Diabetes mellitus is one of the most common causes of chronic kidney disease.Kidney involvement in patients with diabetes has a wide spectrum of clinical presentations ranging from asymptomatic to overt proteinuria an...Diabetes mellitus is one of the most common causes of chronic kidney disease.Kidney involvement in patients with diabetes has a wide spectrum of clinical presentations ranging from asymptomatic to overt proteinuria and kidney failure.The development of kidney disease in diabetes is associated with structural changes in multiple kidney compartments,such as the vascular system and glomeruli.Glomerular alterations include thickening of the glomerular basement membrane,loss of podocytes,and segmental mesangiolysis,which may lead to microaneurysms and the development of pathognomonic Kimmelstiel-Wilson nodules.Beyond lesions directly related to diabetes,awareness of the possible coexistence of nondiabetic kidney disease in patients with diabetes is increasing.These nondiabetic lesions include focal segmental glomerulosclerosis,IgA nephropathy,and other primary or secondary renal disorders.Differential diagnosis of these conditions is crucial in guiding clinical management and therapeutic approaches.However,the relationship between diabetes and the kidney is bidirectional;thus,new-onset diabetes may also occur as a complication of the treatment in patients with renal diseases.Here,we review the complex and multifaceted correlation between diabetes and kidney diseases and discuss clinical presentation and course,differential diagnosis,and therapeutic opportunities offered by novel drugs.展开更多
In patients with primary hypertension,therapeutic strategies should be based on global cardiovascular risk profile rather than on the severity of blood pressure alone.Accurate assessment of concomitant risk factors an...In patients with primary hypertension,therapeutic strategies should be based on global cardiovascular risk profile rather than on the severity of blood pressure alone.Accurate assessment of concomitant risk factors and especially of the presence and extent of subclinical organ damage is of paramount importance in definingindividual risk.Given the high prevalence of hypertension in the population at large,however,extensive diagnostic evaluation is often impractical or unfeasible in clinical practice.Low cost,easy to use markers of risk are needed to improve the clinical management of patients with hypertension.Early renal abnormalities such as a slight reduction in glomerular filtration rate and/or the presence of microalbuminuria are well known and powerful predictors of cardio-renal morbidity and mortality and provide a useful,low cost tools to optimize cardiovascular risk assessment.A greater use of these tests should therefore be implemented in clinical practice in order to optimize the management of hypertensive patients.展开更多
Facing the needs of an increasingly ageing population is rapidly becoming a major public health issue in western countries, Chronic kidney disease （CKD）, whose current prevalence is estimated around 10%-15% in the g...Facing the needs of an increasingly ageing population is rapidly becoming a major public health issue in western countries, Chronic kidney disease （CKD）, whose current prevalence is estimated around 10%-15% in the general population, with considerably higher figures in at-risk groups, is widely known to increase with age. In the elderly, renal impairment is often concomitant or secondary to several other systemic disorders such as hypertension, atherosclerosis,展开更多
文摘Diabetes mellitus is one of the most common causes of chronic kidney disease.Kidney involvement in patients with diabetes has a wide spectrum of clinical presentations ranging from asymptomatic to overt proteinuria and kidney failure.The development of kidney disease in diabetes is associated with structural changes in multiple kidney compartments,such as the vascular system and glomeruli.Glomerular alterations include thickening of the glomerular basement membrane,loss of podocytes,and segmental mesangiolysis,which may lead to microaneurysms and the development of pathognomonic Kimmelstiel-Wilson nodules.Beyond lesions directly related to diabetes,awareness of the possible coexistence of nondiabetic kidney disease in patients with diabetes is increasing.These nondiabetic lesions include focal segmental glomerulosclerosis,IgA nephropathy,and other primary or secondary renal disorders.Differential diagnosis of these conditions is crucial in guiding clinical management and therapeutic approaches.However,the relationship between diabetes and the kidney is bidirectional;thus,new-onset diabetes may also occur as a complication of the treatment in patients with renal diseases.Here,we review the complex and multifaceted correlation between diabetes and kidney diseases and discuss clinical presentation and course,differential diagnosis,and therapeutic opportunities offered by novel drugs.
文摘In patients with primary hypertension,therapeutic strategies should be based on global cardiovascular risk profile rather than on the severity of blood pressure alone.Accurate assessment of concomitant risk factors and especially of the presence and extent of subclinical organ damage is of paramount importance in definingindividual risk.Given the high prevalence of hypertension in the population at large,however,extensive diagnostic evaluation is often impractical or unfeasible in clinical practice.Low cost,easy to use markers of risk are needed to improve the clinical management of patients with hypertension.Early renal abnormalities such as a slight reduction in glomerular filtration rate and/or the presence of microalbuminuria are well known and powerful predictors of cardio-renal morbidity and mortality and provide a useful,low cost tools to optimize cardiovascular risk assessment.A greater use of these tests should therefore be implemented in clinical practice in order to optimize the management of hypertensive patients.
文摘Facing the needs of an increasingly ageing population is rapidly becoming a major public health issue in western countries, Chronic kidney disease （CKD）, whose current prevalence is estimated around 10%-15% in the general population, with considerably higher figures in at-risk groups, is widely known to increase with age. In the elderly, renal impairment is often concomitant or secondary to several other systemic disorders such as hypertension, atherosclerosis,
