DIABETIC NEPHROPATHYPresentation by Kaleigh Connors

St. Petersburg CollegePCB 4723 Fall 2012

KIDNEY FUNCTIONS

• Primary urine: aqueous solution introduced into the kidney tubules

– Ultrafiltration

– Active solute secretion (insects and some marine fish)

• Definitive urine: modified as the solution moves through tubules and

other excretory passages, ultimately to be eliminated

Commonly under endocrine control and

hormonally modulated in regulatory ways

DIABETIC NEPHROPATHY

• Exact cause and mechanism unknown

– Uncontrolled high blood glucose leads to kidney damage

– Causes the glomerulus to become thickened and scarred

– Leads to leakage of the kidney structure: albumin

• Diagnosis: BUN, serum creatinine

• Commonality in those diagnosed with IDDM before age 20, smokers and

people of African-American, Hispanic and American Indian descent

DIABETIC NEPHROPATHY – A REVIEW OF THE NATURAL HISTORY, BURDEN, RISK FACTOS AND TREATMENT

• Greater proportion of Type 2 individuals are diagnosed with DN

– Possibly because the disease had been present over several years before

the diagnosis of diabetes was made

• Incidence of DN increased by 150% over the last 10 years in the US

(similar to Europe and Japan)

• Patients undergoing dialysis have a 22% and 15% higher mortality at

one year and five years compared to those without diabetes

– Death from cardiovascular disease or infection

• Prevention of DN

– Primary: prevention of

diabetes in the population

– Secondary: strict control of

blood glucose, lipids and blood

pressure levels

– Tertiary: regular screening for

proteinuria and appropriate

treatment

DIABETIC NEPHROPATHY – A REVIEW OF THE NATURAL HISTORY, BURDEN, RISK FACTOS AND TREATMENT

LITERATURE CITEDAyodele, O.E., Alebiosu, C.O., Salako, B.L. (2004). Diabetic neuropathy –

a review of the natural history, burden, risk factors and treatment. Journal of the National Medical Association, 96(100: 1445-1454.

Burne, P.N., Toto, R. (2012). Current update in the management of diabetic nephropathy. Current Diabetes Review.

Chow, F., Ozols, E., Nikolic-Paterson, D.J., Atkins, R.C., Tesch, G.H. (2004). Macrophages in mouse type 2 diabetic nephropathy: correlation with diabetic state and progressive renal injury. Kidney International, 65(1): 116-128.

Gross, J.L., de Azevedo, M.J., Silveiro, S.P., Canani, L.H., Caramori, M.L., and Zelmanovitz, T. (2005). Diabetic nephropathy: diagnosis, prevention and treatment. Diabetes Care, 28(1):164-76.

Kiyoshi, K., Masaomi, N., Akira, S., Reiko, I. and Toshio, M. (2003). Current issues and future perspectives of chronic renal failure. Journal of American Society of Nephrology, 13:3-6.

Mogensen, C.E., Christensen, C.K. (1984). Predicting diabetic nephropathy in insulin-dependent patients. The New England Journal of Medicine, 311(2): 89-93.

Mauer, S.M., Steffes, M.W., Ellis, E.N., Sutherland, D.E.R., Brown, D.M., Goetz, F.C. (1984). Structural-Functional Relationships in Diabetic Nephropathy. The American Society for Clinical Investigation, 74: 1143-1155.

Ritz, E., Steanski, A. (1996). Diabetic nephropathy in type II diabetes. American Journal of Kidney Diseases, 27(2): 167-194.

Strippoli, G.F., Di Paolo, S., Cincione, R., Di Palma, A.M., Teutonico, A., Grandaliano, G., Schena, F.P. and Gesualdo, L. (2003). Clinical and therapeutic aspects of diabetic nephropathy. Journal of Nephrology, 16(4): 487-99.

Stevens, L.A., Coresh, J., Greene, T., Levey, A.S. (2006). Assessing kidney function—measured and estimated glomerular filtration rate. The New England Journal of Medicine, 354(23): 2473-83.

Yamagishi, S., Fukami, K., Ueda, S., and Okuda, S. Molecular mechanisms of diabetic nephropathy and its therapeutic intervention. Current Drug Targets, 8(8): 952-9.

Young, B.A., Johnson, R.J., Alpers, C.E., Eng, E., Gordon, K., Floege, J., Couser, W.G., and Siedel K. (1995). Cellular events in the evolution of experiment diabetic nephropathy. Kidney International, 47(3): 935-944.

Questions?

IMAGES OBTAINED FROM (GOOGLE)

1. http://www.encyclopedia.com/doc/1O62-diabeticnephropathy.html

2. http://apbrwww5.apsu.edu/thompsonj/Anatomy%20&%20Physiology/2020/2020%20Exam%20Reviews/E

xam%204/CH25%20Kidney%20Anatomy.htm

3. http://medcell.med.yale.edu/histology/urinary_system_lab/diabetic_neuropathy.php

4. http://researchcenters.info/diseases/diabetic-nephropathy.html

5. https://urinalysis.publishpath.com/Default.aspx

6. http://www.nytimes.com/2012/05/11/health/policy/dialysis-rule-changes-followed-by-transfusion-increa

ses.html

7. http://rmsbunkerblog.wordpress.com/2011/04/13/benefits-of-patient-satisfaction-surveying-healthcare/

8. http://123freevectors.com/medical-background/

9. http://www.123rf.com/photo_2331661_kid-is-doing-a-diabetes-glucose-level-finger-blood-test-in-backgro

und-there-are-older-bigger-devices.html

10. http://www.evroberts.com/evr_desktoptools.php