Diabetic nephropathy overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2] Associate Editor(s)-in-Chief: Olufunmilola Olubukola M.D.[3]
Overview
Diabetic kidney disease (Diabetic Nephropathy) is the most common cause of chronic kidney disease and end stage renal disease (ESRD) in the United States [1] . Due to the ongoing world wide increase in the incidence of diabetes mellitus, Diabetic nephropathy (DN) is increasingly a major cause of ESRD disease worldwide [2].
Diabetic Nephropathy affects male and female patients equally. The incidence of DN in African-Americans, Native Americans and people of Mexican origins is greater than the incidence in white Americans [3]. Currently, the main goal in the treatment of diabetic nephropathy is to slow the progression of chronic kidney disease. This is achieved by excellent control of hyperglycemia, dyslipidemia, and blood pressure. Antiproteinuric therapy through renin-angiotensin-aldosterone system Inhibitors is considered to be a major pillar of the treatment [4]. Renin-angiotensin-aldosterone system inhibition it thought to be beneficial in the early stages of diabetic nephropathy through decreasing proteinuria and progression [5]. Therefore, early diagnosis and institution of prompt treatment is very important in the management of diabetes nephropathy. Also, the role of diabetes prevention becomes paramount patients at high risk (e.g. metabolic syndrome, impaired glucose tolerance).
Diabetic nephropathy (DN) is characterized by the presence of proteinuria or decreased renal function in patients with diabetes mellitus[6][7][8] however, diabetic nephropathy can also present in form of non-proteinuric decline in GFR. Nonetheless, proteinuria remains the hallmark of diagnosis for diabetic nephropathy, despite emerging trends suggestive of non proteinuric diabetic nephropathy [9].
Early Diabetic Nephropathy
The range of proteinuria in early DN is shown below[6][7][8]:
- Males: Microalbuminuria in the range of 30-300 mg/24 hrs or a spot urinary albumin/creatinine ratio of 30-300 mg/g
- Females: Microalbuminuria in the range of 30-300 mg/24 hrs or a spot urinary albumin/creatinine ratio of 20-200 mg/g
Overt Diabetic Nephropathy
Overt DN is defined according to the presence of proteinuria or according to renal function. The following ranges in overt DN are shown below[6][7][8]:
- Proteinuria > 500 mg/24 hrs or albuminuria > 300 mg/24 hrs.
- Estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2
Historical Perspective
Classification
Pathophysiology
Diabetic nephropathy is a serious complication in patients with long standing Type 1 or Type 2 Diabetes Mellitus. It usually occurs in about 10 to 15 years following the onset of diabetes mellitus. Poor glycemic control, dyslipidemia, smoking, and environmental and genetic factors play important roles in the development of diabetic nephropathy.
Causes
Differentiating Diabetic nephropathy from other Diseases
Also called Kimmelstiel-Wilson syndrome, or Nodular diabetic glomerulosclerosis and inter-capillary glomerulonephritis;
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Microalbuminuria, as defined by an urinary albumin-to-creatinine ratio of >30mg/g is an early diagnostic clue to diabetic nephropathy. Some patients may go on to develop high-grade nephrotic range proteinuria, while others may develop diabetic nephropathy without any measurable albuminuria.
Other Diagnostic Studies
Treatment
Medical Therapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
References
- ↑ John S (2016). "Complication in diabetic nephropathy". Diabetes Metab Syndr. 10 (4): 247–249. doi:10.1016/j.dsx.2016.06.005. PMID 27389078.
- ↑ Tuttle KR, Bakris GL, Bilous RW, Chiang JL, de Boer IH, Goldstein-Fuchs J; et al. (2014). "Diabetic kidney disease: a report from an ADA Consensus Conference". Diabetes Care. 37 (10): 2864–83. doi:10.2337/dc14-1296. PMC 4170131. PMID 25249672.
- ↑ Baudy A, Batuman V (2015). "Non-diabetic renal disease in diabetic patients: How to identify? When to biopsy?". J Diabetes Complications. 29 (5): 613–4. doi:10.1016/j.jdiacomp.2015.04.015. PMID 25957005.
- ↑ Lozano-Maneiro L, Puente-García A (2015). "Renin-Angiotensin-Aldosterone System Blockade in Diabetic Nephropathy. Present Evidences". J Clin Med. 4 (11): 1908–37. doi:10.3390/jcm4111908. PMC 4663476. PMID 26569322.
- ↑ Kasiske BL, Kalil RS, Ma JZ, Liao M, Keane WF (1993). "Effect of antihypertensive therapy on the kidney in patients with diabetes: a meta-regression analysis". Ann Intern Med. 118 (2): 129–38. PMID 8416309.
- ↑ 6.0 6.1 6.2 Mogensen CE, Christensen CK (1984). "Predicting diabetic nephropathy in insulin-dependent patients". N Engl J Med. 311 (2): 89–93. doi:10.1056/NEJM198407123110204. PMID 6738599.
- ↑ 7.0 7.1 7.2 Mogensen CE (1984). "Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes". N Engl J Med. 310 (6): 356–60. doi:10.1056/NEJM198402093100605. PMID 6690964.
- ↑ 8.0 8.1 8.2 Reutens AT, Atkins RC (2011). "Epidemiology of diabetic nephropathy". Contrib Nephrol. 170: 1–7. doi:10.1159/000324934. PMID 21659752.
- ↑ MacIsaac RJ, Panagiotopoulos S, McNeil KJ, Smith TJ, Tsalamandris C, Hao H; et al. (2006). "Is nonalbuminuric renal insufficiency in type 2 diabetes related to an increase in intrarenal vascular disease?". Diabetes Care. 29 (7): 1560–6. doi:10.2337/dc05-1788. PMID 16801579.