Diabetic Renal-Retinal Syndrome: 21st Century Management Now PDF
Preview Diabetic Renal-Retinal Syndrome: 21st Century Management Now
DIABETIC RENAL-RETINAL SYNDROME Diabetic Renal-Retinal Syndrome 21 st Century Management Now Editors Eli A. Friedman, M.D. Distinguished Teaching Professor Department of Medicine State University of New York Health Science Center at Brooklyn Brooklyn, NY, USA and Francis A. L'Esperance, Jr. M.D. Clinical Professor of Ophthalmology College of Physicians and Surgeons Columbia University New York, NY, USA SPRINGER-SCIENCE+BUSINESS MEDIA, B.V. A C.I.P. Catalogue record for this book is available from the Library of Congress ISBN 978-94-010-6083-7 ISBN 978-94-011-4962-4 (eBook) DOI 10.1007/978-94-011-4962-4 Printed on acid-free paper AII Rights Reserved © 1998 Springer Science+Business Media Oordrecht Originally published by Kluwer Academic Publishers in 1998 Softcover reprint of the hardcover 1st edition 1998 No part of the material protected by this copyright notice may be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or by any other information storage and retrieval system, without written permission from the copyright owner. Dedication Diabetes can be a horrific affliction that erodes the spirit while inducing bodily disintegration. Coping with the inexorable downhill course that typifies the Diabetic Renal-Retinal Syndrome induces depression, mutes ambition, and destroys hope. Some diabetic individuals, however, evince an inner strength that permits endurance through sequential disasters that reduce less resourceful sufferers to homebound invalidism. Mildred (Barry) Friedman never com- plained or resorted to self pity through a course of type 1 diabetes plagued by stroke, vision loss, myocardial infarction, autonomic neuropathy, peripheral vascular disease, and adrenal insufficiency. Despite obligated retirement from teaching, Barry continued to be intellectually vital, writing medical columns for the American Association of Kidney Patients while serving as a volunteer patient advocate at University Hospital of Brooklyn. Barry died in September 1997, seventeen years after receiving a kidney transplant for diabetic nephro- pathy, in the midst of preparing her latest report for patients on the impact of diabetic vasculopathy. In respect for and recognition of a life force that inspired others to deal with the impossible, we dedicate this book to Barry. E.A.F. F.A.L., Jr. Table of contents Foreword IX List of Contributors X111 1. Diabetes in the United States: epidemiology, scope and impact 1 M.I. Harris 2. Stages of diabetic nephropathy 13 C.E. Mogensen 3. Mesangial expansion in diabetic nephropathy: functional and genetic considerations 19 M. Maurer and P. Foiretto 4. Nephropathy in NIDDM - an update 27 E. Ritz and D. Fliser 5. Clinical imperatives in diabetic nephropathy: the devastating impact of comorbidity 41 E.A. Friedman 6. Dialysis in diabetic patients: three decades of experience, from 1964 to 1997 67 M.M. Avram 7. Hemodialysis in patients with diabetes mellitus 79 A.M. Miles 8. Continuous ambulatory peritoneal dialysis in 224 diabetics with end stage renal disease: evidence of improved survival over the past 10 years 89 P.S. Pasadakis and D.G. Oreopoulos 9. The natural history and classification of diabetic retinopathy 117 F.A. L'Esperance, Jr. 10. Long-term visual outcome of diabetic patients treated with pan- retinal photocoagulation 151 D.H. Berman, F.A. L'Esperance and E.A. Friedman 11. A new hypothesis on mechanisms of retinal vascular permeability in diabetes 169 T. W Gardner, E. Lieth, D.A. Antonetti and A.J. Barber viii 12. Angiogenesis in diabetic retinopathy: a history of accomplishment, discovery and promise 181 L.P. Aiello 13. Surgical management of proliferative diabetic retinopathy 197 S. T. Charles 14. Heart disease in patients with the diabetic renal-retinal syndrome: clinical considerations 211 L.T. Clark 15. NO and diabetic complications 223 R.F. Furchgott 16. AGE and the kidney: an update 233 H. Vlassara 17. Xenotransplantation of encapsulated porcine islets 243 A.M. Sun 18. Generation of non-immunogenic islet cells using genetic