DOCSLIB.ORG

Nephropathy in Diabetes

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Nephropathy in Diabetes POSITION STATEMENT Nephropathy in Diabetes AMERICAN DIABETES ASSOCIATION iabetes has become the most com- detection, prevention, and treatment of abetic patients with microalbuminuria mon single cause of end-stage renal early nephropathy. progress to overt nephropathy, but by 20 D disease (ESRD) in the U.S. and Eu- years after onset of overt nephropathy, ϳ rope; this is due to the facts that 1) dia- NATURAL HISTORY OF only 20% will have progressed to betes, particularly type 2, is increasing in DIABETIC NEPHROPATHY — ESRD. Once the GFR begins to fall, the prevalence; 2) diabetes patients now live The earliest clinical evidence of nephrop- rates of fall in GFR are again highly vari- longer; and 3) patients with diabetic ESRD athy is the appearance of low but abnor- able from one individual to another, but are now being accepted for treatment in mal levels (Ն 30 mg/day or 20 ␮g/min) of overall, they may not be substantially dif- ESRD programs where formerly they had albumin in the urine, referred to as mi- ferent between patients with type 1 and been excluded. In the U.S., diabetic ne- croalbuminuria, and patients with mi- patients with type 2 diabetes. However, phropathy accounts for about 40% of new croalbuminuria are referred to as having the greater risk of dying from associated cases of ESRD, and in 1997, the cost for incipient nephropathy. Without specific coronary artery disease in the older pop- treatment of diabetic patients with ESRD interventions, ϳ80% of subjects with ulation with type 2 diabetes may prevent many with earlier stages of nephropathy was in excess of $15.6 billion. About 20– type 1 diabetes who develop sustained from progressing to ESRD. As therapies 30% of patients with type 1 or type 2 di- microalbuminuria have their urinary al- and interventions for coronary artery dis- abetes develop evidence of nephropathy, bumin excretion increase at a rate of ϳ10–20% per year to the stage of overt ease continue to improve, however, more but in type 2 diabetes, a considerably patients with type 2 diabetes may be ex- smaller fraction of these progress to nephropathy or clinical albuminuria Ն Ն ␮ pected to survive long enough to develop ESRD. However, because of the much ( 300 mg/24 h or 200 g/min) over a period of 10–15 years, with hypertension renal failure. greater prevalence of type 2 diabetes, such In addition to its being the earliest patients constitute over half of those dia- also developing along the way. Once overt nephropathy occurs, without specific in- manifestation of nephropathy, albumin- betic patients currently starting on dialy- uria is a marker of greatly increased car- sis. There is considerable racial/ethnic terventions, the glomerular filtration rate (GFR) gradually falls over a period of sev- diovascular morbidity and mortality for variability in this regard, with Native patients with either type 1 or type 2 dia- Americans, Hispanics (especially Mexi- eral years at a rate that is highly variable from individual to individual (2–20 ml ⅐ betes. Thus, the finding of microalbumin- can-Americans), and African-Americans Ϫ Ϫ min 1 ⅐ year 1). ESRD develops in 50% uria is an indication for screening for having much higher risks of developing of type 1 diabetic individuals with overt possible vascular disease and aggressive ESRD than non-Hispanic whites with nephropathy within 10 years and in intervention to reduce all cardiovascular type 2 diabetes. Recent studies have now Ͼ75% by 20 years. risk factors (e.g., lowering of LDL choles- demonstrated that the onset and course of A higher proportion of individuals terol, antihypertensive therapy, cessation diabetic nephropathy can be ameliorated with type 2 diabetes are found to have of smoking, institution of exercise, etc.). to a very significant degree by several in- microalbuminuria and overt nephropa- In addition, there is some preliminary ev- terventions, but these interventions have thy shortly after the diagnosis of their di- idence to suggest that lowering of choles- their greatest impact if instituted at a abetes, because diabetes is actually terol may also reduce the level of point very early in the course of the de- present for many years before the diagno- proteinuria. velopment of this complication. This po- sis is made and also because the presence sition statement is based on recent review of albuminuria may be less specific for the SCREENING FOR articles that discuss published