledge, we report the first case of infective endocarditis secondary to pedicure in the literature.

A forgotten but important risk factor for infective endocarditis in patients with prosthetic valve: Pedicure

Hypoxia-inducible factor signaling in vascular calcification in chronic kidney disease patients

OBJECTIVE

Anemia is a major clinical problem in patients receiving dialysis therapy and has a substantial impact on morbidity and mortality. Iron metabolism is impaired in chronic kidney disease. Hepcidin functions as a key regulator of iron metabolism. The aims of this study were to compare the serum pro-hepcidin levels in patients with either peritoneal dialysis (PD) or hemodialysis (HD) and control subjects and to evaluate pro-hepcidin and C-reactive protein (CRP), iron parameters, and hemoglobin levels in PD and HD patients with normal serum CRP levels.



METHODS

We studied 85 PD patients, 43 HD patients on regular follow-up, and a control group that was comprised of 41 volunteers in this cross-sectional study. Pro-hepcidin and CRP were studied using commercially available kits. Iron status was assessed by measuring serum iron, transferrin saturation, and ferritin.



RESULTS

Pro-hepcidin levels were significantly higher in dialysis patients than the control subjects (p < .001). Hemodialysis patients had higher pro-hepcidin levels than PD patients; but, this difference was not statistically significant (393.4 ± 157.3 versus 361.3 ± 40.1, p = .19). There were no correlations between pro-hepcidin levels and CRP, and hemoglobin level and iron parameters in PD and HD patients.



CONCLUSION

The present results suggest that dialysis therapy is associated with elevated pro-hepcidin levels and not directly related to CRP, indices of iron metabolism, or hemoglobin levels. Peritoneal dialysis patients have relatively lower pro-hepcidin levels than HD patients, but larger-scale studies are needed to confirm the possibility of impact on various dialytic modalities.

Pro‐Hepcidin Levels in Peritoneal Dialysis and Hemodialysis Patients

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the development of antibodies against a variety of nuclear and cytoplasmic antigens. SLE renal involvement is referred to as ‘lupus nephritis’ and is generally associated with anti-nuclear antibody (ANA) positivity. ANA is negative in approximately 5% of patients diagnosed with SLE. Existence of full-house nephropathy is generally associated with lupus nephritis. Herein, we present a case of full-house nephropathy in a 48-year-old male patient with negative serology for SLE. The patient had signs of lupus such as oral aphthae, symmetrical polyarthritis, and diffuse proliferative glomerulonephritis.

A Case of Full-House Nephropathy with Anti-Nuclear Antibody Negative Lupus

maTERial and mETHOdS: Eighty-eight (88) consecutive patients with decreased renal function (glomerular filtration rate (GFR) between 90 and 30 ml/min), undergoing cardiac catheterization for proven or clinically suspected coronary artery disease were enrolled at the study. Serum levels of creatinine, ADMA, nitric oxide (NO), calcium, phosphate, total cholesterol, HDL and LDL fractions, triglycerides were determined using measurement techniques. The Gensini scoring system was used for the detection of the severity of coronary atherosclerosis.

Mehmet Kanbay

Papers

A forgotten but important risk factor for infective endocarditis in patients with prosthetic valve: Pedicure

Hypoxia-inducible factor signaling in vascular calcification in chronic kidney disease patients

Pro‐Hepcidin Levels in Peritoneal Dialysis and Hemodialysis Patients

A Case of Full-House Nephropathy with Anti-Nuclear Antibody Negative Lupus

Association Between Asymmetric Dimethylarginine and the Severity of Coronary Artery Disease in Patients with Chronic Kidney Disease