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

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==Overview==
==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==
==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==
==Complications==
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*Development and/or worsening of [[hypertension]]
*Development and/or worsening of [[hypertension]]
*Complications related to [[dialysis]]
*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]]
*Type IV [[RTA]]: may occur in both type I and type II [[diabetes mellitus]]


==Prognosis==
==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==
==References==

Revision as of 20:45, 13 June 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) 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

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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