Genetic susceptibility — Genetic susceptibility may be an important determinant of both the incidence and severity of diabetic nephropathy. The likelihood of developing diabetic nephropathy is markedly increased in patients with a diabetic sibling or parent who has diabetic nephropathy.
Age — For type 1 diabetes, the risk of developing ESRD is very low for patients diagnosed prior to age 5; at older ages, the relationship of age to progression to ESRD is uncertain
Blood pressure — Higher blood pressures have been noted to be associated with diabetic nephropathy.
Obesity — A high body mass index (BMI) in patients with diabetes has been associated with an increased risk of chronic kidney disease. In addition, diet and weight loss may
…show more content…
Metabolic memory applies in nephropathy. In nephropathy, significant persistent benefits were noted in those who had received intensive therapy compared with those who received conventional therapy during the DCCT.
After eight years of follow-up in EDIC, patients originally assigned to intensive glycemic control were significantly less likely to develop new microalbuminuria (7 versus 16 percent), new clinical albuminuria, also called macroalbuminuria, (1.4 versus 9 percent), and hypertension (30 versus 40 percent).
After 16 years of follow-up in EDIC (22 years since in the start of the DCCT trial), patients originally assigned to intensive glycemic control were significantly less likely to develop impaired renal function, defined as an estimated glomerular filtration rate less than 60 mL/min per 1.73 m2 (3.9 versus 7.6 percent).
Hyperlipidemia is common in diabetic patients, a tendency that is increased by the development of renal insufficiency. Aggressive lipid lowering is an important part of the medical management of all diabetic patients since diabetes is considered a coronary heart disease equivalent.
An elevation in lipid levels also may contribute to the development of glomerulosclerosis in chronic kidney disease.
A prospective study in patients with type 1 diabetes mellitus found that a plasma cholesterol concentration above 220 mg/dL (5.7 mmol/L) was an important risk factor for progressive renal disease,
Influential leaders have risen to power from a variety of beginnings. Many, like Franklin Delano Roosevelt, start from humble beginnings, and they rise to power to serve the people in their darkest hours. Franklin Delano Roosevelt’s odyssey to power started when he was born on January 30, 1882, in Hyde Park, New York, to two upper middle class parents. Five years later little Franklin got his first peek at the white house when his family got invited there by Grover Cleveland, whose was then the 22nd president of the United States of America. Before graduating Harvard in 1904, Franklin married Ana Eleanor Roosevelt, a distant cousin. Throughout university Franklin became obsessed with politics and after he graduated he decided to run for
Why do we treat diabetes? There are a number of downstream events associated with abnormal blood glucose levels. If glucose levels are managed properly, the complications associated diabetes can be controlled, and sometimes completely prevented. The main problem with having more than the normal amount of glucose circulating in the blood stream is the effect that excess glucose can have on both large and small blood vessels (DTC, 2004). Micro-vascular and macro-vascular problems associated with diabetes can be seen in the heart, eyes, kidney, legs and feet. Diabetic patients are twice as likely to suffer from a mycocardial infaraction, twenty-five times more likely to suffer blindness, and seventeen times more likely to suffer kidney failure compared to a non-diabetic (DTC, 2004). Because of great number of risks associated with abnormal blood glucose levels, diabetes is aggressively treated to improve the quality of life and prevent complications in patients.
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
inverse relationship to GFR. Thus, a rise in S.Cr is associated with a corresponding decrease in GFR and generally implies a reduction in kidney function and vice versa.
High levels of blood sugar caused by diabetes can cause the kidneys to filter too much blood. This overexertion can be hard on the kidneys and eventually they can start to leak and can be lost in the urine. If this is not caught early enough the extra work the kidneys are doing can cause them to lose their ability to filter allowing waste to build up in the blood and eventually leading to kidney failure. Individuals with diabetes are more likely to develop certain problems and diseases along with its effects on the different systems of the body.
Over time, diabetic patients can affect the heart, blood vessels, eyes, kidneys, and nerves. The adults with diabetic will be at risk of getting heart attacks and stroke because of micro vascular and macro vascular involvement. Cases associated with decreased lower blood circulation and neurological damage (nerve damage) increase the likelihood of foot ulcers with infection and infiltration leads to lower limb amputations. Diabetes may be responsible for 2.6% of global blindness. Diabetic is a major cause of kidney failure
The American Association of Clinical Endocrinologist (AACE) treatment goals are individualized and aimed at lowering A1C and prevention of hypoglycemia along with decreased comorbidities associated with diabetes. Diabetics who are at an increased risk for hypoglycemia include: a diagnosis of greater than 15 years, advanced macrovascular disease, hypoglycemia unawareness, limited life expectancy and severe comorbidities (Garber, Blonde, Bush, Einhorn, & Garber,et al., 2017). In addition Fowler (2010) notes that those with renal or hepatic dysfunction are at an increased risk for hypoglycemia due to the combination of less endogenous glucose production and longer insulin half life. This combination can result in a rapid lowering of glucose.
The main goal is to keep sugar levels within the normal range (i.e. fasting glucose <125 mg/dl) as much as possible. Diet, exercise and weight loss play a key role in the progression of the disease. Weight loss alone can control as much as 25% of the cases of diabetes type 2 without the need for medication. In type 1 DM, where the pancreas cannot make insulin, insulin injection is the most common type of treatment. Type 2 DM, is most commonly treated with a combination of diet, exercise and oral hypoglycemic medications. In severe cases insulin injection can be added. Daily blood sugar levels monitoring is an essential part of diabetic care. One must also be careful using both insulin and oral hypoglycemic medications as they can lower blood sugar levels to dangerous levels causing hypoglycemia. Severe complication like diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemia (HHS) can be life threatening. Stress like illness, trauma, and/or surgery frequently aggravate glycemic control and may precipitate as DKA or hyperosmolar hyperglycemia. Its symptoms can be dehydration, weakness, Kussmaul respirations (in DKA), tachycardia, hypotension, and alteration in mental status, and ultimately coma (more frequent in HHS) (2). One must seek medical attention
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).
and metabolic syndrome but also as it increases the risk of developing kidney stones, chronic
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
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).
Mostly, patients with Chronic Kidney Disease in stages 1-3 are asymptomatic. They do not show evident altering of the balance of water or electrolyte levels in the body. At this particular state, the disease may be