research presence of diabetic nephropathy, as ALBUMINURIA — A test for the and issues that remain unresolved and shown by biopsy studies. Without spe- presence of microalbumin should be per- provides recommendations regarding the cific interventions, 20–40% of type 2 di- formed at diagnosis in patients with type 2 ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● diabetes. Microalbuminuria rarely occurs The recommendations in this paper are based on the evidence reviewed in the following publications: with short duration of type 1 diabetes; Diabetic nephropathy: etiologic and therapeutic considerations. Diabetes Rev 3:510–564, 1995; and Pre- therefore, screening in individuals with type vention of diabetic renal disease with special reference to microalbuminuria. Lancet 346:1080–1084, 1995. The initial draft of this paper was prepared by Mark E. Molitch, MD (chair); Ralph A. DeFronzo, MD; Marion 1 diabetes should begin after 5 years’ disease J. Franz, MS, RD, CDE; William F. Keane, MD; Carl Erik Mogensen, MD; Hans-Henrik Parving, MD; and Michael duration. Some evidence suggests that the W. Steffes, MD, PhD. The paper was peer-reviewed, modified, and approved by the Professional Practice Com- prepubertal duration of diabetes may be im- mittee and the Executive Committee, November 1996. Most recent review/revision, October 2001. portant in the development of microvascu- Abbreviations: ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; DCCB, dihy- dropyridine calcium channel blocker; ESRD, end-stage renal disease: GFR, glomerular filtration rate; lar complications; therefore, clinical UKPDS, United Kingdom Prospective Diabetes Study. judgement should be exercised when indi- © 2004 by the American Diabetes Association. vidualizing these recommendations. Be- DIABETES CARE, VOLUME 27, SUPPLEMENT 1, JANUARY 2004 S79 Position Statement Table 1—Definitions of abnormalities in albumin excretion tension is usually caused by underlying diabetic nephropathy and typically be- Spot collection 24-h collection Timed collection comes manifest about the time that pa- Category (␮g/mg creatinine) (mg/24 h) (␮g/min) tients develop microalbuminuria. In patients with type 2 diabetes, hyperten- Normal Ͻ30 Ͻ30 Ͻ20 sion is present at the time of diagnosis of Microalbuminuria 30–299 30–299 20–199 diabetes in about one-third of patients. Clinical albuminuria Ն300 Ն300 Ն200 The common coexistence of glucose in- Because of variability in urinary albumin excretion, two of three specimens collected within a 3- to 6-month tolerance, hypertension, elevated LDL period should be abnormal before considering a patient to have crossed one of these diagnostic thresholds. cholesterol and triglycerides, and a reduc- Exercise within 24 h, infection, fever, congestive heart failure, marked hyperglycemia, marked hypertension, tion in HDL cholesterol, obesity, and sus- pyuria, and hematuria may elevate urinary albumin excretion over baseline values. ceptibility to cardiovascular disease suggests that they may relate to common underlying mechanisms, such as insulin cause of the difficulty in precise dating of to-creatinine ratio does, they are subject resistance; and this complex is often re- the onset of type 2 diabetes, such screening to possible errors from alterations in urine ferred to as syndrome X and/or the meta- should begin at the time of diagnosis. After concentration. All positive tests by re- bolic syndrome. Hypertension in type 2 the initial screening and in the absence of agent strips or tablets should be con- diabetic patients may also be related to previously demonstrated microalbumin- firmed by more specific methods. There is underlying diabetic nephropathy, be due uria, a test for the presence of microalbumin also marked day-to-day variability in al- to coexisting “essential” hypertension, or should be performed annually. bumin excretion, so at least two of three be due to a myriad of other secondary Screening for microalbuminuria can collections done in a 3- to 6-month period causes, such as renal vascular disease. Iso- be performed by three methods: 1) mea- should show elevated levels before desig- lated systolic hypertension has been at- surement of the albumin-to-creatinine ra- nating a patient as having microalbumin- tributed to the loss of elastic compliance tio in a random spot collection; 2) 24-h uria. An algorithm for microalbuminuria of atherosclerotic large vessels. In general, collection with creatinine, allowing the si- screening is given in Fig. 1. the hypertension in patients with both multaneous measurement of creatinine The role of annual microalbuminuria types of diabetes is associated with an ex- clearance; and 3) timed (e.g., 4-h or over- assessment is less clear after diagnosis of panded plasma volume, increased pe- night) collection. The first method is often microalbuminuria and institution of an- ripheral vascular resistance, and low found to be the easiest to carry out in an giotensin-converting enzyme (ACE) in- renin activity. office setting, generally provides accurate hibitor or angiotensin receptor blocker Both systolic and diastolic hyperten- information,
