[Advances in diabetes mellitus, diabetic nephropathy, metabolic syndrome and cardio-vascular-renal risk].
1. Epidemiological aspects: There is evidence that the pandemic of DM is entering a stabilization phase, with a slight downturn in the rates of ESRD attributed to DM in the United States. 2. New pathogenic and progression mechanisms of renal disease are proposed: 1) Intraglomerular hyperpressure with phenotypical cell changes, inducing TGF-beta activation; 2) Genetic polymorphisms, with candidate genes in chromosomes 18q, 3q, 7p and others; 3) Endothelial dysfunction as an injury initiating mechanism, demonstrated in the eNOS knockout rat; 4) Isoforms of PKC molecules that favor progression of nephropathy. 3. Importance of metabolic syndrome as a progression factor of chronic renal disease. 4. Increased CV risk in patients treated with thiazolidinediones (glitazones) -Hydrosaline retention and heart failure. 5. Recent studies: ADVANCE study: Combined treatment with an ACE inhibitor (perindropil) and a diuretic (indapamide) in fixed doses helps to reduce CV risk and overall mortality.DREAM study: Ramipril does not reduce the occurrence of DM2, but does improve reversion to normoglycemia. AVOID study: Direct renin inhibitors add greater antihypertensive and antiproteinuric efficacy. 6. New therapeutic targets: Antifibrotic, anti-inflammatory and antiproteinuric effects of sulodexide, isosorbide mononitrate, PKC inhibitors and others. 7. The most effective strategy continues to be intensive, multifactorial and multidisciplinary management of the type 2 diabetic patient, as shown by long-term follow-up in the Steno-2 study.
Martínez Castelao
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Hospital Universitario de Bellvitge Princeps d'Espanya, L'Hospitalet, IDIBELL, Universitat de Barcelona, GEENDIAB, Barcelona, Spain.
D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002908:Chronic Disease; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology; D019468:Disease Management; D018450:Disease Progression; D016503:Drug Delivery Systems; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use; D007674:Kidney Diseases / Q000453:epidemiology*; D024821:Metabolic Syndrome / Q000453:epidemiology*; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D045162:Thiazolidinediones / Q000009:adverse effects / Q000627:therapeutic use
D007004:Hypoglycemic Agents; D045162:Thiazolidinediones
Avances en diabetes mellitus, nefropatía diabética, síndrome metabólico y riesgo cardio-vasculo-renal.