Claudete Maria Zanatta

Endothelin-1 levels and albuminuria in patients with type 2 diabetes mellitus☆

AIM To evaluate the relationship of plasma endothelin-1 (ET-1) levels, a marker of endothelial dysfunction, and urinary albumin excretion in patients with type 2 diabetes mellitus (DM). METHODS Cross-sectional study was conducted in 279 patients (132 males, mean age: 58.7+/-11.0 years, mean DM duration: 11.3+/-8.1 years). Urinary albumin excretion, ET-1, and insulin were measured. Insulin sensitivity was estimated by homeostasis model assessment (HOMA-ir) index. RESULTS ET-1 was associated with urinary albumin excretion after controlling for age, gender, body mass index, blood pressure, HbA1c test, and total cholesterol (R=0.436; adjusted R(2)=0.190, P<0.01). Furthermore, there was a progressive increase in plasma ET-1 levels from patients with normoalbuminuria (n=187, 0.92+/-0.50pg/ml), microalbuminuria (n=68, 1.13+/-0.52pg/ml) to macroalbuminuria (n=24, 1.93+/-1.10pg/ml, P<0.01). CONCLUSION There is an independent association of plasma ET-1 levels with urinary albumin excretion. In addition, plasma ET-1 levels started to increase in the normal values of urinary albumin excretion suggesting that in patients with type 2 DM endothelial dysfunction is already present, in urinary albumin excretion values considered normal.

Endothelin-1 and Endothelin A Receptor Immunoreactivity Is Increased in Patients with Diabetic Nephropathy

Background: Endothelin-1 (ET-1) is associated with progression of renal disease, acting as a vasoconstrictor and growth factor for mesangial cells. ET-1 and endothelin A receptor (ET-RA) might have a role in the development of diabetic nephropathy (DN). The aims of this study were to determine ET-1 and ET-RA expressions in patients with DN and to correlate these expressions with renal function and proteinuria. Materials and methods: This is a cross-sectional study comprising 13 patients with type 2 diabetes mellitus and DN, 10 patients with proteinuric IgA nephropathy, and 13 samples of normal kidney from tumor nephrectomies. Demographic and selected data were collected from medical charts. The distribution and intensity of ET-1 and ET-RA immunostaining in renal biopsies were determined by immunohistochemistry and these correlated with the estimated glomerular filtration rate (eGFR) and proteinuria. Results: Patients with DN and IgA nephropathy on biopsy had markedly increased staining for ET-1 in endothelial cells of glomerular and peritubular capillaries when compared with controls (p < 0.001). ET-RA staining was also more intense and more diffuse in DN and IgA nephropathy than in controls (p = 0.019) and was restricted to tubular epithelial cells. A positive correlation was observed between ET-1 expression and proteinuria (r = 0.634, p = 0.027), but both ET-1 and ET-RA expressions did not correlate with eGFR. Conclusion: In this preliminary report, the higher expressions of ET-1 and ET-RA found in both DN and IgA nephropathy suggest a potential role for the endothelin system in DN as well as in other nondiabetic glomerular diseases.

Papel do sistema endotelina na nefropatia diabética

Endothelin System Function in Diabetic Nephropathy. Diabetic Nephropathy (DN) is a major chronic complication of diabetes mellitus (DM), and one of the main causes of new cases for dialysis, being associated with increasing mortality. The main risk factors for DN are hypertension, hyperglycemia, dyslipidemia, and genetic susceptibility. The renin-angiotensin system (RAS) plays an important role in genesis and progression of DN and there is evidence of an interrelationship between this system and the endothelins. Endothelins are powerful vasoconstrictor peptides and act as modulators of vasomotor tone, cell proliferation, and hormone production. These peptides act through two types of receptors (ET-A and ET-B) and are expressed on endothelial cells and vascular smooth-muscle cells. Activation of this receptor in renal cells leads to a complex signaling cascade resultanting in stimulation of mesangial cell hypertrophy, proliferation, contraction, and extracellular matrix accumulation. These hemodinamic renal alterations are associated with the onset and progress of renal disease in DM. Elevated endothelin-1 (ET-1) levels have been reported in patients with DM. There is evidence suggesting that an increase in the production of ET-1 leads to glomerular damage. The use of ET receptor antagonists has been reported as renoprotective, correcting the early hemodynamic abnormalities in experimental DM, reinforcing the importance of this system in DN. (Arq Bras Endocrinol Metab 2008; 52/4:581-588)

