Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
Retroperitoneal fibrosis is an uncommon disease that often presents in a subtle manner. Only a fe... more Retroperitoneal fibrosis is an uncommon disease that often presents in a subtle manner. Only a few cases of the combined association of generalized atherosclerosis and retroperitoneal fibrosis are reported in the recent literature, supporting the view that the condition is probably an autoimmune periaortitis. We describe a typical case of retroperitoneal fibrosis associated with generalized atherosclerosis with clinical presentation of progressive renal insufficiency, and claudication from arterial compromise.
Cardiovascular and metabolic risk factors represent potential targets for intervention. A good me... more Cardiovascular and metabolic risk factors represent potential targets for intervention. A good metabolic control, associated with control of blood pressure and cholesterol levels is proven to reduce the risk of cardiovascular disease among individuals with diabetes mellitus. To examine 2004-2005 medical records of adults with previously diagnosed diabetes and to evaluate the fulfillment of diabetes guidelines treatment, for the metabolic control and management of cardiovascular risk factors. We reviewed the data from the National Register of Diabetes (Tirana district), updated during this period. As guidelines we used the ADA 2006 Recommendations for metabolic control, HTA, lipid profile and aspirin therapy. We examined 7259 medical records. Only 14.58% of the patients had an HbA1c <7%. Central obesity was present in 39% of our patients. Overall, only 31.9% of our patients achieved the target for blood pressure (SBP<130 mmHg and DBP<80 mmHg). Two-third of our patients had total cholesterol >200 mg/dl. In total, only 5.5% of our patients attained recommended goals of cardiovascular risk factors for HbA1c, blood pressure and lipid profile. The follow-up of diabetic patients during the transient period in Albania is marked by a deterioration of diabetes metabolic control and poor management of cardiovascular risk factors. Further public health efforts are needed for better control of these risk factors among adults with diagnosed diabetes.
Blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors or angiote... more Blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers has been shown to lessen the rate of decrease in glomerular filtration rate in patients with diabetic nephropathy. A multicenter open-label randomized controlled trial to compare the efficacy of combining the angiotensin-converting enzyme inhibitor lisinopril and the angiotensin II receptor blocker irbesartan with that of each drug in monotherapy (at both high and equipotent doses) in slowing the progression of type 2 diabetic nephropathy. 133 patients with type 2 diabetic nephropathy (age, 66 ± 8 years; 76% men) from 17 centers in Spain. Patients were randomly assigned (1:1:2) to lisinopril (n = 35), irbesartan (n = 28), or the combination of both (n = 70). The primary composite outcome was a >50% increase in baseline serum creatinine level, end-stage renal disease, or death. Baseline values for mean estimated glomerular filtration rate and blood pressure were 49 ± 21 mL/min/1.73 m(2) and 153 ± 19/81 ± 11 mm Hg. Mean geometric baseline proteinuria was protein excretion of 1.32 (95% CI, 1.10-1.62) g/g creatinine. After a median follow-up of 32 months, 21 (30%) patients in the combination group, 10 (29%) in the lisinopril group, and 8 (29%) in the irbesartan group reached the primary outcome. HRs were 0.96 (95% CI, 0.44-2.05; P = 0.9) and 0.90 (95% CI, 0.39-2.02; P = 0.8) for the combination versus the lisinopril and irbesartan groups, respectively. There were no significant differences in proteinuria reduction or blood pressure control between groups. The number of adverse events, including hyperkalemia, was similar in all 3 groups. The study was not double blind. The sample size studied was small. We were unable to show a benefit of the combination of lisinopril and irbesartan compared to either agent alone at optimal high doses on the risk of progression of type 2 diabetic nephropathy.
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
Retroperitoneal fibrosis is an uncommon disease that often presents in a subtle manner. Only a fe... more Retroperitoneal fibrosis is an uncommon disease that often presents in a subtle manner. Only a few cases of the combined association of generalized atherosclerosis and retroperitoneal fibrosis are reported in the recent literature, supporting the view that the condition is probably an autoimmune periaortitis. We describe a typical case of retroperitoneal fibrosis associated with generalized atherosclerosis with clinical presentation of progressive renal insufficiency, and claudication from arterial compromise.
Cardiovascular and metabolic risk factors represent potential targets for intervention. A good me... more Cardiovascular and metabolic risk factors represent potential targets for intervention. A good metabolic control, associated with control of blood pressure and cholesterol levels is proven to reduce the risk of cardiovascular disease among individuals with diabetes mellitus. To examine 2004-2005 medical records of adults with previously diagnosed diabetes and to evaluate the fulfillment of diabetes guidelines treatment, for the metabolic control and management of cardiovascular risk factors. We reviewed the data from the National Register of Diabetes (Tirana district), updated during this period. As guidelines we used the ADA 2006 Recommendations for metabolic control, HTA, lipid profile and aspirin therapy. We examined 7259 medical records. Only 14.58% of the patients had an HbA1c <7%. Central obesity was present in 39% of our patients. Overall, only 31.9% of our patients achieved the target for blood pressure (SBP<130 mmHg and DBP<80 mmHg). Two-third of our patients had total cholesterol >200 mg/dl. In total, only 5.5% of our patients attained recommended goals of cardiovascular risk factors for HbA1c, blood pressure and lipid profile. The follow-up of diabetic patients during the transient period in Albania is marked by a deterioration of diabetes metabolic control and poor management of cardiovascular risk factors. Further public health efforts are needed for better control of these risk factors among adults with diagnosed diabetes.
Blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors or angiote... more Blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers has been shown to lessen the rate of decrease in glomerular filtration rate in patients with diabetic nephropathy. A multicenter open-label randomized controlled trial to compare the efficacy of combining the angiotensin-converting enzyme inhibitor lisinopril and the angiotensin II receptor blocker irbesartan with that of each drug in monotherapy (at both high and equipotent doses) in slowing the progression of type 2 diabetic nephropathy. 133 patients with type 2 diabetic nephropathy (age, 66 ± 8 years; 76% men) from 17 centers in Spain. Patients were randomly assigned (1:1:2) to lisinopril (n = 35), irbesartan (n = 28), or the combination of both (n = 70). The primary composite outcome was a >50% increase in baseline serum creatinine level, end-stage renal disease, or death. Baseline values for mean estimated glomerular filtration rate and blood pressure were 49 ± 21 mL/min/1.73 m(2) and 153 ± 19/81 ± 11 mm Hg. Mean geometric baseline proteinuria was protein excretion of 1.32 (95% CI, 1.10-1.62) g/g creatinine. After a median follow-up of 32 months, 21 (30%) patients in the combination group, 10 (29%) in the lisinopril group, and 8 (29%) in the irbesartan group reached the primary outcome. HRs were 0.96 (95% CI, 0.44-2.05; P = 0.9) and 0.90 (95% CI, 0.39-2.02; P = 0.8) for the combination versus the lisinopril and irbesartan groups, respectively. There were no significant differences in proteinuria reduction or blood pressure control between groups. The number of adverse events, including hyperkalemia, was similar in all 3 groups. The study was not double blind. The sample size studied was small. We were unable to show a benefit of the combination of lisinopril and irbesartan compared to either agent alone at optimal high doses on the risk of progression of type 2 diabetic nephropathy.
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