Load more

Recommended publications
  • Acute Renal Failure in Patients with Type 1 Diabetes Mellitus G
    Postgrad Med J: first published as 10.1136/pgmj.70.821.192 on 1 March 1994. Downloaded from Postgrad Med J (1994) 70, 192- 194 C) The Fellowship of Postgraduate Medicine, 1994 Acute renal failure in patients with type 1 diabetes mellitus G. Woodrow, A.M. Brownjohn and J.H. Turney Renal Unit, Leeds General Infirmary, Great George Street, Leeds LSJ 3EX, UK Summary: Acute renal failure (ARF) is a serious condition which still carries a mortality of around 50%. People with diabetes may be at increased risk of developing ARF, either as a complication of diabetic ketoacidosis or hyperosmolar coma, increased incidence of cardiovascular disease, or due to increased susceptibility ofthe kidney to adverse effects in the presence ofunderlying diabetic renal disease. During the period 1956-1992, 1,661 cases of ARF have been treated at Leeds General Infirmary. Of these, we have identified 26 patients also having type 1 diabetes. ARF due to diabetic ketoacidosis is surprisingly uncommon (14 cases out of 23 patients whose notes were reviewed). All cases of ARF complicating ketoacidosis in the last decade have been associated with particularly severe illness requiring intensive care unit support, rather than otherwise 'uncomplicated' ketoacidosis. We discuss the conditions that may result in ARF in patients with diabetes and the particular difficulties that may be encountered in management. Introduction People with diabetes may be at increased risk of Results developing acute renal failure (ARF). Acute pre- copyright. renal failure may occur as a result ofthe severe fluid Of 23 patients with type 1 diabetes complicated by depletion associated with diabetic ketoacidosis and ARF, diabetic ketoacidosis was the main underly- non-ketotic hyperosmolar coma.
    [Show full text]
  • Effect of Biochemical Parameters Showing Atherogenicity in Type 2 Diabetic Nephropathy
    International Journal of Basic and Applied Chemical Sciences ISSN: 2277-2073 (Online) An Online International Journal Available at http://www.cibtech.org/jcs.htm 2012 Vol. 2 (4) October-December pp.26-30/Raja and Shaker Research Article EFFECT OF BIOCHEMICAL PARAMETERS SHOWING ATHEROGENICITY IN TYPE 2 DIABETIC NEPHROPATHY *G. Raja and Ivvala Anand Shaker *Department of Biochemistry, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur-603319, Tamil Nadu, India *Author for Correspondence ABSTRACT Diabetic nephropathy is one of the major complications of diabetes mellitus characterized by frequent microalbuminuria, elevated arterial blood pressure, a persistent decline in glomerular filtration rate and a high risk of cardiovascular morbidity and mortality. The study comprised of 30 Diabetic mellitus (DM) with microalbuminuria patients (Group 3), 30 DM without microalbuminuria patients (group 2) compared with 30 healthy controls (Group 1). Fasting glucose, post prandial glucose, lipid profile, fructosamine and microalbuminuria were investigated in all the groups. The significant increase in serum fructosamine, fasting and post prandial glucose levels along with increased microalbuminuria observed in group 3 patients compared to group 2 and group 1 patients. Hyperglycemia, increased fructosamine and increased Cholesterol, triglycerides with decreased HDL-cholesterol levels indicates the major risk of atherogenicity. Key Words: Diabetic nephropathy, Microalbuminuria, Fructosamine and Atherogenicity INTRODUCTION Diabetes mellitus (DM) is a disease in which the hallmark feature is elevated blood glucose concentrations due to loss of insulin-producing pancreatic β-cells (type 1 diabetes) or through loss of insulin responsiveness in its target tissues (type 2 diabetes). Type 1 diabetes usually begins to manifest in childhood and early adulthood, but type 2 diabetes is typically a disease for which increased age is a risk factor (Schwarz, 2009).