Controle inadequado da pressão arterial em pacientes com diabete melito tipo 2

BACKGROUND There is evidence indicating that blood pressure control is more effective in reducing macrovascular complications of diabetes mellitus (DM) than glycemic control. However, the reduction in BP to levels recommended by international guidelines is difficult in clinical practice. OBJECTIVE To assess the percentage of patients with both type 2 diabetes and hypertension (HBP) assisted in a tertiary hospital with adequate blood pressure control and to determine the clinical and laboratory factors related. METHODS Cross-sectional study with 348 patients with type 2 diabetes and hypertension assisted in the outpatient clinic of Endocrinology, Hospital de Clínicas de Porto Alegre. Patients underwent history assessment, physical examination, with measurement of blood pressure (BP), and samples were collected from blood and urine for laboratory analysis. Patients were divided into 3 three groups: optimal (< 130/80 mmHg), regular (130-139/80-89 mmHg) or inadequate blood pressure control (> or = 140/90 mmHg). RESULTS The mean age was 61.2 +/- 10.1 years (46% men, 80% white) and DM duration, 14.8 +/- 9.5 years. Eighteen per cent of the patients studied, 17% of patients had optimal BP value, 22% regular BP value and 61% inadequate BP value. Patients with inadequate BP control had longer diabetes duration, waist circumference and fasting glucose. The other variables were similar in 3 groups. CONCLUSION Most patients assessed had inadequate BP control. Higher BP values are associated with an adverse clinical profile, represented by longer diabetes duration, abdominal obesity, higher fasting glucose and chronic complications of diabetes.Resumen Fundamento: Hay evidencias indicando que el control de presion es mas efectivo en la reduccion de complicaciones macrovasculares de la diabetes melito (DM) que el control glucemico. Sin embargo, la reduccion de la PA para los niveles recomendados por las directrices es dificil en la practica clinica.Objetivo: Evaluar el porcentual de pacientes que presentaban simultaneamente DM tipo 2 y hipertension arterial sistemica (HAS), atendidos en hospital terciario, con control de presion adecuado, y determinar los factores clinicos y laboratoriales asociados.Metodos: Estudio transversal con 348 pacientes con DM tipo 2 y HAS atendidos en el ambulatorio de Endocrinologia del Hospital de Clinicas de Porto Alegre. Los pacientes fueron sometidos a anamnesis, examen fisico, con medicion de la presion arterial (PA), y se recolecto muestra de sangre y orina para analisis laboratorial. Los pacientes se dividieron en tres grupos: control de presion ideal (< 130/80 mmHg), regular (130-139/80-89 mmHg) o inadecuado (≥ 140/90 mmHg).Resultados: El promedio de edad fue de 61,2 ± 10,1 anos (el 46% hombre, 80% blanco) y la duracion del DM, 14,8 ± 9,5 anos. Del total de pacientes, el 17% expresaba valores ideales de PA, el 22% regular y el 61% inadecuados. Los pacientes con control inadecuado de la PA expresaban mayor duracion del DM, cintura abdominal y glucemia de ayuno. Las demas variables se asemejaron en los tres grupos.Conclusion: La mayoria de los pacientes evaluados presento control inadecuado de la PA. Valores mas elevados de PA estan asociados a un perfil clinico adverso, representado por mayor duracion del DM, obesidad abdominal, mayor glucemia de ayuno y complicaciones cronicas del DM. (Arq Bras Cardiol 2010;94(5):633-637)Palabras clave: Presion arterial, diabetes mellitus, obesidad, circunferencia abdominal, complicaciones de la diabetes.continua y para cada descenso de 10 mmHg en la PA sistolica se observa una reduccion promedia del 24% en el riesgo de cualquier complicacion relacionada al DM; del 32% en la mortalidad relacionada al DM; del 44% en los accidentes vasculares encefalicos y del 37% en las complicaciones microvasculares del DM

