Diabetic nephropathy natural history, complications and prognosis: Difference between revisions

	Diabetic nephropathy Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Diabetic nephropathy from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Diabetic nephropathy natural history, complications and prognosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Diabetic nephropathy natural history, complications and prognosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Diabetic nephropathy natural history, complications and prognosis
CDC on Diabetic nephropathy natural history, complications and prognosis
Diabetic nephropathy natural history, complications and prognosis in the news
Blogs on Diabetic nephropathy natural history, complications and prognosis
Directions to Hospitals Treating Diabetic nephropathy
Risk calculators and risk factors for Diabetic nephropathy natural history, complications and prognosis

VisualWikitext

Revision as of 20:45, 13 June 2018

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) an progress to develop ESRD. 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

It is estimated that 20-40% of patients with diabetes develop diabetic nephropathy.
The main trigger of diabetic nephropathy is chronic hyperglycemia.^[1] 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.^[2]
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.^[2]

Complications

Possible complications include:^[1]

Coronary artery disease (CAD): In patients with diabetes mellitus, the main risk factor for the development of CAD is nephropathy^[2]
Chronic kidney disease (CKD)
End-stage renal disease (ESRD)
Development and/or worsening of hypertension
Complications related to dialysis
Complications related to renal transplantation
Type IV RTA: may occur in both type I and type II diabetes mellitus

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

↑ ^1.0 ^1.1 Kasper, Dennis (2015). Harrison's Principles of Internal Medicine. New York, New York: McGraw-Hill. ISBN 0071802150.
↑ ^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.
↑ 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)

Template:WH Template:WS

[book-1] 1.0 ^1.1 Kasper, Dennis (2015). Harrison's Principles of Internal Medicine. New York, New York: McGraw-Hill. ISBN 0071802150.

[pmid8487827-2] 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.

[pmid25342915-3] 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)

[1]

[2]

[3]

@@ Line 4: / Line 4: @@
 ==Overview==
+If left untreated, diabetic nephropathy (DN) an progress to develop [[ESRD]]. 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==
+* 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]].<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><br>
+* 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.<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.<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==
@@ Line 17: / Line 21: @@
 *Development and/or worsening of [[hypertension]]
 *Complications related to [[dialysis]]
-*Complications related to [[kidney transplant]]
+*Complications related to [[renal transplantation]]
 *Type IV [[RTA]]: may occur in both type I and type II [[diabetes mellitus]]
 ==Prognosis==
-Diabetic nephropathy has become the most common cause of [[ESRD]] in most countries due to the [[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]]).
+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==