Diabetic Nephropathy Epidemiology In Asia And The Current State Of Treatment
Diabetic nephropathy Epidemiology in Asia and the current state of treatment Department of Internal Medicine, Division Nephrology, Ruperto Carola University of Heidelberg, Germany 1Nephrology Division, West China Hospital of Sichuan University, 17 Guo Xue Alley, Chengdu, China Address for correspondence: Prof. Eberhard Ritz, Department of Internal Medicine, Division Nephrology, Nierenzentrum, Im Neuenheimer Feld 162, D-69120 Heidelberg, Germany. E-mail: [email protected] Author information Copyright and License information Disclaimer Copyright : Indian Journal of Nephrology This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Type 2 diabetes is by no means a novel disease. No definite description of diabetes can be found in the Corpus Hippocraticum or in the subsequent European literature, except inconclusive descriptions by Galenus and Aretaios. It took centuries before the sweet taste of urine in diabetes was described by Thomas Willis (in 1674) and sugar in the urine was identified by Matthew Dobson (in 1776). In contrast, a large body of evidence points to the common presence and diagnosis of diabetes in ancient India and China, presumably the result of genetics and lifestyle and acumen of the respective physicians. The characteristic sweet urine in diabetes was mentioned in the Indian Sanskrit medicine literature[ 1 ] presumably written between 300 before and 600 after Chr. The ancient physicians described sugar cane urine (Iksumeha) or honey urine (Madhumeha and Hastimeha) as well as urine flow like el Continue reading >>
Mechanisms Hyperglycemia Tissue damage *Repeated acute changes in cellular metabolism **Cumulative long term changes in stable macromolecules Genetic susceptibility Independent accelerating factors * Sorbitol accumulation ï‚ NADH/NAD ratio ï‚¯ Myoinositol early glycation ** Forming advanced glycation end products Independent accelerating factors: - HT - Hyperlipidemia - Smoking Macro-vascular Complications The major cardiovascular risk factors in the non-diabetic population (smoking, hypertension and hyperlipidemia) also operate in diabetes, but the risks are enhanced in the presence of diabetes. Overall life expectancy in diabetic patients is 7 to 10 years shorter than non-diabetic people. Macro-vascular Disease Once clinical macro-vascular disease develops in diabetic patients they have a poorer prognosis for survival than normoglycemic patients with macrovascular disease The protective effect females have for the development of vascular disease are lost in diabetic females CAD Morbidity and Mortality in Type 2 DM Framingham Data: 20 year follow-up:Age 45-74: 2-3 fold increase in clinically evident atherosclerotic disease in diabetics women diabetics=male diabetics in terms of CAD mortality Multiple Risk Factor Intervention Trial (MRFIT) 5000 men with type 2 DM Followed for 12 years Men with type 2 DM had absolute risk of CAD-related death 3 times higher than non-diabetic cohort To further focus on the epidemiology of coronary disease in type 2 diabetes, it is important to understand that diabetics have a significantly increased risk when compared to their non-diabetic cohorts. Framingham data with 20 year follow-up on patients aged 45 to 74 revealed that diabetics had a 2-3 fold increase in clinically evident atherosclerotic disease. Furthermore, women diabeti Continue reading >>
Classification And Differential Diagnosis Of Diabetic Nephropathy
Copyright © 2017 Chenyang Qi 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. Abstract Diabetic nephropathy (DN) is a major cause of end-stage renal disease throughout the world in both developed and developing countries. This review briefly introduces the characteristic pathological changes of DN and Tervaert pathological classification, which divides DN into four classifications according to glomerular lesions, along with a separate scoring system for tubular, interstitial, and vascular lesions. Given the heterogeneity of the renal lesions and the complex mechanism underlying diabetic nephropathy, Tervaert classification has both significance and controversies in the guidance of diagnosis and prognosis. Applications and evaluations using Tervaert classification and indications for renal biopsy are summarized in this review according to recent studies. Meanwhile, differential diagnosis with another nodular glomerulopathy and the situation that a typical DN superimposed with a nondiabetic renal disease (NDRD) are discussed and concluded in this review. 1. Introduction Diabetic nephropathy (DN) caused by diabetes mellitus is one of the major causes of end-stage renal failure worldwide . Clinically, microalbuminuria is an important index to assess the progression of DN . However, it is not accurate to evaluate the severity or prognosis simply based on the degree of proteinuria. It is now well recognized that not all diabetic patients who develop renal function failure have massive albuminuria . Therefore, nephrologists and endocrinologists should be aware of the significance of pathological c Continue reading >>
How Far Would You Go To Address Diabetic Microvascular Complications?
