Diabetic Nephropathy : The Leading Cause Of Chronic Kidney Diseases Worldwide And Most Of The Affected Patients

Diabetes mellitus (DM) is a pandemic that affects millions of people. The growth rate of unrecognized pre-diabetes in America is expected to rise up to 52% by 2020 (Lorenzo, 2013). As the prevalence of diabetes increases, so will the complications and burden of the disease. One of the leading causes for cardiovascular disease, renal failure, nontraumatic lower limb amputations, stroke, and new cases of blindness is DM (Lorenzo, 2013).

Type-2 Diabetes mellitus (T2DM) is a common disease worldwide. According to the American Diabetes association (ADA), 1808 million people in the United States have been diagnosed with diabetes, and another 7 million are thought to have the disease but have not been diagnosed. (Hilaire, Woods, 2013). This disease has impacted everyone in some way. It is a controllable disease; however many individuals choose not to control it or are uneducated on how to control it. Many people with type 2 diabetes (T2DM) also have hypertension, high cholesterol, obesity, lack of physical activity, poorly controlled blood sugars, and smoking. “Current evidence supports the concept that hyperglycemia significantly contributes to the development of both cardiovascular and microvascular complications of T2DM” (Chittari, McTernan, 2011). Cardiovascular disease (CVD) remains the leading cause of death in patients with diabetes mellitus, accounting for 50% of all deaths (Campbell & Hillman, 2010).

Underdiaxonsied and undertreated it is a major concern for the aging population of the United States. One of the first steps is educating the public on early detection techniques and risk factor for developing CKD. High blood pressure and diabetes is a major contributor in developing the disease and thus high risk factor groups should be identified early. This way the individuals can begin implementing lifestyle changes that can not only decrease the rate of kidney function decline but improve it as well. Management of the disease focus on the major complications. Anemia, dyslipidemia, CKD-MBD, nutrition and cardiovascular are the forefront of the disease management. Management with not only medications, but lifestyle changes creates a holistic care plan specialized to each individual patient. By treating not CKD but the individual patient, outcomes will improve. Implementing the health care team as a whole will unify the strengths in modern medicine and thus relieve a huge financial burden that chronic kidney disease yields at a national and local

Type 1 Diabetes Mellitus is a disease that occurs when insulin-producing beta cells of the pancreas are damaged or are being destroyed (Mahan, Escott-Stump & Raymond, 2012). The gradual destruction of the beta cells of the pancreas usually leads to complete insulin deficiency, which ultimately manifests itself in the following symptoms at clinical onset: “high blood glucose (hyperglycemia), frequent urination (polyuria), excessive thirst (polydipsia), and a significant amount of weight loss, dehydration, electrolyte disturbances and ketoacidosis”, requiring dependency of exogenous insulin in order to promote optimal glycemic control in order to prevent further more severe complications; such as, ketoacidosis, microvascular diseases, macrovascular diseases, neuropathy, or worse – Death (Mahan et al., 2012). Type 1 Diabetes Mellitus can result from two existing forms: 1. Immune-mediated diabetes Mellitus, which is characterized by autoimmune destruction of the beta cells of the pancreas and an idiopathic (unknown cause) commonly seen in ethnic groups of African or Asian descent (Mahan et al., 2012). Of all diagnosed diabetes cases, prevalence of Type 1 Diabetes Mellitus cases account for 5%-10%, and although onset may present itself at any age, 70% of cases are diagnosed in young adults (younger than age 30), with a peak in occurring incidences seen mostly in children and adolescents (Mahan et al., 2012). “In the United States, approximately 1 in every 400

Diabetes is a common chronic disease that causes problems in the way the blood uses food. The inability of the body to transform the sugar into energy is called diabetes. Glucose, a simple sugar, is the primary source of fuel for our bodies. When food is digested, some of the food will be converted into glucose which is then transferred from the blood into the cells however, insulin, which is produced by beta cells in the pancreas is needed. In individuals with diabetes, this process is impaired.

According to the Centers for Disease Control and Prevention (CDC), diabetes and hypertension are the leading causes of kidney failure in the United States. In 2011, approximately 44% of new cases of kidney failure, as a primary diagnosis, were attributed to diabetes with an additional 28% attributed to hypertension. Adults with diabetes, hypertension, or both have a higher risk of developing CKD than those without these diseases. (CDC, 2014)

Diabetes is a common chronic disease that causes problems in the way the blood uses food. The inability of the body to transform the sugar into energy is called diabetes. Glucose is the primary source of fuel for our body. When foods are digested, some of those foods are converted into glucose. Glucose then is transferred into the bloodstream and is used by cells for energy. However, for the glucose to be transferred from the blood into the cells, insulin, which was produced by beta cells in the pancreas is needed. In individuals with diabetes, this process is impaired. Currently, the disease affects approximately 371 million people of the world 's population with incidence and prevalence rates rising rapidly (Alotabi, A.,

Diabetes mellitus has risen to epidemic proportions in the United States, from 1980 through 2011, the number of adults with diabetes has increased immensely from 5.5 million to 19.6 million (Centers for Disease Control and Prevention [CDC], n.d.). Diabetes global prevalence research by Wild, Roglic, Green, Sicree, and King (2004) predicted that, the total number of people with diabetes will rise from 171 million in 2000 to 366 million in 2030. Diabetes has many causative factors that encompass genetic, lifestyle, and environmental categories. Diabetes can vary in different individuals in correlation with their surrounding population and environmental exposures. Individuals who manage their diabetes often need specific plans and counseling.

