DOCSLIB.ORG

Acanthocytes in the Urine Useful Tool to Differentiate Diabetic Nephropathy from Glomerulonephritis?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read 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). When urine sediments of hematuria; acanthocyturia of 2–4% was classified as suspected glomerular hematuria. patients with biopsy-proven glomerulo- nephritis and patients with nonglomeru- RESULTS — Hematuria was found in 62% of patients with the clinical diagnosis of diabetic lar kidney diseases, urolithiasis, cystitis, nephropathy, in 84% of patients with glomerulonephritis, and in 20% of the healthy control subjects upon a single urine examination. In contrast, glomerular hematuria occurred in 4% of urethritis, and tumors are compared, ac- patients with diabetic nephropathy and in 40% of patients with glomerulonephritis (P Ͻ 0.001). anthocytes are an excellent predictive marker of glomerular bleeding (11). CONCLUSIONS — In contrast to hematuria, acanthocyturia is uncommon in patients with Acanthocyte formation in glomerulo- the clinical diagnosis of diabetic nephropathy. In diabetic patients with proteinuria, the finding nephritis has been explained by a possible of acanthocyturia points to nondiabetic glomerulopathies, and renal biopsy should be mechanical influence of the impaired glo- considered. merular basement membrane on the Diabetes Care 27:190–194, 2004 spectrin backbone of the erythrocyte that passes the glomerular barrier. Compared with glomerulonephritis, diabetic ne- phropathy is characterized by a different he prevalence of microscopic hema- tion of renal tissue from diabetic patients pattern of glomerular lesions, which may turia in diabetic patients with mac- with hematuria fairly often only demon- result in a different type of hematuria. It roalbuminuria may range between strates diabetic nephropathy without evi- T has been suggested that hematuria in di- 12.5% (1) and 67–73% (2,3), depending dence of nondiabetic glomerulonephritis on the population of diabetic patients (isolated diabetic nephropathy) (1,4–7). abetic nephropathy might result from studied and the definition of hematuria. In addition, it was recently reported that areas of aneurysmal dilatation in glomer- The finding of microscopic hematuria in the prevalence of hematuria in diabetic ular capillaries with subsequent rupture diabetic patients has been suggested to in- patients with histologic evidence of non- and with little mechanical damage to dicate nondiabetic glomerulopathy, diabetic nephropathy is only slightly (6) erythrocytes. which would demand further nephrologi- or not at all (8,9) increased when com- We studied the prevalence of hema- cal examination, including renal biopsy pared with patients with biopsy-proven turia and acanthocyturia in patients with (1). However, renal biopsy is an invasive isolated diabetic nephropathy. Therefore, clinically diagnosed diabetic nephropa- procedure with potentially severe compli- it would be helpful to define a pattern of thy and in patients with biopsy-proven cations, and careful histologic examina- hematuria that characterizes a subgroup glomerulonephritis to examine whether ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● acanthocyturia occurs with both glomer- From the Department of Nephrology, University of Homburg, Homburg, Germany. ular lesions or whether it is specific for Address correspondence and reprint requests to Gunnar Heine, MD, Department of Nephrology, Uni- glomerulonephritis. In the latter case, the versity of Homburg, 66421 Homburg, Germany. E-mail: [email protected]. finding of acanthocyturia in a diabetic pa- Received for publication 1 July 2003 and accepted in revised form 17 September 2003. tient might point to nondiabetic, poten- A table elsewhere in this issue shows conventional and Syste`me International (SI) units and conversion factors for many substances. tially treatable glomerulopathy, in which © 2004 by the American Diabetes Association. renal biopsy may be indicated. 190 DIABETES CARE, VOLUME 27, NUMBER 1, JANUARY 2004 Heine and Associates nephropathy (10 patients), mesangial- proliferative glomerulonephritis (8 pa- tients), membranous glomerulonephritis (5 patients), focal glomerulosclerosis (3 patients), crescentic glomerulonephritis (2 patients), and other forms/mixed forms of glomerulonephritis (5 patients). Urinalysis Urinalysis within 4 hours after voiding was performed by an observer who was blinded for the clinical diagnosis and who was experienced in urinalysis (perform- ing Ͼ100 urinary examinations per month). Whenever possible, three urine samples from three separate days were an- alyzed; this procedure is known to in- crease sensitivity to detect glomerular bleeding (11). The urine samples were analyzed by phase-contrast microscopy. Cell numbers of urinary erythrocytes and leukocytes were counted in a Fuchs-Rosenthal Figure 