    [Show full text]
  • Acanthocytes in the Urine Useful Tool to Differentiate Diabetic Nephropathy from Glomerulonephritis?
    Pathophysiology/Complications ORIGINAL ARTICLE Acanthocytes in the Urine Useful tool to differentiate diabetic nephropathy from glomerulonephritis? GUNNAR H. HEINE, MD MATTHIAS GIRNDT, MD of patients who are most likely to have a URBAN SESTER, MD HANS K¨OHLER, MD nondiabetic glomerulopathy and to selec- tively perform renal biopsy in this sub- group of patients. Urinary erythrocyte morphology ex- amined by phase-contrast microscopy al- OBJECTIVE — The presence of hematuria has been suggested to indicate nondiabetic ne- lows to differentiation of glomerular and phropathy in diabetic patients with proteinuria. However, hematuria is frequently found in patients with biopsy-proven diabetic glomerulosclerosis without nondiabetic nephropathy. nonglomerular bleeding (10). Glomeru- Urine microscopy allows discrimination of glomerular hematuria, which is defined as acantho- lar bleeding is indicated by urinary excre- cyturia (urinary excretion of acanthocytes, which are dysmorphic erythrocytes with vesicle-like tion of acanthocytes. Acanthocytes are protrusions), from nonglomerular hematuria. We hypothesized that acanthocyturia is an un- characteristic ring-formed erythrocytes common finding in diabetic nephropathy, which suggests the presence of a nondiabetic ne- with vesicle-shaped protrusions (Fig. 1) phropathy in diabetic patients with proteinuria. (11,12) that have been described previ- ously in the peripheral blood of patients RESEARCH DESIGN AND METHODS — Urine samples of patients with the clinical diagnosis of diabetic nephropathy (n ϭ 68), of patients with biopsy-proven glomerulonephritis suffering from certain hereditary neuro- (n ϭ 43), and of age-matched healthy control subjects (n ϭ 20) were examined by phase-contrast logical disorders (abetalipoproteinemia, microscopy for the presence of hematuria (Ն8 erythrocytes/␮l) and acanthocyturia. Acantho- chorea-acanthocytosis, and McLeod syn- cyturia of Ն5% (5 acanthocytes among 100 excreted erythrocytes) was classified as glomerular drome) (13).