Inadequate blood pressure control in patients with type 2 diabetes mellitus

BACKGROUND There is evidence indicating that blood pressure control is more effective in reducing macrovascular complications of diabetes mellitus (DM) than glycemic control. However, the reduction in BP to levels recommended by international guidelines is difficult in clinical practice. OBJECTIVE To assess the percentage of patients with both type 2 diabetes and hypertension (HBP) assisted in a tertiary hospital with adequate blood pressure control and to determine the clinical and laboratory factors related. METHODS Cross-sectional study with 348 patients with type 2 diabetes and hypertension assisted in the outpatient clinic of Endocrinology, Hospital de Clínicas de Porto Alegre. Patients underwent history assessment, physical examination, with measurement of blood pressure (BP), and samples were collected from blood and urine for laboratory analysis. Patients were divided into 3 three groups: optimal (< 130/80 mmHg), regular (130-139/80-89 mmHg) or inadequate blood pressure control (> or = 140/90 mmHg). RESULTS The mean age was 61.2 +/- 10.1 years (46% men, 80% white) and DM duration, 14.8 +/- 9.5 years. Eighteen per cent of the patients studied, 17% of patients had optimal BP value, 22% regular BP value and 61% inadequate BP value. Patients with inadequate BP control had longer diabetes duration, waist circumference and fasting glucose. The other variables were similar in 3 groups. CONCLUSION Most patients assessed had inadequate BP control. Higher BP values are associated with an adverse clinical profile, represented by longer diabetes duration, abdominal obesity, higher fasting glucose and chronic complications of diabetes.Resumen Fundamento: Hay evidencias indicando que el control de presion es mas efectivo en la reduccion de complicaciones macrovasculares de la diabetes melito (DM) que el control glucemico. Sin embargo, la reduccion de la PA para los niveles recomendados por las directrices es dificil en la practica clinica.Objetivo: Evaluar el porcentual de pacientes que presentaban simultaneamente DM tipo 2 y hipertension arterial sistemica (HAS), atendidos en hospital terciario, con control de presion adecuado, y determinar los factores clinicos y laboratoriales asociados.Metodos: Estudio transversal con 348 pacientes con DM tipo 2 y HAS atendidos en el ambulatorio de Endocrinologia del Hospital de Clinicas de Porto Alegre. Los pacientes fueron sometidos a anamnesis, examen fisico, con medicion de la presion arterial (PA), y se recolecto muestra de sangre y orina para analisis laboratorial. Los pacientes se dividieron en tres grupos: control de presion ideal (< 130/80 mmHg), regular (130-139/80-89 mmHg) o inadecuado (≥ 140/90 mmHg).Resultados: El promedio de edad fue de 61,2 ± 10,1 anos (el 46% hombre, 80% blanco) y la duracion del DM, 14,8 ± 9,5 anos. Del total de pacientes, el 17% expresaba valores ideales de PA, el 22% regular y el 61% inadecuados. Los pacientes con control inadecuado de la PA expresaban mayor duracion del DM, cintura abdominal y glucemia de ayuno. Las demas variables se asemejaron en los tres grupos.Conclusion: La mayoria de los pacientes evaluados presento control inadecuado de la PA. Valores mas elevados de PA estan asociados a un perfil clinico adverso, representado por mayor duracion del DM, obesidad abdominal, mayor glucemia de ayuno y complicaciones cronicas del DM. (Arq Bras Cardiol 2010;94(5):633-637)Palabras clave: Presion arterial, diabetes mellitus, obesidad, circunferencia abdominal, complicaciones de la diabetes.continua y para cada descenso de 10 mmHg en la PA sistolica se observa una reduccion promedia del 24% en el riesgo de cualquier complicacion relacionada al DM; del 32% en la mortalidad relacionada al DM; del 44% en los accidentes vasculares encefalicos y del 37% en las complicaciones microvasculares del DM

