Objective To make individualized evidence-based treatment for patients with diabetic nephropathy with albuminuria. Methods Based on the clinical questions we raised, evidence was collected and critically assessed. Patients’ willingness was also taken into consideration in the decision-making treatment Results Seventy studies were retrieved and finally 14 randomized controlled trials, 2 systematic reviews, 2 meta-analyses and 41 clinical guidelines were considered eligible. The evidence indicated that albuminuria was an independent cardiovascular risk factor of diabetic patients; angiotensin receptor antagonists might decrease the level of urinary albumin excretion in patients with type 2 diabetic nephropathy; and such patients might benefit from blood glucose and blood pressure control. The individualized treatment plans were developed based on the available evidence. After 1 month of treatment, the serum creatinine returned to normal and albuminuria became negative. Conclusion The individualized treatment plans based on the high quality evidence were optimal in reducing cardiovascular complications and urinary albumin excretion. However, long-term prognostic benefits need to be confirmed by further follow-up.
Objective To assess the therapeutic effect of sulodexide for diabetic patients with early nephropathy. Methods A total of 60 patients with early diabetic nephropathy (albuminuria: 30 to 300 mg/24 h, male/female: 30/30, mean age: 51.23 years, mean course of disease: 12.9 years) were randomized equally into three groups: the routine treatment group, cozaar group (50 mg qd, po for 12 weeks) and sulodexid group (600 LSU qd, iv or im for 4 weeks, 250 LSU bid, po for 8 weeks). The levels of urinary albumin excretion rate (UAER), urea nitrogen and creatinine were determined. Results After three months of treatment, the level of UAER was decreased significantly in both the sulodexide group and cozaar group (Plt;0.01), but not in the routine treatment group (Pgt;0.05). The level of UAER was reduced by 34.04% and 33.62% in the cozaar group and the sulodexide group, respectively. Significant difference was noted in the level of UAER between the cozaar/sulodexide groups and the routine treatment group (Plt;0.01), but no significant difference was observed between cozaar group and sulodexide group (Pgt;0.05). Conclusion Sulodexide could decrease the level of UAER in patients with early diabetic nephropathy. It has similar efficacy to cozaar.
Objective To formulate an evidence-based treatment plan for a patient with type 2 diabetes and microalbuminuria. Methods According to the patient’s clinical conditions, we put forward 5 clinical problems. We searched the Cochrane Library (Issue 4, 2005), ACP Journal Club (1991 to 2005), and MEDLINE (1991 to 2005) databases. Systematic review, meta-analysis and randomized controlled trials about the treatment of diabetic nephropathy were included. The treatment plan was developed accordingly. Results Thirteen eligible studies were included. Evidence indicated that an intensive intervention aimed at the multiple potential risk factors could be applied to delay or prevent the progression of diabetic nephropathy, which included intensive blood glucose control, tight blood-pressure control, lipid modulation, restriction of protein intake and smoking cessation. The individualized treatment plan was based on the high quality evidence as well as the patient’s specific condition. The patient is still being followed-up. Conclusion Interventions for risk factors of type 2 diabetes like changing living style, decreasing serum glucose, blood pressure, and level of blood fat help to release the clinical symptom and better the long-term living quality of patients.
目的:探讨老年原发性高血压(EH)患者早期肾损害指标微量白蛋白尿(MAU)和动脉粥样硬化的早期征象颈动脉内中膜厚度(C-IMT)之间的关系。方法:99名老年EH患者按尿白蛋白/肌酐比值(ACR)分为异常ACR组和正常ACR组,对两组的C-IMT、斑块发生率、ACR水平及血中尿素氮(Bun)、肌酐(Cr)、总胆固醇(TC)、甘油三酯(TG)、血糖(Glu)、体重指数(BMI)等进行分析和比较。结果:异常ACR组的年龄、尿酸、ACR、C-IMT、24小时平均收缩压,平均动脉压及脉压均高于正常ACR组(Plt;0.05);且C-IMT与ACR水平呈正相关(Plt;0.05)。结论:微量白蛋白尿和颈动脉IMT密切相关,提示微量白蛋白尿不仅和老年高血压肾脏病变有关,也是亚临床期动脉粥样硬化的早期标志.
ObjectiveTo discuss the relationship between microalbuminuria (MAU) and antioxidant activity of plasma hyper density lipoprotein (HDL) in hypertensive patients, and investigate whether MAU could be a predictor of HDL antioxidant activity. MethodFrom December 2007 to March 2009, sixty consecutive primary hypertensive patients from the inpatient and outpatient departments of West China Hospital and Sichuan Electric Power Central Hospital were included in the study, and 30 healthy volunteers served as controls. MAU, plasma HDL and paraoxonase (PON1) activity were tested. ResultsPON1 activity was lower in hypertensive patients than the controls (P<0.05), and this degree of decline was positively related to MAU (P<0.05). ConclusionMAU reflects PON1 activity in hypertensive patients and can be a predictor to judge plasma HDL function in patients with hypertension.