Diabetic nephropathy, an irreversible kidney failure, continues to be the most common cause of end stage renal disease requiring either a kidney transplant or renal replacement therapies, such as dialysis (Bilous, 2013). Worldwide, approximately fifty percent of cases of end-stage chronic kidney disease are caused by diabetes mellitus, with type II comprising the majority (Vladu, 2014). The prevalence of diabetes has been estimated to increase worldwide with the total number of diabetics rising from 285 million in 2010 to 439 million in 2030 (Mantelo, Oliveira, Ferraz, Lima, & Silva, 2015). This rise in diabetes is a concern to public health, as the effects of diabetes can have life altering consequences.

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) .

Diabetes Mellitus (DM) is a serious, chronic disease which affects one out of every eleven people in the United States. Diabetes Mellitus, also known as Diabetes, is a complex endocrine disease dealing with excessive glucose in the blood. The disease process lies within the body’s metabolic state in which the body metabolizes carbohydrates, proteins, and fats leading to either defective insulin production or insufficient amounts of insulin. Diabetes has several pathogeneses, signs and symptoms, risk factors, complications, treatment goals and teaching practices. In this paper, I will discuss the complex nature of Diabetes and its effects on the human body.

Diabetes Mellitus (DM) is a chronic condition that affects a big portion of the United States population, and is one of the biggest problematics with the patients in the Progressive Care Unit of Florida Hospital Celebration. The project addressed the improvement of nursing education in order to better assess, educate and guide patients on their treatment. Eventually patients will have a better understanding, and adherence to their complex DM treatment.

Diabetes kidney disease is normally rare, and diabetes itself is not a direct disease. It is a retrograde functioning of the body which occurs due to low secretion of insulin (type 1) or due to ineffective insulin (type 2) produced by the pancreas. Diabetes and kidney disease are closely related. Insulin is a hormone that helps glucose floating in the blood to enter the blood cells. With the entry of the glucose into the cells, it is converted into energy needed for the body. If there is no insulin secretion, or if it is not working what it should, the glucose keeps on circulating in the blood stream.

Background: Diabetic nephropathy is the major micro-vascular complication of type 2 diabetes mellitus (T2DM) and is the main cause for end-stage kidney disease. In view of metabolic derangements of T2DM, we went further to investigate the role played by oxidized low density lipoprotein (ox-LDL), toll like receptor 4 (TLR4), lipocalin-2 (LCN2), and omentin-1 in DN. Patients and methods: 15 normo-albuminuria T2DM, 15 micro-albuminuria T2DM and 15 macro-albuminuria T2DM in addition to 15 healthy volunteer who served as control group were enrolled in this study. Demographic and clinical data were recorded. Plasma Ox-LDL, omentin- 1 and urinary LCN2 levels by immunoassy and TLR4 mRNA level with real time PCR were assessed. Results: TLR4 gene expression, Plasma ox-LDL, urinary LCN2 levels were increased in T2DM cases as compared to their allied control group with the higher values were for macro-albuminuria T2DM cases. Meanwhile Plasma omentin-1 level was decreased in T2DM cases when compared to their allied control group with least values were for macro-albuminuria T2DM cases. Also there were positive correlations between TLR4 mRNA, ox-LDL, urinary LCN2 levels and serum creatinine, fasting blood glucose, urinary albumin/creatinine ratio, meanwhile omentin 1 showed negative correlations with serum creatinine, fasting blood glucose, urinary albumin/creatinine ratio. Conclusions: Ox-LDL, TLR4, LCN2 and omentin 1 may confer a relevant role in diabetic nephropathy development and

participant in sterilized urine containers and used to determine albumin in 24 h urine specimen. The urine levels of the biomarkers were normalized to the urinary creatinine concentration to control for variations in hydration status. Serum and urinary TNF-α: serum levels were measured by an enzyme-linked immune absorbent assay (ELISA) using commercially available standard kits (Quantikine high-sensitivity human TNF-α Research & Diagnostic Systems, Europe Ltd, Abington, UK). The urinary concentration of TNF-α was determined using an enzyme-linked immunosorbent assay (ELISA) with a Human TNF-α Quantikine ELISA kit (DTA00C; R&D systems, Minneapolis, MN, USA). The study protocol was approved by the Ethical Committee of Faculty of Medicine, Zagazig University and informed written consent was obtained from each individual. Statistical analyses Were performed using the Statistical Package for the Social Sciences for Windows (version 22.0; SPSS Inc., Chicago, IL, USA). Data were expressed using descriptive statistic (mean ± standard deviation) and were analyzed. One-way analysis of variance (ANOVA) test was done to compare different parameters between more than two groups. Pearson correlation coefficient was used to assess the association between serum and urinary TNF-α levels, clinical, biochemical tests and other studied metabolic parameters in patients with diabetic nephropathy. P-values were considered significant if < 0.05).On the other hand there were no significant