Control inadecuado de la presión arterial en pacientes con diabetes melito tipo 2

BACKGROUND There is evidence indicating that blood pressure control is more effective in reducing macrovascular complications of diabetes mellitus (DM) than glycemic control. However, the reduction in BP to levels recommended by international guidelines is difficult in clinical practice. OBJECTIVE To assess the percentage of patients with both type 2 diabetes and hypertension (HBP) assisted in a tertiary hospital with adequate blood pressure control and to determine the clinical and laboratory factors related. METHODS Cross-sectional study with 348 patients with type 2 diabetes and hypertension assisted in the outpatient clinic of Endocrinology, Hospital de Clínicas de Porto Alegre. Patients underwent history assessment, physical examination, with measurement of blood pressure (BP), and samples were collected from blood and urine for laboratory analysis. Patients were divided into 3 three groups: optimal (< 130/80 mmHg), regular (130-139/80-89 mmHg) or inadequate blood pressure control (> or = 140/90 mmHg). RESULTS The mean age was 61.2 +/- 10.1 years (46% men, 80% white) and DM duration, 14.8 +/- 9.5 years. Eighteen per cent of the patients studied, 17% of patients had optimal BP value, 22% regular BP value and 61% inadequate BP value. Patients with inadequate BP control had longer diabetes duration, waist circumference and fasting glucose. The other variables were similar in 3 groups. CONCLUSION Most patients assessed had inadequate BP control. Higher BP values are associated with an adverse clinical profile, represented by longer diabetes duration, abdominal obesity, higher fasting glucose and chronic complications of diabetes.Resumen Fundamento: Hay evidencias indicando que el control de presion es mas efectivo en la reduccion de complicaciones macrovasculares de la diabetes melito (DM) que el control glucemico. Sin embargo, la reduccion de la PA para los niveles recomendados por las directrices es dificil en la practica clinica.Objetivo: Evaluar el porcentual de pacientes que presentaban simultaneamente DM tipo 2 y hipertension arterial sistemica (HAS), atendidos en hospital terciario, con control de presion adecuado, y determinar los factores clinicos y laboratoriales asociados.Metodos: Estudio transversal con 348 pacientes con DM tipo 2 y HAS atendidos en el ambulatorio de Endocrinologia del Hospital de Clinicas de Porto Alegre. Los pacientes fueron sometidos a anamnesis, examen fisico, con medicion de la presion arterial (PA), y se recolecto muestra de sangre y orina para analisis laboratorial. Los pacientes se dividieron en tres grupos: control de presion ideal (< 130/80 mmHg), regular (130-139/80-89 mmHg) o inadecuado (≥ 140/90 mmHg).Resultados: El promedio de edad fue de 61,2 ± 10,1 anos (el 46% hombre, 80% blanco) y la duracion del DM, 14,8 ± 9,5 anos. Del total de pacientes, el 17% expresaba valores ideales de PA, el 22% regular y el 61% inadecuados. Los pacientes con control inadecuado de la PA expresaban mayor duracion del DM, cintura abdominal y glucemia de ayuno. Las demas variables se asemejaron en los tres grupos.Conclusion: La mayoria de los pacientes evaluados presento control inadecuado de la PA. Valores mas elevados de PA estan asociados a un perfil clinico adverso, representado por mayor duracion del DM, obesidad abdominal, mayor glucemia de ayuno y complicaciones cronicas del DM. (Arq Bras Cardiol 2010;94(5):633-637)Palabras clave: Presion arterial, diabetes mellitus, obesidad, circunferencia abdominal, complicaciones de la diabetes.continua y para cada descenso de 10 mmHg en la PA sistolica se observa una reduccion promedia del 24% en el riesgo de cualquier complicacion relacionada al DM; del 32% en la mortalidad relacionada al DM; del 44% en los accidentes vasculares encefalicos y del 37% en las complicaciones microvasculares del DM