what is Diabetic nephropathy : Definition,risk factor, symptoms diagnosis and treatment

What is diabetic nephropathy?

Diabetic nephropathy or kidney diseases secondary to diabetic microvascular changes in the kidney, is a common complications of diabetes

- about 20% to 30% of people with type1 or type 2 diabetes develop nephropathy, but fewer of those with type 2 Diabetes progress end stage of renal diseases

When person develop diabetic nephropathy?

-person with type1 diabetes frequently show initial signs of kidney diseases after 10 to 15 years

- type 2 diabetic tend to develop kidney diseases within 10 years after the diagnosis of diabetes 

What are the Risk factors for developing diabetic nephropathy?

1.genetic

2.Patient with type1 and type2 diabetes

3.Sustained hyperglycemia

4.Frequent hypertension

Others

5.Smoking,dyslipidemia, dietary factor such as amount and source of protein and fat in the diet.

What is the Pathophysiology of diabetic nephropathy?

- Due to risk factor contribute to blood glucose levels are elevated consistently for a significant period of time

- The kidneys filtration mechanism is stressed,

- allowing blood protein to leak into the urine

- as a result, the pressure in the blood vessels of the kidney increases

- increased pressure serves as the stimulus for the development of nephropathy.

Clinical symptoms of diabetic nephropathy

1.protein or albumin in the urine

2.inflammation of feet, ankle and hands

3.confusion

4.Shortness of breath

5. Loss of appetite

Diagnostic of diabetic nephropathy 

Albumin is one of the most important blood protein that leak into the urine

1. The urine should be checked annually for the presence of microalbumin

2.The urine should be checked annually for the presence of microalbumin,if the microalbuminuria exceeds 30mg/24 hours on two consecutive random urine tests, 24 hours urine sample should be obtained and tested, if results are positive, treatment is indicated

3.addition tests for serum creatinine and BUN level should be conducted annually

4. Diagnostic testing for cardiac or other systemic disorder

Diabetic nephropathy treatment guidelines

-Intensive treatment for type 1 diabetes with a goal of achieving a glycolated hemoglobin level as a close to the non-diabetic range as a possible reduced the occurrance of early signs of nephropathy

- achieving and maintenance near normal blood glucose, patient with Diabetic need careful attention to the following

-Control of hypertension ( use of ACE inhibitor) it's helps to decrease or delay the onset of early proteinuria

- prevent or treat urinary tract infection

-avoid of nephrotoxic medication and contrast dye

-Adjustment of medication as kidney function changes

- low sodium diet

- low protein diet

-If the patient have already microalbuminuria with the exceed 30mg/24 hours on two consecutive tests, an ACE inhibitor should be prescribed, it's helps to lower the blood pressure and reduce the microalbuminuria thereby protect the kidney

- End stage of renal diseases two types of treatment are available dialysis ( hemodialysis or peritoneal dialysis)

- in medical centers performing large numbers of transplantation,the chance are 75% to 80% that the transplanted at least 5 years.

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