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{{Diabetic nephropathy}}
{{Diabetic nephropathy}}
{{CMG}}; {{AE}} {{AN}}
{{CMG}}; {{AE}}{{AN}}, {{DN}}


==Overview==
==Overview==
If left untreated, diabetic nephropathy (DN) can progress to develop [[ESRD|ESRD (end stage renal disease)]]. Diabetic nephropathy can be complicated with [[Coronary heart disease|coronary artery disease]], [[hypertension]], and type IV [[RTA]], The prognosis of DN is bad with continued disease progression even after proper [[glycemic control]].


==Natural History==
==Natural History==
 
* It is estimated that 20-40% of patients with [[diabetes]] develop diabetic nephropathy.  
Not all patients with [[diabetes mellitus]] suffer from diabetic nephropathy. It is estimated that 20-40% of patients with [[diabetes]] develop diabetic nephropathy. The main trigger of diabetic nephropathy is chronic [[hyperglycemia]]. However, a strict glycemic control reduces the rate at which [[microalbuminura]] appears and progress in patients with both type I and type II [[diabetes mellitus]]. However, it is debatable as to whether or not an improved blood [[glucose]] control halts the progression of renal disease once [[microalbuminuria]] is present.  
* The main trigger of diabetic nephropathy is chronic [[hyperglycemia]].<ref name="book">{{cite book |last= Kasper |first=Dennis |date=2015 |title=Harrison's Principles of Internal Medicine |url= |location= New York, New York |publisher= McGraw-Hill |page= |isbn=0071802150}}</ref> While a strict glycemic control reduces the rate at which [[microalbuminura]] appears and progress in patients with both type I and type II [[diabetes mellitus]], it is debatable as to whether or not an improved blood [[glucose]] control halts the progression of renal disease once [[microalbuminuria]] is present.<ref name="pmid8487827">{{cite journal |vauthors=Nathan DM |title=Long-term complications of diabetes mellitus |journal=N. Engl. J. Med. |volume=328 |issue=23 |pages=1676–85 |year=1993 |pmid=8487827 |doi=10.1056/NEJM199306103282306 |url=}}</ref>
The natural history of the disease begins with the development of [[microalbuminuria]], which usually begins 5 years after the onset of [[diabetes]]. The range for [[microalbuminura]] is 30 to 300 mg of [[albumin]] per 24 hours. Over the next 5-10 years, patients are more likely to develop overt [[proteinuria]]. Finally, over the next decade, [[nephrotic syndrome]] is more likely to occur. If left without management, diabetic nephropathy is most likely to be associated with a declining [[GFR]] and ultimately, [[end-stage renal disease]] ([[ESRD]]). At the point of [[ESRD]], [[dialysis]] and [[kidney transplantation]] are the viable options for treatment.
* The natural history of the disease begins with the development of [[microalbuminuria]], which usually begins 5 years after the onset of [[diabetes]]. The range for [[microalbuminura]] is 30 to 300 mg of [[albumin]] per 24 hours.  
* Over the next 5-10 years, patients are more likely to develop overt [[proteinuria]].  
* Finally, over the next decade, [[nephrotic syndrome]] is more likely to occur. If left without management, diabetic nephropathy is most likely to be associated with a declining [[GFR]] and ultimately, [[end-stage renal disease]] ([[ESRD]]).  
* At the point of [[ESRD]], [[dialysis]] and [[kidney transplantation]] are the viable options for treatment.<ref name="pmid8487827">{{cite journal |vauthors=Nathan DM |title=Long-term complications of diabetes mellitus |journal=N. Engl. J. Med. |volume=328 |issue=23 |pages=1676–85 |year=1993 |pmid=8487827 |doi=10.1056/NEJM199306103282306 |url=}}</ref>


