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Diabetic Nephropathy Review Article

The Role Of Novel Biomarkers In Predicting Diabetic Nephropathy: A Review

The Role Of Novel Biomarkers In Predicting Diabetic Nephropathy: A Review

Pediatric Nephrology Firm, Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria Abstract: Diabetic nephropathy (DN) is one of the microvascular complications of the kidney arising commonly from type 1 diabetes mellitus (T1DM), and occasionally from type 2 diabetes mellitus (T2DM). Microalbuminuria serves as an early indicator of DN risk and a predictor of its progression as well as cardiovascular disease risk in both T1DM and T2DM. Although microalbuminuria remains the gold standard for early detection of DN, it is not a sufficiently accurate predictor of DN risk due to some limitations. Thus, there is a paradigm shift to novel biomarkers which would help to predict DN risk early enough and possibly prevent the occurrence of end-stage kidney disease. These new biomarkers have been broadly classified into glomerular biomarkers, tubular biomarkers, biomarkers of inflammation, biomarkers of oxidative stress, and miscellaneous biomarkers which also include podocyte biomarkers, some of which are also considered as tubular and glomerular biomarkers. Although they are potentially useful for the evaluation of DN, current data still preclude the routine clinical use of majority of them. However, their validation using high-quality and large longitudinal studies is of paramount importance, as well as the subsequent development of a biomarker panel which can reliably predict and evaluate this renal microvascular disease. This paper aims to review the predictive role of these biomarkers in the evaluation of DN. Keywords: type 1 diabetes mellitus, renal microvascular complication, microalbuminuria, end-stage kidney disease, biomarker panel This work is published and licensed by Dove Medical Press Limited. The full terms of this license are Continue reading >>

Diabetic Nephropathy

Diabetic Nephropathy

Practice Essentials Diabetic nephropathy is a clinical syndrome characterized by the following [1] : Persistent albuminuria (>300 mg/d or >200 μg/min) that is confirmed on at least 2 occasions 3-6 months apart Elevated arterial blood pressure (see Workup) Proteinuria was first recognized in diabetes mellitus in the late 18th century. In the 1930s, Kimmelstiel and Wilson described the classic lesions of nodular glomerulosclerosis in diabetes associated with proteinuria and hypertension. (See Pathophysiology.) By the 1950s, kidney disease was clearly recognized as a common complication of diabetes, with as many as 50% of patients with diabetes of more than 20 years having this complication. (See Epidemiology.) Currently, diabetic nephropathy is the leading cause of chronic kidney disease in the United States and other Western societies. It is also one of the most significant long-term complications in terms of morbidity and mortality for individual patients with diabetes. Diabetes is responsible for 30-40% of all end-stage renal disease (ESRD) cases in the United States. (See Prognosis.) Generally, diabetic nephropathy is considered after a routine urinalysis and screening for microalbuminuria in the setting of diabetes. Patients may have physical findings associated with long-standing diabetes mellitus. (See Clinical Presentation.) Good evidence suggests that early treatment delays or prevents the onset of diabetic nephropathy or diabetic kidney disease. This has consistently been shown in both type1 and type 2 diabetes mellitus. (See Treatment and Management). Regular outpatient follow-up is key in managing diabetic nephropathy successfully. (See Long-term Monitoring.) Recently, attention has been called to atypical presentations of diabetic nephropathy with dissociati Continue reading >>

