The American journal of the medical sciences
-
Cancer is a leading cause of mortality in the United States. Despite much research on specific carcinogens, the cause of many cancers remains unclear. The identification of novel causative agents offers the potential for cancer prevention. ⋯ The reduced insulin levels seen with physical activity, weight loss, and a high fiber diet may account for decreased cancer risk. The role of newer drugs that restore sensitivity to insulin, thereby reducing hyperinsulinemia, is an exciting potential area of cancer prevention. In this review, we discuss the potential role of insulin as a tumor growth factor.
-
Diabetic nephropathy (DN) is the No. 1 cause of end-stage renal disease in the United States and is highly prevalent in African Americans. Almost all DN in African Americans is caused by type 2 diabetes. Glycemic control and control of blood pressure are essential to prolong renal survival and to protect against cardiovascular events. ⋯ In addition to gender, the development of albuminuria, family history, and possibly birth weight are factors that predict progression of renal disease in African Americans with DN. The impact of glycemic control, appropriate antihypertensives, and the optimal level of blood pressure control in African Americans with advanced DN require further study. This article will review the clinical characteristics, risk factors, predictors of disease progression, and treatment of diabetic nephropathy in African Americans.
-
Renal transplantation is the therapy of choice for patients with end-stage renal disease (ESRD). However, African Americans' (AA) access to this modality is not commensurate with that of other races. This imbalance, coupled with AA disproportionately representing those with ESRD, has kept AA disadvantaged compared with other races, especially whites. ⋯ ESRD management has improved dramatically with the advent of successful renal transplantation. However, AA remain significantly disadvantaged in both access and outcomes compared with whites. Further evaluation of underlying causes and development of specific remedies is warranted.
-
Focal segmental glomerulosclerosis (FSGS), the leading glomerular cause of the nephrotic syndrome among African Americans, is typically associated with edema, proteinuria, hypertension, microscopic hematuria, and renal insufficiency. Recent studies suggest that either the incidence of FSGS has increased or an increased number of biopsies of African American patients have made the diagnosis more common. ⋯ There are no randomized control trials of treatment regimens for FSGS. Steroids, alkylating agents, and cyclosporin have all been used with variable results to treat FSGS.