1—Glomerular hematuria characterized by the presence of Ն5% acanthocytes (ring- counting chamber without prior centrifu- formed erythrocytes with vesicle-shaped protrusions) among all erythrocytes excreted (phase- gation (unspun urine). contrast microscopy). For patients with erythrocyte counts Ն8 red cells/␮l urine (defined as hematu- ria), red cell morphology was assessed in a RESEARCH DESIGN AND diagnosis of diabetic nephropathy was spun urine specimen. A total of 10 ml of METHODS — Between April 1999 confirmed by an experienced nephrologi- urine was centrifuged at 2,000 rpm for 5 and August 2001, we examined urine cal consultant. min. The sediment was resuspended with samples of all patients who presented to Patients with diabetic nephropathy 0.5 ml of urine. Aliquots of 20 ␮lofthe our Department of Nephrology with the and nondiabetic control subjects were suspension were analyzed by phase- clinical diagnosis of diabetic nephropathy older than patients with glomerulone- contrast microscopy to examine at least (n ϭ 68) or with biopsy-proven glomer- phritis, and renal function was more se- 100 erythrocytes. ulonephritis (n ϭ 43). Patients with glo- verely impaired in patients with diabetic Acanthocytes were defined as a ring- merulonephritis were only included if nephropathy than in those with glomeru- form of erythrocytes with vesicle-shaped urinalysis was performed before initiation lonephritis (Table 1). protrusions (Fig. 1) (11). Acanthocyturia of immunosuppressive treatment of the Results of renal biopsy in patients of Ն5% (5 acanthocytes among 100 ex- underlying renal disease. For a control with glomerulonephritis included mi- creted red cells) was classified as glomer- group, urine samples were obtained from nimal-change disease (10 patients), IgA ular hematuria; acanthocyturia of 2–4% 20 volunteers who were matched in age to the patients with the clinical diagnosis of diabetic nephropathy and who had nei- Table 1—Biometric data and serum creatinine levels of patients with diabetic nephropathy ther symptomatic nephrological or uro- and patients with glomerulonephritis; biometric data of control subjects logical diseases nor diabetes. Diabetic nephropathy was diagnosed Serum Serum in patients treated for type 1 diabetes (n ϭ ϭ Sex (male/ creatinine creatinine 4) or type 2 diabetes (n 64) who were female) Age (years) Ն130 ␮mol/l mean (␮mol/l) on insulin therapy and who had mi- croalbuminuria (30–300 mg albumin/ Diabetic nephropathy (n ϭ 68) 35/33 64.6 Ϯ 11.7 84% (57/68) 329.9 Ϯ 213.9 day; n ϭ 5) or overt proteinuria (Ͼ300 Glomerulonephritis (n ϭ 43) 27/16 49.2 Ϯ 16.7 47% (20/43) 165.1 Ϯ 130.4 mg protein/day; n ϭ 63). Diabetic ne- Control subjects (n ϭ 20) 7/13 56.8 Ϯ 23.3 —— phropathy was not diagnosed in patients Diabetic nephropathy vs. NS P Ͻ 0.001 P Ͻ 0.001 P Ͻ 0.001 in whom case history, renal ultrasonogra- glomerulonephritis
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]
  • 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]
  • Pregnancy in Preexisting Diabetes Thomas A
    Chapter 36 Pregnancy in Preexisting Diabetes Thomas A. Buchanan, M.D. SUMMARY ata from birth certificates in the United macrosomia (an excessively large infant). Stillbirths States indicate that maternal diabetes com- are now uncommon in diabetic pregnancies; congeni- plicates 2%-3% of all pregnancies, but tal malformations and complications of maternal hy- these data may underestimate the true pertensive disorders account for most of the 1.5- to Dprevalence of maternal diabetes in pregnancy. Two 2-fold increase in perinatal mortality compared with major forms of maternal diabetes may occur during nondiabetic pregnancies. Macrosomia appears to be pregnancy: preexisting or "pregestational" diabetes, the most frequent fetal complication, affecting 10%- and gestational-onset or gestational diabetes mellitus 33% of infants, depending on the definition used for (GDM). Only the former is known prior to pregnancy, macrosomia. Macrosomia increases the risk of birth and this form constitutes ~10% of cases of maternal trauma and has been associated with a long-term risk diabetes. Thus, prevalence rates for pregestational of obesity in offspring. diabetes appear to be in the range of 0.1%-0.3% of all pregnancies. These pregnancies are at risk for both Maternal risks in diabetic pregnancies are greatest in maternal and fetal complications. the presence of preexisting microvascular disease (ret- inopathy and nephropathy). Diabetic retinopathy is Fetal complications of maternal diabetes can be di- present in 15%-66% of women early in pregnancy, and vided into two major categories. Complications that the retinopathy frequently worsens during gestation, arise from the effects of maternal diabetes on early especially when severe background or proliferative fetal development (i.e., in the first trimester) include changes are present early on.
    [Show full text]