    [Show full text]
  • Diabetic Nephropathy and Microalbuminuria in Pregnant Women with Type 1 and Type 2 Diabetes Prevalence, Antihypertensive Strategy, and Pregnancy Outcome
    Clinical Care/Education/Nutrition/Psychosocial Research ORIGINAL ARTICLE Diabetic Nephropathy and Microalbuminuria in Pregnant Women With Type 1 and Type 2 Diabetes Prevalence, antihypertensive strategy, and pregnancy outcome 1,2 1,2 JULIE AGNER DAMM, MD LENE RINGHOLM, MD, PHD In pregnant women with type 1 di- 1,2 1,4 BJÖRG ASBJÖRNSDÓTTIR, MD BERIT WOETMANN PEDERSEN, MD 1,2 1,2,3 abetes, nephropathy is associated with NICOLINE FOGED CALLESEN ELISABETH R. MATHIESEN, MD, DMSC 1,2 poor pregnancy outcome in terms of JONATHAN M. MATHIESEN increased rates of preeclampsia and pre- term delivery (11–13). In these women, d intrauterine growth restriction (11) oc- OBJECTIVE To evaluate the prevalence of diabetic nephropathy and microalbuminuria in curs almost twice as often as in the general pregnant women with type 2 diabetes in comparison with type 1 diabetes and to describe population (13), and in the late 1990s, pregnancy outcomes in these women following the same antihypertensive protocol. preterm delivery before 34 weeks oc- RESEARCH DESIGN AND METHODSdAmong 220 women with type 2 diabetes and curred in ;30% (13). In women with 445 women with type 1 diabetes giving birth from 2007–2012, 41 women had diabetic ne- type 1 diabetes and microalbuminuria, phropathy (albumin-creatinine ratio $300 mg/g) or microalbuminuria (albumin-creatinine ratio preterm delivery and preeclampsia are 30–299 mg/g) in early pregnancy. Antihypertensive therapy was initiated if blood pressure also frequent and serious complications $ $ 135/85 mmHg or albumin-creatinine ratio 300 mg/g. (11,13,14). RESULTSdThe prevalence of diabetic nephropathy was 2.3% (5 of 220) in women with type 2 In nonpregnant subjects with diabe- diabetes and 2.5% (11 of 445) in women with type 1 diabetes (P =1.00).Thefigures for micro- tes, inhibition of the renin angiotensin albuminuria were 4.5 (10 of 220) vs.
    [Show full text]
  • Diabetic Neuropathy: a Position Statement by the American
    136 Diabetes Care Volume 40, January 2017 Diabetic Neuropathy: A Position Rodica Pop-Busui,1 Andrew J.M. Boulton,2 Eva L. Feldman,3 Vera Bril,4 Roy Freeman,5 Statement by the American Rayaz A. Malik,6 Jay M. Sosenko,7 and Dan Ziegler8 Diabetes Association Diabetes Care 2017;40:136–154 | DOI: 10.2337/dc16-2042 Diabetic neuropathies are the most prevalent chronic complications of diabetes. This heterogeneous group of conditions affects different parts of the nervous system and presents with diverse clinical manifestations. The early recognition and appropriate man- agement of neuropathy in the patient with diabetes is important for a number of reasons: 1. Diabetic neuropathy is a diagnosis of exclusion. Nondiabetic neuropathies may be present in patients with diabetes and may be treatable by specific measures. 2. A number of treatment options exist for symptomatic diabetic neuropathy. 3. Up to 50% of diabetic peripheral neuropathies may be asymptomatic. If not recognized and if preventive foot care is not implemented, patients are at risk for injuries to their insensate feet. 4. Recognition and treatment of autonomic neuropathy may improve symptoms, POSITION STATEMENT reduce sequelae, and improve quality of life. Among the various forms of diabetic neuropathy, distal symmetric polyneurop- athy (DSPN) and diabetic autonomic neuropathies, particularly cardiovascular au- tonomic neuropathy (CAN), are by far the most studied (1–4). There are several 1 atypical forms of diabetic neuropathy as well (1–4). Patients with prediabetes may Division of Metabolism, Endocrinology & Diabe- – tes, Department of Internal Medicine, University also develop neuropathies that are similar to diabetic neuropathies (5 10).
