Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Jan 1998
ReviewEfficacy of antihypertensive therapy in decreasing renal and cardiovascular complications in diabetes mellitus.
The mechanism underlying the pathogenesis of microangiopathy and macroangiopathy in diabetes mellitus is hypothesized to be chronic hyperglycaemia. However, the values of blood glucose at which chronic diabetic complications develop at the renal and cardiac level are quite different. It is not clear whether this is due to different responses of kidney and heart tissues to the metabolic challenge of diabetes, or to the simultaneous role of other mechanisms contributing differently to the pathogenesis of chronic diabetic complications in renal and cardiac tissues. ⋯ We extensively reviewed the available literature which reported comparisons between angiotensin-converting enzyme inhibitors (ACE inhibitors) and calcium channel blockers (CCBs) in the treatment of arterial hypertension in diabetes. Intensified antihypertensive therapy achieving a blood pressure level below 130/85 mmHg has been shown to be useful in decreasing the rate of occurrence of chronic diabetic complications in diabetes mellitus. Both ACE inhibitors and CCBs have been shown to significantly improve the course of renal function in diabetic patients with incipient and overt nephropathy.
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Nephrol. Dial. Transplant. · Jan 1998
Anatomical variation of the internal jugular vein and its impact on temporary haemodialysis vascular access: an ultrasonographic survey in uraemic patients.
Creation of a reliable haemoaccess is a critical problem for practicing nephrologists once haemodialysis has been considered. A double-lumen internal jugular-vein catheter is favoured in most cases requiring temporary haemoaccess. However, numerous complications, even lethal ones, may occur with the cannulating procedure. Using ultrasound, we attempted to describe the occult anatomical variations of vessels which may be responsible for complications. ⋯ The external anatomical landmarks for cannulating the IJV are not reliable in about one-quarter of uraemic patients. An ultrasound survey on the IJV anatomy is recommended for selecting proper puncture site and reducing risks of insertion complications for IJV dialysis catheters.