Diabetic Nephropathy

Grossman and Porth (2014) define Diabetes Insipidus (DI) as a disease “caused by a deficiency of or a decreased response to antidiuretic hormone (ADH)” (p. 1032). Polyuria puts the DI in diuresis, which means that excessive micturition accompanies DI. According to Bichet (2013a), polyuria is “a urine output exceeding 3 L/day in adults and 2 L/m2 in children. It must be differentiated from the more common complaints of frequency or nocturia, which are not associated with an increase in the total urine output” (Definition section, para. 1). In order to conclude a final diagnosis of DI, one must understand every aspect of the disease. This will include the pathophysiology of the phenomenon, its incidence and impact

Diabetes is a disease where the body is unable to produce or use insulin effectively. Insulin is needed for proper storage and use of carbohydrates. Without it, blood sugar levels can become too high or too low, resulting in a diabetic emergency. It affects about 7.8% of the population. The incidence of diabetes is known to increase with age. It’s the leading cause of end-stage renal disease in the US, and is the primary cause of blindness and foot and leg amputation. It is known to cause neuropathy in up to 70% of diabetic patients. Individuals with diabetes are twice as likely to develop cardiovascular disease. There are two types of diabetes: Type 1 and Type 2.

Diabetes refers to a set of several different diseases. It is a serious health problem throughout the world and fourth leading cause of death by disease in the country. All types of diabetes result in too much sugar, or glucos in the blood. To understand why this happens it would helpful if we understand how the body usually works. When we eat, our body breaks down the food into simpler forms such as glucose. The glucose goes into the bloodstream, where it then travels to all the cells in your body. The cells use the glucose for energy. Insulin, a hormone made by the pancreas, helps move the glucose from bloodstream to the cells. The pathophysiology of diabetes mellitus further explains the concept on how this disease works. Pancreas

Uncontrolled diabetes can affect nearly every organ of the body; of which, heart disease and kidney failure are most commonly impacted. Known as diabetes mellitus, a collective term for various blood abnormalities, the term diabetes refers to either a scarcity of insulin in the body or the body’s inability to accept insulin. Though the symptoms of diabetes are manageable, many are unaware as to having it. According to the CDC report “2011 Diabetes Fact Sheet,” approximately 6 million people in the United States have undiagnosed diabetes. Undetected, diabetes can become deadly. In a recent World Health Organization report “Diabetes Action Now: An Initiative of the World Health Organization and the International Diabetes Federation,” it

In the United States People 65 years or older has diabetes, and the aging in general population is significant for diabetes become epidemic, diabetes not limited to impact the elderly from working also has the highest mortality rate. In addition elderly with diabetes has hither risk for chronic heart disease and kidney disease (Sure Kirkman, 2012). The number of cases of diabetes type 2 in the United States increase with the increase of age. In 2007 and 2008 national survey data showed “diabetes was 18% higher among Asian Americans, 66% higher among Hispanics, and 77% higher

Type 2 diabetes is becoming more and more common in children and teenagers because of the increase in obesity in young people” (Journal of the American Medical Association, 2011). As a result, there a many risk factors and health risks associated with type 2 diabetes. Risk factors include people with poorly managed blood glucose, overweight, family history, and poor diet. In people with diabetes kidney disease or kidney damage is a complication of diabetes, the nephrons slowly thicken and become scarred over time. The kidneys begin to leak and protein (albumin) passes into the urine. This damage can happen years before any symptoms begin” (National Library of Medicine, 2014). Secondly, diabetic retinopathy is a condition which causes progressive damage to the retina, the light sensitive lining at the back of the eye. Diabetic retinopathy is the result of damage to the tiny blood vessels that nourish the retina. They leak blood and other fluids that cause swelling of retinal tissue and clouding of vision” (American Optometric Association, 2014). Lastly, according to the U.S. Department of Health and Human Services, (2013) diabetic neuropathies are a family of nerve disorders which can occur overtime and develop nerve damage throughout the

Chronic elevated glucose in blood (hyperglycemia) with disturbances metabolism of protein, fat and carbohydrate resulting from disorder in insulin secretion, insulin action, or both. (1) Expected to increase diabetic patients by 2025 to approximately 300 million people in the worldwide (2) In ancient times it was difficult to identify diabetes as the ability of patients to heal weak, the researchers think the diabetes resulting from defect in the bladder and kidneys are the cause of diabetes. (6)

blood count indicates anemia due to decreased production of erythropoietin (Castner, 2010). A CT scan or MRI can evaluate the anatomy and function of the kidneys to help determine the cause and stage of the disease. A renal biopsy may also be performed. These diagnostic tests determine the progression of the disease. There are five stages of chronic kidney disease. The treatment plan depends on the stage of the disease. If it is diagnosed in stage one, the patient and physician can work to treat the contributing factors and slow the progression of the disease. By the fifth stage the patient is on dialysis, needs a transplant, or in the most severe cases is in hospice care (Castner, 2010).