Recent Advances In Diabetic Nephropathy

Recent Advances In Diabetic Nephropathy

The classical definition of diabetic nephropathy is of a progressive rise in urine albumin excretion, coupled with increasing blood pressure, leading to declining glomerular filtration and eventually end stage renal failure. Patients generally have diabetic retinopathy. Recently, greater appreciation of the close links between nephropathy and cardiovascular disease have lead to the inclusion of premature cardiovascular disease, cardiovascular risk increasing in parallel with albuminuria (box 1). Diabetic nephropathy is now the single commonest cause of end stage renal failure worldwide and is acknowledged as an independent risk factor for cardiovascular disease. In many countries, the majority of diabetic patients starting renal replacement therapy now have type 2 rather than type 1 diabetes. This review will therefore encompass nephropathy in both type 1 and type 2 diabetes. Box 1: Clinical definition of diabetic nephropathy Progressive rise in urine albumin excretion. Progressive rise in blood pressure. Eventual decline in glomerular filtration rate and end stage renal failure. In the presence of diabetic retinopathy. Accompanied by progressive rise in cardiovascular risk. NATURAL HISTORY OF NEPHROPATHY Type 1 diabetes The initial rise in protein excretion is small and highly selective, albumin being the main protein excreted in excess. At this stage, specific immunologically based assays detect small increases in urine albumin which are below the detection limit of conventional dipstick tests (table 1). This so-called microalbuminuria generally appears within 5–15 years’ duration of diabetes. Without specific intervention, over approximately a further 10 years, albumin excretion slowly increases through the microalbuminuric range, until dipstick positive or conve Continue reading >>

Improvements In The Management Of Diabetic Nephropathy

Improvements In The Management Of Diabetic Nephropathy

SBDR - SOCIETY FOR BIOMEDICAL DIABETES RESEARCH Improvements in the Management of Diabetic Nephropathy Improvements in the Management of Diabetic Nephropathy Evangelia Dounousi1, Anila Duni1, Konstantinos Leivaditis2, Vasilios Vaios2, Theodoros Eleftheriadis2, Vassilios Liakopoulos2 1University of Ioannina, School of Health Siences, Department of Internal Medicine, Division of Nephrology, Ioannina, Greece 2Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece Address correspondence to: Vassilios Liakopoulos, Division of Nephrology and Hypertension, First Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 1 St. Kyriakidi street, 54636 Thessaloniki, Greece, e-mail: [email protected] Manuscript submitted April 15, 2015; resubmitted April 24, 2015; accepted April 27, 2015. Keywords: diabetes mellitus, albuminuria, diabetic nephropathy, end-stage renal disease, ACE inhibitors The burden of diabetes mellitus is relentlessly increasing. Diabetic nephropathy is the most common cause of end-stage renal disease (ESRD) worldwide and a major cause of morbidity and mortality in patients with diabetes. The current standard therapy of diabetic nephropathy involves intensive treatment of hyperglycemia and strict blood pressure control, mainly via blockade of the renin-angiotensin system (RAS). Attention has been drawn to additional beneficial effects of oral hypoglycemic drugs and fibrates on other aspects of diabetic nephropathy. On the other hand, antiproteinuric effects of RAS combination therapy do not seem to enhance the prevention of renal disease progression, and it has been associated with an increased r Continue reading >>

Diabetic Nephropathy And Its Two Phenotypes: The Proteinuric And Non-proteinuric

Diabetic Nephropathy And Its Two Phenotypes: The Proteinuric And Non-proteinuric

Diabetic Nephropathy and its two phenotypes: the proteinuric and non-proteinuric Regina Silva, Catarina Meng, Lus Coentro Nephrology and Infectious Diseases Research and Development Group, INEB-(I3S), University of Porto, Porto Portugal. The typical progression of diabetic nephropathy is from the normoalbuminuric stage to microalbuminuria (urinary albumin creatinine rate, UACR, 30-300 mg/g) to end in overt proteinuria. A growing body of recent evidence has shown an accelerated decrease in glomerular filtration rate predominately seen in normoalbuminuric patients with type 2 diabetes. This discovery raises the the possibility of there being two independent diabetic nephropathy phenotypes. The aim of this review is to collect, summarize and compare the most relevant data referring to both the classical/proteinuric (UACR>300mg/g) and the non-classical/ non-proteinuric (UACR < 300 mg/g) phenotypes in type 2 diabetic patients. PubMed research into diabetic nephropathy and both proteinuric and non-proteinuric phenotypes was undertaken. A total of 67 articles were included. Several studies have shown that diabetic nephropathy may co-exist within a normal range of albumin excretion. This new emerging phenotype is nowadays extremely frequent in type 2 diabetic patients, and seems to be found more often in female sex, older adults, and patients with metabolic syndrome. Albumin does not seem to be the best marker for this phenotype. New possible markers for early stage renal disease were found. Treatment with Renin-Angiotensin-System inhibitors, according to evidence, might not be the most adequate therapy for non-proteinuric diabetic patients. Prognosis is still unclear. This new diabetic nephropathy phenotype exists and clinicians should be aware of it, to ensure these patients Continue reading >>