    [Show full text]
  • View of the Salient Patho- Important and Are Interrelated
    J Am Soc Nephrol 14: 1396–1405, 2003 Diabetic Nephropathy in Type 2 Diabetes Prevention and Patient Management GUNTER WOLF* and EBERHARD RITZ† *Department of Medicine, Division of Nephrology, University of Hamburg, Hamburg, Germany; and †Department of Internal Medicine, Renal Unit, Ruperto Carola University, Heidelberg, Germany. It is an irony of medical progress that the renal involvement in genetic (7) as well as environmental factors. In subgroups of diabetes mellitus type 2 had been considered twenty years ago patients with type 2 diabetes, monogenetic causes have been (1) as a benign condition for the kidney without causing renal identified, but which genes are responsible for the more com- function loss greater than expected from the “normal” aging mon polygenic forms is still unclear (8). process. In contrast, today it has become the single most common cause of end-stage renal disease (ESRD) in the entire How Do Microvascular Complications, Including Western world (2–4). Apart from the individual human suf- Renal Disease, Develop? fering that cannot be expressed in numbers, patients with type Recent evidence suggests that increased superoxide forma- 2 diabetes undergoing maintenance dialysis consume signifi- tion after high glucose–induced throughput in the mitochon- cantly more financial resources than those with nondiabetic drial electron-transport chain generates reactive oxygen spe- ESRD. In addition, type 2 diabetic patients do poorly on cies, which are involved in the development of diabetic dialysis and have an excess mortality (5). An interdisciplinary complications (9). Particularly in the development of diabetic approach is needed for patients with type 2 diabetes and nephropathy, proteins modified by glucose or glucose-derived nephrologists must deal with a spectrum of comorbidity be- products such as methylglyoxal, i.e., Amadori products, and sides diabetic nephropathy.
    [Show full text]
  • Relationship Between Fructosamine Levels and Microalbuminuria of Selected Individuals with Type 2 Diabetes Mellitus
    International Journal of Clinical Chemistry and Laboratory Medicine (IJCCLM) Volume 3, Issue 1, 2017, PP 29-32 ISSN: 2455-7153(Online) http://dx.doi.org/10.20431/2455-7153.0301004 www.arcjournals.org Relationship between Fructosamine Levels and Microalbuminuria of Selected Individuals with Type 2 Diabetes Mellitus Gil P. Soriano, Ma. Gladys B. Aquino Assistant Professor, School of Medical Technology, Centro Escolar University, Manila, Philippines Abstract: Objectives: The research determined the relationship between the fructosamine level and microalbuminuria of selected individuals with Type 2 diabetes mellitus. The determination will suggest the effect of short-term glycemic (using fructosamine) to the impairment of kidney function (through the detection of microalbuminuria) due to kidney damage. Methods: The study utilized descriptive correlational design to compare the fructosamine level and microalbuminuria. Colorimetric method using nitro blue tetrazolium was used to measure the fructosamine level from venous blood. In determining urine albumin level, immunoturbidimetric method was used; both blood and urine creatinine was measured using coupled enzymatic reactions. Results: All of the selected participants had fructosamine levels above the normal value, which is 205-280 umol/L. Almost 50 percent of the participants were microalbuminuric (16 out of 32) and 50 percent (16 out of 32) were normoalbuminuric. Conclusion: There is a significant difference between the fructosamine level of normoalbuminuric and microalbuminuric participants while there is no correlation between fructosamine levels and microalbuminuria. Keywords: Diabetes Mellitus, Fructosamine, Normoalbuminuric, Microalbuminuric 1. INTRODUCTION Diabetes mellitus is a chronic life-long condition characterized by poor glucose control. Globally, one person dies every seven seconds due to diabetes while an estimated 382 million individuals or a total of 8.3% of the world population are living with diabetes [1].
    [Show full text]
  • Fructosamine Is a Valuable Marker for Glycemic Control And
    www.nature.com/scientificreports OPEN Fructosamine is a valuable marker for glycemic control and predicting adverse outcomes following total hip arthroplasty: a prospective multi‑institutional investigation Noam Shohat1,2, Karan Goswami1, Leigham Breckenridge1, Michael B. Held3, Arthur L. Malkani4, Roshan P. Shah3, Ran Schwarzkopf5 & Javad Parvizi1* Recently, fructosamine has shown promising results in predicting adverse outcomes following total knee arthroplasty. The purpose of this study was to assess the utility of fructosamine to predict adverse outcomes following total hip arthroplasty (THA). A prospective multi‑center study involving four institutions was conducted. All primary THA were evaluated for glycemic control using fructosamine levels prior to surgery. Adverse outcomes were assessed at a minimum 1 year from surgery. Primary outcome of interest was periprosthetic joint infection (PJI) based on the International Consensus Meeting (ICM) criteria. Secondary outcomes assessed were superfcial infections, readmissions and death. Based on previous studies on the subject, fructosamine levels above 293 µmol/L were used to defne inadequate glycemic control. Overall 1212 patients were enrolled in the present study and were available for follow up at a minimum 1 year from surgery. Of those, 54 patients (4.5%) had elevated fructosamine levels (> 293 µmol/L) and these patients were 6.7 times more likely to develop PJI compared to patients with fructosamine levels below 293 µmol/L (p = 0.002). Patients with elevated fructosamine were also associated with more readmissions (16.7% vs. 4.4%, p < 0.007) and a higher mortality rate (3.7% vs. 0.6%, p = 0.057). These associations remained statistically signifcant in a multi‑regression analysis after adjusting for age, comorbidities and length of stay; Adjusted odds ratio were 6.37 (95% confdence interval 1.98–20.49, p = 0.002) for PJI and 2.68 (95% confdence interval 1.14–6.29, p = 0.023) for readmissions.