Diabetes mellitus, often shortened to just “diabetes,” can be diagnosed in a person in two different types. Diabetes mellitus type 1 can be inherited by a person’s genes, be it dominant or recessive, however, there is no clear pattern in the inheritance (“Type 1 Diabetes”). Despite an unclear pattern to familial inheritance of the disease, it is interesting to note that caucasians are the most susceptible to inherit this disease (“Genetics & Diabetes”). Despite this fact, susceptibility of type 1 diabetes among caucasians vary per living environment and geography (“Genetics & Diabetes). In the United States, in 100,000 people, 10 in 20 people will have type 1 diabetes while approximately 6.2 million are undiagnosed; on the other hand, approximately 10% of the world population have type 1 diabetes (“Type 1 Diabetes”). In the past 20 years, type 1 diabetes has been escalating 2-5% annually (“Type 1 Diabetes”) in the United States. Statistically, more people are diagnosed with type 2 diabetes than type 1 (“Type 1 Diabetes”).

According to National Kidney Foundation (2010), the majority of people with diabetes tend to develop kidney disease. This is probably the result of poor or improper dietary and life-style practices, although genetics seem to be a factor. This makes it the single leading cause of kidney failure. High blood pressure/Hypertension is another pre-disposing factor of kidney failure. This disease is also aggravated by improper dietary and life-style practices. High blood pressure/Hypertension speeds up the loss of kidney function and eventually leads to kidney failure. It also appears to have genetic and familial factors (National Kidney Foundation, 2010).

Similarly, patients with long-standing hypertension with hypertensive retinopathy and a family history of hypertension and CKD are likely to have hypertensive nephrosclerosis, particularly if urinalysis reveals minimal proteinuria and no hematuria22. It is worth noting that the presence of diabetes or hypertension does not rule out another cause of CKD, particularly since hypertension is a consequence of CKD. In addition, distinguishing between diabetic and hypertensive nephropathy is frequently challenging. However, a biopsy is usually not recommended because distinguishing between hypertension and diabetes as the underlying cause of CKD does not change management.

Diabetic nephropathy has worldwide prevalence due to diabetes complications crises , according to the united states renal data system reports that most common patients affected with type 2 diabetes were developed to End-Stage Renal Disease (ESRD) for twenty years , although the newly incidence of diabetes have been rising within constant level during the last twenty years until 2000 , the prevalence of diabetic nephropathy expected to rise 70% by 2015 ((Rossing, 2006).data records from Canada , Australia , Japan , Europe , show similar increases in ESRD related to incidence of diabetes (Van Dijk et al,2005) .

Other issues that make diabetes and related conditions should be evaluated by the healthcare provider. For example, if an older adult who has diabetes smokes, counseling and other services should be looked at and discussed with the patient. Some are willing to quit smoking but it is still tough to do it on your own. The problems of smoking and the disease caused by it are clear and have been discussed in many places. Smoking cessation should therefore be part of the plan for a diabetic patient. Medication taken by the older patient with diabetes should also be looked at. Some combinations of medications can increase blood pressure or affect other chemical balance of the body causing serious conditions or

One of the diseases is diabetes mellitus which is a major cause of renal failure. This disease can be defined as an increase of fasting blood glucose that is affected by a deficiency in insulin hormone. The normal range for glucose (fasting) in the blood is 2.8-6.0 mmol/L. It is classified into two groups, type 1 (insulin-dependent diabetes mellitus) and type 2 (non insulin-dependent diabetes mellitus). Stein (2008, p.6) points out that kidney failure happens most often when patients have suffered from diabetes mellitus for more than 10 years. According to United States Renal Data System (USRDS) report in 2007, approximately 44% of primary causes of renal failure is diabetes mellitus in the United States in 2005. Also, Stein (2008) indicates that 15% of dialysis patients are influenced by diabetes mellitus in the United Kingdom. Diabetes mellitus has negative affects throughout the kidneys where the increase of the range of blood sugar causes the damages to the cells in the kidneys. This leads to the presence of the glucose in the urine which is known as glycosuric.

Diabetes is highly prevalent condition, affecting 8.2 % of adults globally or 382 million people. Incidence is increasing with a estimated global prevalence of 592 million people by 2035. It further results in Chronic kidney disease & further may lead to ESKD(End-Stage Kidney Disease).