Diabetic Nephropathy

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

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

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).

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

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.

According to The American Diabetes Association, “Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels” (p.1).

The writer will examine the prevalence of diabetes among the patients with end-stage renal disease (ESRD), potential benefits, and harm during management of underlying cause, and analysis of glycemic index hemoglobin A1c (HgbA1c) in managing diabetic ESRD patients. Diabetes is one of the frequent reasons and common persistent complications of ESRD (Kovesdy, Park, & Kalantar-Zadeh, 2010). According to the United States Renal Data System (USRDS), diabetes is the primary cause leading to ESRD. Among 20.8 million diabetic population, approximately 232,984 were affected by ESRD that accounted for increase in Medicare budget from 5.4% to 6.3% at the end of 2011 (United States Renal Data System [USRDS], 2013). Not everyone with diabetes develop ESRD, thus strictly controlling blood sugar level lower the chances of getting kidney disease (Mehrotra, Kalantar-Zadeh, & Alder, 2011).

Diabetic neuropathy is the most common factor in almost 90% of diabetic foot ulcers [9, 10]. Nerve damage in diabetes affects the motor, sensory, and autonomic fibers. In patients with peripheral diabetic neuropathy, loss of sensation in the feet can cause further damage such as repetitive minor injuries that are undetected at the time and may subsequently prompt foot ulceration. In addition, structural deformities and abnormalities of the foot further increase the risk of ulceration. Other risk factors include a previous history of foot ulceration or amputation, visual impairment, diabetic nephropathy, poor glycemic control, and cigarette smoking. This may increases the chance of infection to the ulcer. Lack of wound healing, systemic sepsis,

Blood pressure — Higher blood pressures have been noted to be associated with diabetic nephropathy.

In order to further investigate the aetiology and pathophysiology of renal microvascular complications in type 2 diabetes, papers were reviewed through 2000 using the NIH PubMed Literature Search System. Inclusion criteria were that manuscripts 1) be primary peer-review research article; 2) concisely explained, or investigated, the pathophysiology of renal microvascular complications in type 2 diabetes; 3) be published in English.

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.

Diabetic nephropathy is considered a major microvascular complication of diabetes mellitus that affects approximately one-third of

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).

Diabetes is the commonest cause of ESRD (End Stage renal disease) worldwide, nearly in 20-40% of the ESRD patients it is considered as the etiological factor. Among T2DM patients, microalbuminuria is a known predictor of poor renal outcome (13 - 15). If T2DM patients with microalbuminuria were left untreated, it progress to macroalbuminuria and overt diabetic nephropathy. A combined and intensified management strategy is superior to a conventional treatment. In the present study all the biochemical parameters were similar at baseline but differ significantly at the end of the follow up period in group II, which shows that in intensive follow up was superior to conventional therapy in maintaining and controlling, Blood pressure, Triglyceride, total