Question

The patient's history for update purposes

Patient A age 70. He is obese and 100% sedentary. He needs to do physical exercises, to lose weight, to decrease stress and to eat better (but he does not do that). He has diabetes: 25 years ago, he was diagnosed with diabetes type 2 and he has to take insulin.

Diet: He eats meat 3 times a day and does not eat dietary fiber.

Emotional: He is stressed and anxious, and works hard.

Parents: The mother and father died young because of complications of diabetes. Father: died at age 53 of myocardial infarction.

Symptoms now: shortness of breath, chest pain due to physical exertion (angina).

Has high blood pressure: 140/90. Never had hypertension before. His doctor prescribed for hypertension: Vasotec (enalapril).

He must take the following exams:

FSC: red blood cells, white blood cells and platelets

Lipid profile

Creatinine test

Uremia test (urine in the blood)

Electrolytes test (usually sodium or potassium or an acid-base imbalance)

Clearance of creatinine test

HbA1c test (also called glycated hemoglobin test, and glycohemoglobin)

Stress ECG test

Urine analysis

3 weeks later, the results:

Clearance of creatinine test show to us the GFR (Glomerular Filtration Rate) results:
GFR 55mL/min (normal: 90-125mL/min)

Lipid profile: low level HDL, high level LDL

Plasma creatinine level (creatinine test): 150 mmol/L (normal: 50-110 umol/L)

Uremia test : 8 mmol/L (N : 3 - 6,5 mmol/L)

Urine analysis: 120 mg/L of proteins (normal: < 80 mg/L)

Stress ECG test: Anomalies related to unstable angina

Doctor's conclusion: chronic renal insufficiency (CRI), unstable angina. Needs to do an emergency angiography.

Angiography test results: several atheroma plaques in the coronary arteries. He had to put four stents during the procedure.

He had to take these medicaments:

Clopidogrel (Plavix), Aspirine (acide salicylique, for 1 year), and Crestor (is a statine). And also, the insulin and Vasotec (énalapril).

Question D: What is the link of diabetes with the chronic renal insufficiency (CRI)? What is the role of the kidneys in this case?

Answer 1

Diabetes is known to have many side effects. One of the major concerns is the damage it causes to the kidney. People suffering from diabetes mellitus for many years have metabolic changes that lead to the damage of the glomeruli . Glomerulus is involved in the filtration of blood in the kidneys. This condition is known as diabetes nephropathy. Chronic kidney disease (CKD) is defined as the loss of kidney function over a long period of time. High blood pressure as well as diabetes is the major risk factors for CKD. Diagnosis involves the testing of blood samples for creatinine levels. High levels indicate that glomerular filtration is not functioning properly. Diabetic nephropathy has been cited as one of the primary causes for chronic kidney disease.

With diabetes, the little veins in the body are harmed. At the point when the veins in the kidneys are harmed, her kidneys can't spotless her blood legitimately. Her body will hold more water and salt than it should, which can bring about weight pick up and lower leg swelling. She may have protein in her pee. What's more, squander materials will develop in her blood.

Diabetes additionally may make harm nerves in her body. This can cause trouble in exhausting her bladder. The weight coming about because of her full bladder can go down and harm the kidneys. Additionally, if pee stays in her bladder for quite a while, she can build up a disease from the quick development of microbes in pee that has a high sugar level.