The Treatment Of Diabetic Nephropathy

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

The patient, Ms. Wanda Johnson was treated Humana Hospital now Glen of Virginia for six weeks before

The patient is an 86-year-old female who was brought to the emergency room because of bilateral leg swelling. She was recently discharged from the Arbor Glen Reha and she's developed increasing bilateral leg edema. Her medical history is significant for hypothyroidism, chronic kidney disease stage II, anemia which is a chronic, ulcer in the sacral ulcer stage III and she denies any other symptoms. Review of the lab work does show a bump in her creatinine from 1.27 baseline in February of 18 to 1.54 on this admission with an increase in her BUN. She also demonstrates a mild anemia of 10 with a MCV of 90. Her edema is described as massive by the attending physician. PT examination reveals she needs significant assistance to moneuver her

Past Medical History: The patient has a history of end-stage renal disease secondary to IgA nephropathy, hypertension, alcohol abuse, biopsy proven liver cirrhosis, history of right leg cellulitis,

In reviewing Heparin flushes in Central Venous Catheters (CVCs); one must first understand the importance of their placement. To properly investigate central venous catheter (CVC) care; documentation will focus on Heparin flushes as it relates to renal care. The renal dialysis patient undergoes CVC placement as a basis of receiving hemodialysis treatments. It is essentially the first access point placed in preparation of a more permanent access point. Central venous catheters, fistulas, and grafts are considered the lifeline of a dialysis patient. Their function and patency is of the utmost importance to the morbidity and mortality rate of a renal patient. “Venous catheters generally develop a fibrin sheath at the tip, which evolve into a clot due to body’s physiological response to the vein injury and the foreign catheter 1 and subsequent catheter obstruction.” (Journal of Evolution of Medical and Dental Sciences, 2014, pg. 46).

is not significant except with diagnosis of renal stones 3 years ago. Patient lives alone and

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).

The patient is usually awake during angioplasty, and chest discomfort may be experienced during the procedure. The patient remains awake in order to monitor the patient symptoms. If symptoms indicate the procedure is causing ischemia the cardiologist may alter or abort the part of the procedure. Bleeding from the insertion point in the groin (femoral artery) and wrist (radial artery) is common, in part due to the use of antiplatelet drugs. Some bruising is therefore to be expected. But occasionally a hematoma may form. This may delay hospital discharge as flow from the artery into the hematoma may continue which requires surgical repair. Infection at the skin puncture site is rare and dissection of the access blood vessel is

Diabetic nephropathy (DN) is one of the leading causes of chronic kidney diseases worldwide and most of the affected patients have T2DM. A considerable number of patients newly diagnosed with T2DM may already have developed nephropathy due to a preceding period of undiagnosed diabetes and impaired glucose tolerance [11]. According to the classification of American Diabetes Association, DN is divided into three stages, incipient nephropathy (micro-albuminuria), clinical diabetic nephropathy (macro-albuminuria) and ESRD. To diagnose those DN patients in its early stage can effectively prevent or delay the progression to ESRD [12]. Renal biopsy is a useful way to diagnose DN but is an invasive method so we are in need to simple, accurate and non-invasive test for early diagnosis and/or monitoring DN progression [13]. Several mechanisms, including hyperglycemia, advanced glycation end products (AGEs), oxidative stress, and inflammation are the main contributors to DN pathogenesis through activation of nuclear factor κB (NF-κB) signaling which is the key regulator of inflammation and apoptosis [14].

Chronic renal disease is a universal health puzzle and now consider one of the leading causes of death in the world [107].

I was intrigued by the theme of your Thread Discussion this week since I am the Outpatient Diabetes Educator and come across numerous patients with renal disease who stare at the face of the only life-saving option - dialysis. As you indicated, it is imperative to educate these patients on continuous self -care to avoid this dreadful treatment and prevent further complications related to lack of taking timely interventions. Because diabetes-related nephropathy is on many occasions a sad repercussion of a person's non-compliance resulting in a poor glycemic control which creates a devastating recipe for renal disease, the healthcare providers must focus on early prevention and self-care education. However, in my current position, I am exposed

Case No. 2: A 78-year-old female and nursing home resident, presented with fever and confusion, was diagnosed with pneumonia and UTI. Her past medical history was significant for CKD with AKI (GFR: 10 ml/min/1.73m2 -15 ml/min/1.73m2, BUN: 35mg/dl - 40 mg/dl), hypertension, dementia, diabetes mellitus and congestive heart failure. The patient had inconsistent responses regarding initiation of the dialysis

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.

Lo C, Toyama T, Hirakawa Y, Jun M, Cass A, Hawley C, Pilemore H, Badev SV, Percovic V, Zoungas S. Insuline & Glucose lowering agents for treating people with diabetics and chronic Kidney disease. Cochrane Database of systematic reviews 2015, Issue 8. Art. No. CD011798. DOI:10.1002/14651858.CD011798.

For the purpose of confidentiality, the patient will be identified by the initials A. S. A.S was a 52- year old African American woman who was admitted to the hospital when she started to experience severe urinary retention and shortness of breath. She has three adult children and eight grandchildren, but recently lost her husband of 25 years to diabetes. The patient appears to be very independent because she lives alone in her home and is aware of the disease process. She has a past medical history of acute renal