    [Show full text]
  • Nutritional Approach to Diabetic Nephropathy
    ogy: iol Cu ys r h re P n t & R y e s Anatomy & Physiology: Current m e o a t r a c n h Saxena, Anat Physiol 2015, 5:4 A Research ISSN: 2161-0940 DOI: 10.4172/2161-0940.1000181 Review Article Open Access Nutritional Approach to Diabetic Nephropathy Anita Saxena* Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India *Corresponding author: Anita Saxena, Department of Nephrology, Sanjay Gandhi Post Graduate Institute Of Medical Sciences, Raebarelly 226014, Lucknow, India, Tel: +05222668004; E-mail: [email protected] Rec date: Aug 13, 2015; Acc date: Sep 29, 2015; Pub date: Oct 5, 2015 Copyright: © 2015 Saxena A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Diabetes is an important cause of renal disease. Diabetic nephropathy (DN) is characterized by albuminuria, which is usually accompanied by hypertension, progressive rise in proteinuria (albuminuria >0.5 g/24 h), and decline in renal function. Long term complications of diabetes are macrovascular disease (coronary heart disease), cerebrovascular disease, peripheral arterial disease and microvascular disease retinopathy and nephropathy. DN carries a 20- to 40-fold increased risk for cardiovascular (CV) mortality. To delay progression of DN to ESRD following measures are recommended a) good control of blood glucose, b) low-protein diet, c) control of hypertension, d) restriction of dietary salt, phosphorus and potassium in advanced cases and e) control of hyperfiltration, usually through angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blocking (ARB) agents.
    [Show full text]
  • Kdigo Clinical Practice Guideline on Diabetes Mangement in Chronic Kidney Disease
    KDIGO CLINICAL PRACTICE GUIDELINE ON DIABETES MANGEMENT IN CHRONIC KIDNEY DISEASE CONFIDENTIAL: DO NOT DISTRIBUTE PUBLIC REVIEW DRAFT DECEMBER 2019 TABLE OF CONTENTS KDIGO Executive Committee………………………………………………....................................................... vii Reference Keys…………………………………………………………………………..................................... ix CKD Nomenclature…………………………………………………………………….………………………. x Conversion Factors……………………………………………………………………..……………………..... xi Abbreviations and Acronyms………………………………………………………….…………….................. xii Notice…………………………………………………………………………………..………………………. xii Foreword………………………………………………………………..……………..……………………….. xiv Update to Guideline Format………………………………………………………………………………......... xvi Work Group Membership ………………..……………………………………….....………………………… xx Abstract……………………………………….……………………………………..………………….. …….. xxii Introduction from the Guideline Co-Chairs………………………………………..…….…………………….. xxiii Summary of Recommendation Statements and Practice Points.....…………………………………………….. xxvi Chapter 1. Comprehensive Care in Patients with Diabetes and CKD.................................................................. 1 Chapter 2. Glycemic Monitoring and Targets in Patients with Diabetes and CKD............................................. 17 Chapter 3. Lifestyle Interventions in Patients with Diabetes and CKD....………….……….……………. …... 30 Chapter 4. Anti-hyperglycemic Therapies in Patients with Diabetes and CKD…..……………..…………….. 51 Chapter 5. Approaches to Management of Patients with Diabetes and CKD………………..……..….………. 89 Methods
    [Show full text]
  • Renal Transplantation in Diabetic Nephropathy
