Question

How is kidney health affected by uncontrolled DM?

Based on your studies in this unit, thoroughly explain how kidney health can deteriorate in response to chronic hyperglycemia.

?       Discuss diabetic nephropathy in terms of

?       definition

?       What is it?

?       causes

?       What is the pathological mechanism?

?       signs/symptoms

?       What is the first clinical sign of kidney dysfunction due to DM?

?       prevalence/significance

?       How common is this?

?       What statistics reveal the magnitude of this condition?

?       How does the control of hypertension and hyperglycemia directly affect development of end-stage kidney disease?

Answer 1

Definition: Nephropathy means kidney disease or damage. Diabetic nephropathy is damage to the kidneys caused by diabetes. In severe cases it can lead to kidney failure. But not everyone with diabetes has kidney damage.

Causes: Diabetes can cause the nephrons to thicken and scar, which make them less able to filter waste and remove fluid from the body. This causes them to leak a type of protein called albumin into your urine. The exact reason this occurs in people with diabetes is unknown, but high blood sugar levels and high blood pressure are thought to contribute to diabetic nephropathy. Persistently high blood sugar or blood pressure levels are two things that can damage your kidneys, making them unable to filter waste and remove water from your body. Other factors have been shown to increase your risk of getting diabetic nephropathy, such as:

• being African-American, Hispanic, or American Indian
• having a family history of kidney disease
• developing type 1 diabetes before you are 20 years of age
• smoking
• being overweight or obese
• having other diabetes complications, such as eye disease or nerve damage

Signs and symptoms:

In the early stages of diabetic nephropathy, you may not notice any signs or symptoms. In later stages, the signs and symptoms include:

• Worsening blood pressure control
• Protein in the urine
• Swelling of feet, ankles, hands or eyes
• Increased need to urinate
• Less need for insulin or diabetes medicine
• Confusion or difficulty concentrating
• Loss of appetite
• Nausea and vomiting
• Persistent itching
• Fatigue

Prevalance:

Diabetic nephropathy rarely develops before 10 years’ duration of type 1 DM (previously known as insulin-dependent diabetes mellitus [IDDM]). Approximately 3% of newly diagnosed patients with type 2 DM (previously known as non–insulin-dependent diabetes mellitus [NIDDM]) have overt nephropathy. The peak incidence (3%/y) is usually found in persons who have had diabetes for 10-20 years, after which the rate progressively declines. The risk for the development of diabetic nephropathy is low in a normoalbuminuric patient with diabetes’ duration of greater than 30 years. Patients who have no proteinuria after 20-25 years have a risk of developing overt renal disease of only approximately 1% per year.