engineering 257 M. Brownlee 19. Insulin-independence for> 10 years in 32 pancreas transplant recipients from a historical era 267 J.S. Najarian, A.C. Gruessner, M.B. Drangsteveit, R. WS. Gruessner, F.C. Doet and D.E.R. Sutherland 20. Giving up: discontinuation of dialysis 269 C.M. Kjellstrand Index 279 Foreword - Inferences gleaned from twenty years of study of diabetic complications ELI A. FRIEDMAN & FRANCIS A. L'ESPERANCE Jr. Exactly twenty years has elapsed between the first Brooklyn conference explor- ing the Diabetic Renal-Retinal Syndrome and the proceedings contained in this volume, the fifth in the series held on 12-13 November 1979. The growing economic and resource burden imposed by complications of diabetes is evident from statistics compiled by the Health Care Finance Administration indicating that between the first and fifth conference the proportion of those with end- stage renal disease (ESRD) in the United States who had diabetes burgeoned from approximately 20% to 40%. Concurrently, the estimated prevalence of diabetes in the general population increased between the first and current symposium from 2.3% to 5.9%. After the 1979 symposium, we observed that "few data are available from which to construct a natural history of diabetic nephropathy in maturity onset diabetes." Since then, a clearer picture of the microvascular and macrovascular complica- tions of type 2 diabetes has emerged in the intervening 18 years. If there is a single overriding lesson to be learned from investigators conversant with dia- betic complications it is that type 2 diabetes is not a benign disorder. Documented within reports that follow is the pragmatic inference that the severity of microvascular and macrovascular complications of diabetes are equivalent in type 1 and type 2 diabetes. Microalbuminuria, proteinuria, azo- temia, and ESRD occur at the same incidence in both major diabetes types. Similarly, background and proliferative retinopathy are duration related in diabetes of either type. Neither renal pathologist nor ophthalmologist is able to distinguish diabetes type at any stage of deterioration leading to uremia and blindness. Gradually yielding to reality is the broadly held incorrect belief that individuals may have 'a touch of sugar' as a mild form of type 2 diabetes. Permeating presentations at the fifth symposium is overriding optimism that the 'problem' of diabetic complications can be solved. Having learned that intensified metabolic regulation and reduction of hypertensive blood pressure slows progression of retinopathy and nephropathy in type 1 and type 2 diabetes transformed contemporary treatment regimens to include these components of care. The next plateau in interdicting diabetic complications - blocking molec- ular perturbations induced by hyperglycemia - is foreshadowed in the discus- sion of advanced glycated endproducts (AGEs). Studies in progress, to be reported within the next two years, will assess the value of aminoguanidine, a E.A. Friedman and F.A. L'Esperance, Jr. (eds.), Diabetic Renal-Retinal Syndrome, ix-xi. © 1998 Kluwer Academic Publishers. x E. A. Friedman and F. A. L'Esperance Jr. chemical shown to prevent diabetic nephropathy by blocking synthesis of AGEs, in the streptozotocin induced diabetic rat, in the protein uric individual with type 1 and type 2 diabetes. Derivative studies of other AGE blockers herald intensifying recognition of the role of deranged molecular biological events in the pathogenesis of diabetic complications. Extrapolation from virtu- ally total success applying amino guanidine to arrest diabetic complications in rodent models is reason to anticipate that a reduction in diabetic complications is a truly attainable near-term objective. Changes in presentation of diabetic renal-retinal syndrome Variable 1979 1997 Incidence of diabetes Few data. Estimated 'crude' 798 000 new cases diagnosed in the US in annual incidence of 1996# 612000 cases in the US in Foreword xi Variable 1979 1997 Peritoneal dialysis Less than 20 % alive after About 60% of all diabetic patients alive 2 years at 2 years (higher mean age of subset)" Hemodialysis