    BRITISH MEDICAL JOURNAL VOLUME 285 11 DECEMBER 1982 1713 Br Med J (Clin Res Ed): first published as 10.1136/bmj.285.6356.1713 on 11 December 1982. Downloaded from MEDICAL PRACTICE Occasional Survey Renal transplantation in diabetic nephropathy M GONZALEZ-CARRILLO, A MOLONEY, M BEWICK, V PARSONS, C J RUDGE, P J WATKINS Abstract peripheral nerves, and some patients are incapacitated by these Forty diabetics who had developed- end-stage renal problems. Many centres have therefore been reluctant to under- take renal transplantation in diabetics especially where resources failure from diabetic nephropathy and underwent renal have been transplantation have been followed up from one to six limited. Since 1966, however, patients with diabetic years. After one and two years 63% and 42% survived nephropathy attending the University of Minnesota have been (45 and 33 respectively with accepted into the transplant programme, and this centre has now % % functioning kidneys). the world's greatest experience in treating this disease. The Older patients, those with coronary and peripheral less in vascular disease, and those with severe are results, although satisfactory than non-diabetics, have neuropathy been very encouraging.5 -1 prone to higher postoperative morbidity and mortality. http://www.bmj.com/ The presence of advanced retinopathy, on the other hand, does not appear to influence the outcome. Patients Between January 1974 and December 1980, 44 renal transplants Introduction were performed in 40 diabetics with end-stage renal failure from diabetic nephropathy, and these have been followed up from 12 months Diabetic nephropathy is a common complication of long-term to six years.
    [Show full text]
  • Discovery Awaits You at the 81ST Scientific Sessions
    VIRTUAL | JUNE 25–29, 2021 Discovery awaits you at the ST 81 Scientific Sessions Final Program scientificsessions.diabetes.org #ADA2021 THE RIGHT SOLUTION AT THE RIGHT TIME View The Scientific Sessions Closed-Loop Increases Time-in-Range Glycemic outcomes of new InPen™ Durable insulin pumps vs. multiple daily in Older Adults with Type 1 Diabetes smart insulin pen users who injections for type 1 diabetes: Healthcare Compared with Sensor-Augmented received virtual onboarding utilization and A1C Pump Therapy: A Randomized Smith | ePoster Shah | ePoster Crossover Trial Patient Reported Satisfaction During Infusion Set Survival and Performance McAuley | Oral | Sun. 6/27 @ 4:30 pm the Medtronic Extended-Wear During the Medtronic Extended-Wear Infusion Set (EWIS) Pivotal Trial Infusion Set (EWIS) Pivotal Trial Impact of InPen™ smart insulin pen use Brazg | ePoster Buckingham | ePoster on real-world glycemic and insulin Preclinical study of a combined Robust glycemic outcomes after MiniMed™ dosing outcomes in individuals with insulin infusion and glucose sensing Advanced Hybrid Closed-Loop (AHCL) poorly controlled diabetes device (DUO) System use regardless of previous therapy Vigersky | Oral | Sun. 6/27 @ 6:15 pm Zhang | ePoster Shin | ePoster Visit Our Virtual Exhibit https://www.medtronic.com/diabetes-exhibit to find more information on: Smart MDI Therapy Insulin Pump Therapy Personalized Service Stay on Track with the First Automated Insulin Delivery & Support Smart MDI System* for Improved Glucose Control Always By Your Side View Our Presentations Product Theater: Shared Decision With Diabetes Technology Friday, June 25, 2021 | 10:00 – 11:00 am ET The introduction of smart insulin pens is bringing the vast majority of people on insulin injection therapy into the digital age.
    [Show full text]