Atul Tiwari

extremamente importante prestar aten o preven o como prefer ncia ao tratamento da nefropatia diab tica. Quando a nefropatia se manifesta, a progress o n o pode ser evitada, apenas retardada. O indicador cl nico mais precoce de les o renal a microalbumin ria, que deve ser rastreada a intervalos regulares com testes sens veis. V rios estudos demonstram o efeito preventivo da redu o da glicemia nas complica es microvasculares da diabetes, incluindo a nefropatia, e servem de base para a nfase no controlo glic mico rigoroso em vez do controlo casual. Antes e especialmente ap s o in cio da nefropatia precoce, o controlo da press o arterial fundamental para prevenir ou retardar a progress o da les o renal. Os agentes de primeira escolha para o tratamento da microalbumin ria s o os inibidores da ECA. O enalapril tem um efeito antiprotein rico independente do efeito sobre a press o arterial sist mica. O tratamento com enalapril pode reduzir a taxa de decl nio da fun o renal em doentes com nefropatia diab tica mais do que um tratamento anti-hipertensivo igualmente eficaz com metoprolol. Isto aponta para um efeito protetor renal espec fico dos inibidores da enzima de convers o da angiotensina na nefropatia diab tica.

Di fondamentale importanza l'attenzione alla prevenzione, preferibile al trattamento della nefropatia diabetica. Una volta che la nefropatia evidente, la progressione non pu essere evitata, ma solo ritardata. L'indicatore clinico pi precoce del danno renale la microalbuminuria, che deve essere controllata a intervalli regolari con test sensibili. Diversi studi dimostrano l'effetto preventivo della riduzione della glicemia sulle complicanze microvascolari del diabete, compresa la nefropatia, e costituiscono il razionale per l'enfasi sul controllo glicemico stretto piuttosto che casuale. Prima e soprattutto dopo l'insorgenza della nefropatia precoce, il controllo della pressione arteriosa fondamentale per prevenire o rallentare la progressione del danno renale. Gli agenti di prima scelta per il trattamento della microalbuminuria sono gli ACE-inibitori. L'enalapril ha un effetto antiproteinurico indipendente dall'effetto sulla pressione arteriosa sistemica. Il trattamento con enalapril pu ridurre il tasso di declino della funzione renale nei pazienti con nefropatia diabetica pi di un trattamento antipertensivo altrettanto efficace con metoprololo. Ci indica uno specifico effetto protettivo renale degli inibitori dell'enzima di conversione dell'angiotensina nella nefropatia diabetica.

Es ist von entscheidender Bedeutung, der Vorbeugung gegen ber der Behandlung der diabetischen Nephropathie den Vorzug zu geben. Wenn eine manifeste Nephropathie vorliegt, kann das Fortschreiten der Erkrankung nicht verhindert, sondern nur verz gert werden. Der fr heste klinische Indikator f r eine Nierensch digung ist die Mikroalbuminurie, die in regelm igen Abst nden mit empfindlichen Tests untersucht werden sollte. Mehrere Studien belegen die vorbeugende Wirkung einer Senkung des Blutzuckerspiegels auf die mikrovaskul ren Komplikationen von Diabetes, einschlie lich Nephropathie, und dienen als Begr ndung f r die Betonung einer engen statt einer lockeren Blutzuckerkontrolle. Vor und insbesondere nach dem Auftreten einer fr hen Nephropathie ist die Blutdruckkontrolle entscheidend, um das Fortschreiten von Nierensch den zu verhindern oder zu verlangsamen. Mittel der ersten Wahl zur Behandlung von Mikroalbuminurie sind ACE-Hemmer. Enalapril hat eine antiproteinurische Wirkung, die unabh ngig von der Wirkung auf den systemischen Blutdruck ist. Die Behandlung mit Enalapril kann die Rate der Verschlechterung der Nierenfunktion bei Patienten mit diabetischer Nephropathie st rker reduzieren als eine ebenso wirksame blutdrucksenkende Behandlung mit Metoprolol. Dies deutet auf eine spezifische nierensch tzende Wirkung von Angiotensin-Converting-Enzym-Hemmern bei diabetischer Nephropathie hin.

Il est essentiel de privil gier la pr vention plut t que le traitement de la n phropathie diab tique. Une fois que la n phropathie est manifeste, la progression ne peut tre vit e, mais seulement retard e. Le premier indicateur clinique des l sions r nales est la microalbuminurie, qui doit tre d pist e intervalles r guliers l'aide de tests sensibles. Plusieurs tudes d montrent l'effet pr ventif d'une baisse de la glyc mie sur les complications microvasculaires du diab te, y compris la n phropathie, et justifient l'importance accord e un contr le glyc mique rigoureux plut t qu'occasionnel. Avant et surtout apr s l'apparition d'une n phropathie pr coce, le contr le de la pression art rielle est essentiel pour pr venir ou ralentir la progression des l sions r nales. Les agents de premier choix pour le traitement de la microalbuminurie sont les inhibiteurs de l'ECA. L' nalapril a un effet antiprot inurique ind pendant de l'effet sur la pression art rielle syst mique. Le traitement l' nalapril peut r duire le taux de d clin de la fonction r nale chez les patients atteints de n phropathie diab tique de mani re plus importante qu'un traitement antihypertenseur d'efficacit gale base de m toprolol. Cela indique un effet protecteur r nal sp cifique des inhibiteurs de l'enzyme de conversion de l'angiotensine dans la n phropathie diab tique.

Polymers have emerged as one of the most innovative classes of materials in modern materials science, leading to new applications in medicine and pharmacy. This book offers a convincing and understandable approach to polymer biomaterial devices being used in various areas related to biomedical and pharmaceutical fields. The polymer materials finding application as biomaterials are discussed and described in detail pertaining to the areas of artificial implants, orthopedics, ocular devices, dental implants, drug delivery systems, burns and wounds.

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Polymers have emerged as one of the most innovative classes of materials in modern materials science, leading to new applications in medicine and pharmacy. This book offers a convincing and understandable approach to polymer biomaterial devices being used in various areas related to biomedical and pharmaceutical fields. The polymer materials finding application as biomaterials are discussed and described in detail pertaining to the areas of artificial implants, orthopedics, ocular devices, dental implants, drug delivery systems, burns and wounds.

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