Diagnosis And Management Of Type 2 Diabetic Kidney Disease

Diagnosis And Management Of Type 2 Diabetic Kidney Disease

Diagnosis and Management of Type 2 Diabetic Kidney Disease Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana Dr. Allon N. Friedman, Department of Medicine, Indiana University School of Medicine, 550 University Blvd., Suite 6100, Indianapolis, IN 46202. Email: allfried{at}iu.edu Type 2 diabetic kidney disease (DKD) is the most common cause of CKD and ESRD worldwide, and carries with it enormous human and societal costs. The goal of this review is to provide an update on the diagnosis and management of DKD based on a comprehensive review of the medical literature. Topics addressed include the evolving presentation of DKD, clinical differentiation of DKD from non-DKD, a state-of-the-art evaluation of current treatment strategies, and promising emerging treatments. It is expected that the review will help clinicians to diagnose and manage patients with DKD. Continue reading >>

[pathophysiology Of Diabetic Nephropathy: A Literature Review].

[pathophysiology Of Diabetic Nephropathy: A Literature Review].

[Pathophysiology of diabetic nephropathy: a literature review]. Facultad de Medicina, Universidad Catlica del Maule, Talca, Regin del Maule, Chile. Address: Calle Cuatro y Medio Norte B 3415, Talca, Regin del Maule, Chile. Email: [email protected] More Facultad de Medicina, Universidad Catlica del Maule, Talca, Regin del Maule, Chile. More 1.Facultad de Medicina, Universidad Catlica del Maule, Talca, Regin del Maule, Chile. Address: Calle Cuatro y Medio Norte B 3415, Talca, Regin del Maule, Chile. Email: [email protected] 2.Facultad de Medicina, Universidad Catlica del Maule, Talca, Regin del Maule, Chile. Find all citations in this journal (default).Or filter your current search Chronic kidney disease is a common complication of diabetes. Its importance lies in its high prevalence and future projection. It is associated with high health costs and global cardiovascular deterioration as well. The development of this disease pathophysiology is being studied and it is known that a series of complex molecular pathways determining a microvascular disease are involved. This review addresses the known pathways in the development of diabetic nephropathy aiming to improve the understanding of potential therapeutic targets that could be developed in the future. Continue reading >>

Pathophysiology Of Diabetic Nephropathy: Involvement Of Multifaceted Signalling Mechanism

Pathophysiology Of Diabetic Nephropathy: Involvement Of Multifaceted Signalling Mechanism

Diabetic nephropathy is a major cause of end-stage renal failure and the mortality rate due to this disease is continuously progressing worldwide. The multifaceted signalling mechanisms have been identified to be involved in the pathogenesis of diabetic nephropathy. Despite the modern therapies like antidiabetics, antihypertensives, and antioxidants available to treat diabetic nephropathy; most of patients continue to show progressive renal damage. It suggests that the key pathogenic mechanism involved in the induction and progression of diabetic nephropathy is still remaining active and unmodified by the present therapies. The purpose of this review is to bring together the current information concerning the signalling systems involved in the pathogenesis of diabetic nephropathy. From the *Department of Physiology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; and Cardiovascular Pharmacology Division, ISF College of Pharmacy, Punjab, India. Received for publication March 3, 2009; accepted May 1, 2009. The authors report no conflicts of interest. Reprints: Pitchai Balakumar, MPharm, PhD, Department of Physiology, Faculty of Medicine, University of Montreal, CP 6128, Succ. Centreville, Montreal, QC, Canada H3C 3J7 (e-mail: [email protected] ). 2009 Lippincott Williams & Wilkins, Inc. Thought you might appreciate this item(s) I saw at Journal of Cardiovascular Pharmacology. Your message has been successfully sent to your colleague. Some error has occurred while processing your request. Please try after some time. Continue reading >>