Approximately 50% alive About 60% of all diabetic patients alive after 2 years at 2 years (higher mean age of subset)* Cadaver donor kidney Patient survival about 50% Patient survival about 87% at 2 years; transplant at 3 years; graft function graft function 69% at 3 years" 35% at 3 years Living donor kidney Patient survival 75% at Patient survival 90% at 2 years; graft transplantation 3 years; graft function function 82% at 3 years" 68% at 3 years Islet transplants Promising outcome Sporadic clinical trials in patients, (induced diabetes is encapsulated islets under evaluation in curable) in rats China Pancreas Segmental grafts functioned World Pancreas Transplant Registry .... transplantation o to 415 days in a series indicates variable survival according to of 14 transplants in Lyon surgical technique; for simultaneous pancreas plus kidney with bladder drainage, 92% alive at 1 year with 79% pancreas graft function Prognosis for vision Uncertain. Ongoing trials High probability of retaining at least retention of panretinal ambulatory vision after laser treatment photocoagulation combined with reduction of intercalated with hypertensive blood pressure. vitrectomy promising Extent of rehabilitation Dismal during dialytic Poor during dialytic therapy. Substantive therapy. Marginal after a rehabilitation achieved in the majority kidney transplant of renal transplant recipients. Key issues Value of treating Best strategy for blocking effects of hypertension and striving noxious kinins and advanced for euglycemia. General glycosylated end-products (AGEs). survival. Wisdom of attempting organ replacement @ Bennet PH. Report of Workgroup on Epidemiology. National Commission on Diabetes, vol. 3, part 2. US Department of Health, Education, and Welfare Publication (NIH) 76-1022, 1976, pp 65-135. # Centers for Disease Control and Prevention. National Diabetes Fact Sheet: National estimates and general information on diabetes in the United States. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, 1997. * US Renal Data System, USRDS 1997 Annual Data Report, The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, April 1997. ** Gruessner A, Sutherland DE, Pancreas transplantation in the United States (US) and non-US as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR). in Clinical Transplants, 1996,1. Michael Cecka, Paull. Terasaki editors, UCLA Tissue Typing Laboratory, Los Angeles, 1997; pp 47-67. List of contributors L.P. AIELLO, M.D., Ph.D. D.H. BERMAN, M.D. Assistant Professor of Clinical Associate Professor Ophthalmology Department of Ophthalmology Beetham Eye Institute State University of New York Harvard Medical School Health Science Center at Brooklyn The Joslin Diabetes Center Director of Retina Service One Joslin Place The Brooklyn Hospital Center Boston, MA 02215, USA 240 Willoughby Street #6D Brooklyn, NY 11201, USA D.A. ANTIONETTI, Ph.D. CD. BROWN, M.D. Assistant Professor of Cellular and Assistant Professor of Medicine Molecular Physiology and SUNY, Health Science Center at Ophthalmology Brooklyn Departments of Ophthalmology, 450 Clarkson Avenue Cellular and Molecular Physiology Brooklyn, NY 11203, USA Penn State University College of M. BROWNLEE, M.D. Medicine Saltz Professor of Diabetes Research 500 University Drive Albert Einstein College of Medicine Hershey, PA 17033, USA Forch Heimer Room 529 1300 Morris Park Avenue M.M. AVRAM, M.D. Bronx, NY 10461, USA Professor of Medicine State University of New York S.T. CHARLES, M.D. Health Science Center at Brooklyn Clinical Professor of Ophthalmology Chief of Nephrology College of Medicine The Long Island College Hospital University of Tennessee 340 Henry Street 6401 Poplar Avenue Brooklyn, NY 11201, USA Suite 190 Memphis, TN 18119, USA A.J. BARBER, Ph.D. L.T. CLARK, M.D. Research Associate in Professor of Clinical Medicine Ophthalmology Chief Division of Cardiology Department of Ophthalmology Department of Medicine Penn State University College of SUNY, Health Science Center at Medicine Brooklyn 500 University Drive 450 Clarkson Avenue Hershey, PA 17033, USA Brooklyn, NY 11203, USA
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