==Complications==
==Complications==
Possible complications include:
Possible complications include:<ref name="book">{{cite book |last= Kasper |first=Dennis |date=2015 |title=Harrison's Principles of Internal Medicine |url= |location= New York, New York |publisher= McGraw-Hill |page= |isbn=0071802150}}</ref>
* [[Hypoglycemia]] (from decreased excretion of insulin)
*[[Coronary artery disease]] ([[CAD]]): In patients with [[diabetes mellitus]], the main risk factor for the development of [[CAD]] is [[nephropathy]]<ref name="pmid8487827">{{cite journal |vauthors=Nathan DM |title=Long-term complications of diabetes mellitus |journal=N. Engl. J. Med. |volume=328 |issue=23 |pages=1676–85 |year=1993 |pmid=8487827 |doi=10.1056/NEJM199306103282306 |url=}}</ref>
* Rapidly progressing chronic [[kidney failure]]
*[[Chronic kidney disease]] ([[CKD]])
* [[End-stage kidney disease]]
*[[End-stage renal disease]] ([[ESRD]])
* [[Hyperkalemia]]
*Development and/or worsening of [[hypertension]]
* Severe [[hypertension]]
*Complications related to [[dialysis]]
* Complications of [[hemodialysis]]
*Complications related to [[renal transplantation]]
* Complications of [[kidney transplant]]
*Type IV [[RTA]]: may occur in both type I and type II [[diabetes mellitus]]
* Coexistence of other [[diabetes]] complications
* [[Peritonitis]] (if peritoneal dialysis used)
* [[Infections]]


==Prognosis==
==Prognosis==
Diabetic nephropathy continues to get gradually worse. Complications of chronic kidney failure are more likely to occur earlier, and progress more rapidly, when it is caused by diabetes than other causes. Even after initiation of dialysis or after transplantation, people with diabetes tend to do worse than those without diabetes.
Diabetic nephropathy has become the most common cause of [[ESRD]] in most countries due to the increased prevalence of [[diabetes]] epidemic.<ref name="pmid25342915">{{cite journal |vauthors=Lim AKh |title=Diabetic nephropathy - complications and treatment |journal=Int J Nephrol Renovasc Dis |volume=7 |issue= |pages=361–81 |year=2014 |pmid=25342915 |pmc=4206379 |doi=10.2147/IJNRD.S40172 |url=}}</ref> Even with medical interventions to slow the progression of [[microalbuminuria]], diabetic nephropathy can progress to [[chronic kidney disease]] ([[CKD]]) and [[end-stage renal disease]] ([[ESRD]]).


==References==
==References==
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[[Category:Needs content]]
[[Category:Pediatrics]]
[[Category:Endocrinology]]
[[Category:Nephrology]]


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Latest revision as of 14:18, 26 July 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2], Dima Nimri, M.D. [3]

Overview

If left untreated, diabetic nephropathy (DN) can progress to develop ESRD (end stage renal disease). Diabetic nephropathy can be complicated with coronary artery disease, hypertension, and type IV RTA, The prognosis of DN is bad with continued disease progression even after proper glycemic control.

Natural History

Complications

Possible complications include:[1]

Prognosis

Diabetic nephropathy has become the most common cause of ESRD in most countries due to the increased prevalence of diabetes epidemic.[3] Even with medical interventions to slow the progression of microalbuminuria, diabetic nephropathy can progress to chronic kidney disease (CKD) and end-stage renal disease (ESRD).

References

  1. 1.0 1.1 Kasper, Dennis (2015). Harrison's Principles of Internal Medicine. New York, New York: McGraw-Hill. ISBN 0071802150.
  2. 2.0 2.1 2.2 Nathan DM (1993). "Long-term complications of diabetes mellitus". N. Engl. J. Med. 328 (23): 1676–85. doi:10.1056/NEJM199306103282306. PMID 8487827.
  3. Lim A (2014). "Diabetic nephropathy - complications and treatment". Int J Nephrol Renovasc Dis. 7: 361–81. doi:10.2147/IJNRD.S40172. PMC 4206379. PMID 25342915. Vancouver style error: initials (help)


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