Diabetic Nephropathy: Time To Withhold Development And Progression - A Review

Diabetic Nephropathy: Time To Withhold Development And Progression - A Review

Diabetic nephropathy: Time to withhold development and progression - A review aNephrology Unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt aNephrology Unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt bEndocrinology Unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt cRheumatology and Rehabilitation Department, School of Medicine, Cairo University, Egypt Usama A.A. Sharaf El Din: [email protected] Received 2017 Feb 22; Revised 2017 Apr 19; Accepted 2017 Apr 20. Copyright 2017 Production and hosting by Elsevier B.V. on behalf of Cairo University. This is an open access article under the CC BY-NC-ND license (This article has been cited by other articles in PMC. Keywords: Type 1 diabetes, Type 2 diabetes, Diabetic nephropathy, DPP-4 inhibitors, SGLT2 inhibitors, Hyperfiltration The recent discoveries in the fields of pathogenesis and management of diabetic nephropathy have revolutionized the knowledge about this disease. Little was added to the management of diabetic nephropathy after the introduction of renin angiotensin system blockers. The ineffective role of the renin- angiotensin system blockers in primary prevention of diabetic nephropathy in type 1 diabetes mellitus necessitated the search for other early therapeutic interventions that target alternative pathogenic mechanisms. Among the different classes of oral hypoglycemic agents, recent studies highlighted the distinguished mechanisms of sodium glucose transporter 2 blockers and dipeptidyl peptidase-4 inhibitors that settle their renoprotective actions beyond the hypoglycemic effects. The introduction of antioxidant and anti-inflammatory agents to this field had also added wealth of knowledge. However, many of these agents Continue reading >>

Diabetic Nephropathy: Diagnosis, Prevention, And Treatment

Diabetic Nephropathy: Diagnosis, Prevention, And Treatment

Diabetic nephropathy is the leading cause of kidney disease in patients starting renal replacement therapy and affects ∼40% of type 1 and type 2 diabetic patients. It increases the risk of death, mainly from cardiovascular causes, and is defined by increased urinary albumin excretion (UAE) in the absence of other renal diseases. Diabetic nephropathy is categorized into stages: microalbuminuria (UAE >20 μg/min and ≤199 μg/min) and macroalbuminuria (UAE ≥200 μg/min). Hyperglycemia, increased blood pressure levels, and genetic predisposition are the main risk factors for the development of diabetic nephropathy. Elevated serum lipids, smoking habits, and the amount and origin of dietary protein also seem to play a role as risk factors. Screening for microalbuminuria should be performed yearly, starting 5 years after diagnosis in type 1 diabetes or earlier in the presence of puberty or poor metabolic control. In patients with type 2 diabetes, screening should be performed at diagnosis and yearly thereafter. Patients with micro- and macroalbuminuria should undergo an evaluation regarding the presence of comorbid associations, especially retinopathy and macrovascular disease. Achieving the best metabolic control (A1c <7%), treating hypertension (<130/80 mmHg or <125/75 mmHg if proteinuria >1.0 g/24 h and increased serum creatinine), using drugs with blockade effect on the renin-angiotensin-aldosterone system, and treating dyslipidemia (LDL cholesterol <100 mg/dl) are effective strategies for preventing the development of microalbuminuria, in delaying the progression to more advanced stages of nephropathy and in reducing cardiovascular mortality in patients with type 1 and type 2 diabetes. DEFINITION AND EPIDEMIOLOGY Diabetic nephropathy is the leading cause of chronic Continue reading >>

