Microsoft powerpoint - benigninafplio0309.ppt

Kidney proteomic analysis in
patients with diabetic
nephropathy
Ariela Benigni
Mario Negri Institute for Pharmacological Research Bergamo, Italy TYPE 2 DIABETES MELLITUS IS A PUBLIC HEALTH CONCERN
People with diabetes: (2004-2030)
* In million subjects
Developed
Developing
THE FACT
40 % of type 1 and of type 2 diabetics are
at risk of overt nephropathy
CARDIOVASCULAR EVENTS ARE PREDICTED BY
RENAL INSUFFICIENCY
1,120,295 adults2.84 years follow-up Rate of events
Estimated GFR (ml/min/1.73m2)
Insulin resistance/endothelial dysfunction
Albuminuria
Unselective proteinuria
Normoalbuminuria
UAE µg/min < 20
20 - 200
> 200
TYPE 2 DIABETIC ESRD INCIDENCE RATE
Changes from 1991 to 2000 (US)
Coresh et al., Nephrology Self-Assessment Program, 20056 BENEDICT
Normoalbuminuria
UAE µg/min < 20
20 - 200
> 200
The BENEDICT trial
Screened patients: 6.500
Included: 1.200
Placebo
(30 events)
(%)
Trandolapril plus
verapamil
Cumulative incidence
of microalbuminuria
(17 events)
Follow-up (months)
Ruggenenti et al., N Engl J Med,
Normoalbuminuria
UAE µg/min < 20
20 - 200
> 200
DEMAND: The Delapril and Manidipine for Nephroprotection A multicenter, prospective, randomized, double-blind, placebo-controlled, study in type 2 diabetic patients with hypertension 380 patients stratified according to normo- or microalbuminuria Normoalbuminuria
UAE µg/min < 20
20 - 200
> 200
VARIETY Trial
A prospective, randomized, open-label blinded end point trial to evaluate whether, at comparable blood pressure control, combined therapies with the ACE inhibitor benazepril and the angiotensin II receptor blocker valsartan, reduce the incidence of microalbuminuria more effectively than benazepril or valsartan alone in hypertensive patients with type 2 diabetes and high-normal albuminuria Normoalbuminuria
UAE µg/min < 20
20 - 200
> 200
VALID Trial
A randomized trial to assess the effects, at comparable blood pressure control, of dual renin-angiotensin blockade (RAS) by benazepril and valsartan combination therapy, as compared to single RAS blockade by benazepril or valsartan alone on ESRD and cardiovascular events in high-risk patients with type 2 diabetes and overt nephropathy. VARIETY, VALID trials
To characterize robust biomarkers that would help to identify patients with type 2 diabetes at risk of progressive renal injury and related cardiovascular events as well as for assessing response to treatment These slides are belonging to
Ariela Benigni, Ph.D.
Mario Negri Institute for Pharmacological
Research, Bergamo, Italy.
Using these slides is only authorized by
mentioning the source

Source: http://www.eurokup.org/sites/default/files/Benigni-Proteomics%20in%20Diabetic%20Nephrophathy_0.pdf