Diabetic Nephropathy: From Pathophysiology To Treatment

Diabetic Nephropathy: From Pathophysiology To Treatment

Diabetic Nephropathy: From Pathophysiology to Treatment 1Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China 2Shanghai Institute of Kidney and Dialysis, Shanghai, China 3Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China 4Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, China Correspondence should be addressed to Yi Fang and Feng Wang Received 9 July 2017; Accepted 9 July 2017; Published 23 October 2017 Copyright 2017 Ziyan Shen et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Diabetic kidney disease (DKD) has been surging as the leading cause of end-stage renal disease (ESRD), as approximately one-half, in Europe, United States, Japan, and Taiwan. While in Mainland China, it has surpassed glomerulonephritis to become the number 1 cause of chronic kidney disease (CKD) in hospitalized population (1.10% versus 0.75%) in 2015 and with a substantially ascending rate doubling over the past one decade [ 1 ]. In clinical practice, some individuals with diabetes mellitus do not progress to DKD even if their blood glucose is not strictly controlled, or they are not so easily to progress from diabetic nephropathy (DN) into ESRD [ 2 ]. However, some individuals are inevitable to progress into ESRD with perfect blood glucose [ 3 ]. Thanks to international collaboration and novel analytical approaches, the underlying mechanism has been unraveled as a sophisticated model with interaction between hereditary basis and nonhereditary factors. The onset and progression of DKD are not only influenced by genetic profi Continue reading >>

Diabetic Nephropathy Review Articles

Diabetic Nephropathy Review Articles

Diabetic nephropathy is the most common cause of kidney failure. It accounts for more than half of all cases of end-stage renal disease. Kidney diseases will affect between 20-40% of diabetics in their lifetime. Diabetic nephropathy is involved steadily in increasing proteinuria, accompanied by elevated blood pressure, with a progressive decline in Glomerular Filtration Rate. There is also a greatly increased risk of cardiovascular disease.Review articles are the summary of current state of understanding on a particular research topic. They analyze or discuss research previously published by scientist and academicians rather than reporting novel research results.Review article comes in the form of systematic reviews and literature reviews and are a form of secondary literature. Systematic reviews determine an objective list of criteria, and find all previously published original research papers that meet the criteria. They then compare the results presented in these papers. Literature reviews, by contrast, provide a summary of what the authors believe are the best and most relevant prior publications.The concept of "review article" is separate from the concept of peer-reviewed literature. It is possible for a review to be peer-reviewed, and it is possible for a review to be non-peer-reviewed. Continue reading >>

Comprehensive Approach To Diabetic Nephropathy - Sciencedirect

Comprehensive Approach To Diabetic Nephropathy - Sciencedirect

Volume 33, Issue 3 , September 2014, Pages 121-131 Author links open overlay panel BanchaSatirapoj1 Sharon G.Adler2 Open Access funded by The Korean Society of Nephrology Diabetic nephropathy (DN) is a leading cause of mortality and morbidity in patients with diabetes. This complication reflects a complex pathophysiology, whereby various genetic and environmental factors determine susceptibility and progression to end-stage renal disease. DN should be considered in patients with type 1 diabetes for at least 10 years who have microalbuminuria and diabetic retinopathy, as well as in patients with type 1 or type 2 diabetes with macroalbuminuria in whom other causes for proteinuria are absent. DN may also present as a falling estimated glomerular filtration rate with albuminuria as a minor presenting feature, especially in patients taking reninangiotensinaldosterone system inhibitors (RAASi). The pathological characteristic features of disease are three major lesions: diffuse mesangial expansion, diffuse thickened glomerular basement membrane, and hyalinosis of arterioles. Functionally, however, the pathophysiology is reflected in dysfunction of the mesangium, the glomerular capillary wall, the tubulointerstitium, and the vasculature. For all diabetic patients, a comprehensive approach to management including glycemic and hypertensive control with RAASi combined with lipid control, dietary salt restriction, lowering of protein intake, increased physical activity, weight reduction, and smoking cessation can reduce the rate of progression of nephropathy and minimize the risk for cardiovascular events. This review focuses on the latest published data dealing with the mechanisms, diagnosis, and current treatment of DN. Continue reading >>

Diabetic Nephropathy--a Review Of The Natural History, Burden, Risk Factors And Treatment.

Diabetic Nephropathy--a Review Of The Natural History, Burden, Risk Factors And Treatment.

Diabetic nephropathy--a review of the natural history, burden, risk factors and treatment. This article has been cited by other articles in PMC. The earliest clinical evidence of diabetic nephropathy is microalbuminuria. Progression from microalbuminuria to overt nephropathy occurs in 20-40% within a 10-year period with approximately 20% of these patients progressing to end-stage renal disease. End-stage renal disease develops in 50% of type-1 diabetes patients with overt nephropathy within 10 years and in more than 75% by 20 years in the absence of treatment. In type-2 diabetes, a greater proportion of patients have microalbuminuria and overt nephropathy at or shortly after diagnosis of diabetes. The incidence of diabetes is increasing worldwide, with subsequent increase in the incidence of diabetic nephropathy. The risk factors identified in the development of DN from longitudinal and cross-sectional studies include race, genetic susceptibility, hypertension, hyperglycemia, hyperfiltration, smoking, advanced age, male sex, and high-protein diet. Treatment interventions in diabetic nephropathy include glycemic control, treatment of hypertension, hyperlipidemia, cessation of smoking, protein restriction, and renal replacement therapy. Multifactorial approach includes combined therapy targeting hyperglycemia, hypertension, microalbuminuria, and dyslipidemia. Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (2.2M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References . These references are in PubMed. This may not be the complete list of references from this article. Reeves WB, Andreoli TE. Transforming growth factor beta contributes Continue reading >>

Diabetic Nephropathy: Progression And Pathophysiology - - Scopemed.org - Deposit For Medical Articles

Diabetic Nephropathy: Progression And Pathophysiology - - Scopemed.org - Deposit For Medical Articles

Diabetic nephropathy: Progression and pathophysiology Diabetic nephropathy is the leading cause of kidney disease in patients starting renal replacement therapy and affects ~30% of type 1 and type 2 diabetic patients. This review focuses on the progression and pathophysiological aspects of the condition. The natural history of diabetic nephropathy is characterized by specific renal morphological and functional alterations. Features of early diabetic renal changes are microalbuminuria (30-300mg/day), glomerular hyperfiltration, glomerular and renal hypertrophy, increased basement membrane thickness, and mesangial expansion with the accumulation of extracellular matrix proteins such as collagen, fibronectin, and laminin. Advanced diabetic nephropathy is characterized by macroalbuminuria ( >300mg/day), a progressive decline in glomerular filtration rate, decreasing creatinine clearance, glomerulosclerosis, and interstitial fibrosis. Although poor glycemic control is an important risk factor, glycemia does not fully explain why only a subset of diabetic patients progress to end stage renal disease. Several decades of extensive research has elucidated various pathways to be implicated in the development of diabetic kidney disease such as systemic and glomerular hypertension, advanced glycation endproducts and the aldose reductase system. Furthermore, hemodynamic factors, the reninangiotensin system, the endothelin system, the intracellular signaling molecule protein kinase C, transforming growth factor-, growth hormone, insulin like growth factors, vascular endothelial growth factor, and platelet-derived growth factor are believed to be involved in the pathogenesis. Thus, there are clearly many points at which therapeutic approaches could be tried to provide renoprotection Continue reading >>

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