Diabetes is a Significant Healthcare Problem in the United States Over 18 million Americans have diabetes Up to 30% of diabetes cases have not been diagnosed 1.3 million new cases are diagnosed each year in the US Economic burden of $132 billion per year (2002 healthcare costs) Approximately $7333 per patient American Diabetes Association. Available at: Hogan P, et al. Diabetes Care. 2003;26:917-932. Global prevalence of Type 1 and Type 2 diabetes is soaring. In the United States, over 18 million Americans â€“ approximately 1 in 16 â€“ have diabetes.1,2 Type 2 diabetes is the most common, accounting for 90% of all diabetes cases throughout the world.3 The World Health Organization (WHO) has determined that in most communities, at least 20% of diabetes cases have not been diagnosed; however, in many communities more than 50% remain undiagnosed.4 The impact of diabetic complications extends beyond patient health, with dramatic increases in direct healthcare costs.5 A study designed to provide estimates of the economic burden of diabetic complications in the United States reported that direct medical and indirect expenditures totaled $132 billion in 2002.5 References: 1. American Diabetes Association. Available at: 2. World Health Organization. Available at: Accessed October 15, 2003. 3. Edlund H. Diabetologia. 2001;44:1071-1079. 4. King H, Rewers Ml. Diabetes Care. 1993:16;157-177. 5. Hogan P, et al. Diabetes Care. 2003;26:917-932. Additional information: Latest US census data: 292 million people in America. According to ADA, 18 million Americans have diabetes, equating to 1 in 16 of the total population. The total cost in 2002 was $132 billion, which equates to $7333 per patient. Continue reading >>
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Diabetic Nephropathyclinical Presentation
Diabetic NephropathyClinical Presentation Author: Vecihi Batuman, MD, FASN; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Diabetic nephropathy should be considered in patients who have diabetes mellitus (DM) and a history of one or more of the following: Fatigue and foot edema secondary to hypoalbuminemia (if nephrotic syndrome is present) Other associated disorders such as peripheral vascular occlusive disease, hypertension, or coronary artery disease 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, such as the following: Peripheral vascular occlusive disease (decreased peripheral pulses, carotid bruits) Evidence of diabetic neuropathy in the form of decreased fine sensations and diminished tendon reflexes Evidence of fourth heart sound during cardiac auscultation Almost all patients with nephropathy and type 1 DM demonstrate signs of diabetic microvascular disease, such as retinopathy and neuropathy. [ 15 ] Clinical detection of the retinopathy is easy, and in these patients the condition typically precedes the onset of overt nephropathy. The converse is not true. Only a minority of patients with advanced retinopathy have histologic changes in the glomeruli and increased protein excretion that is at least in the microalbuminuric range, and most have little or no renal disease (as assessed by renal biopsy and protein excretion). Patients with type 2 DM who have marked proteinuria and retinopathy typically have diabetic nephropathy, while those persons who do not have retinopathy frequently exhibit nondiabetic glomerular disease. To see complete information on the conditions below, please go t Continue reading >>
Educate Physicians And Nurses On Practical Management Tips For Diabetes Control.
Type 2 Diabetes Common in Hispanics, Native Americans and Pima Indians Incidence of ESRD is lower, but the disease is more frequent â€“ thus it is the most common cause of renal failure United Kingdom Prospective Diabetes Study UKPDS â€“ large British study, (predominantly Caucasians) Adler, AI, Stevens, RJ, Manley, SE, Bilous, RW, Cull, CA & Holman, RR: Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int, 63:225-32, 2003. Incidence of microalbuminuria 25% but incidence of ESRD only 0.8% Microlbuminuria patients spent an average of 11 years before progressing to overt proteinuria Only 2.3% progress from macroalbuminuria to ESRD 1. Hypertension in people with Type 2 diabetes: knowledge-based diabetes-specific guidelines. Diabet Med, 20:972-87, 2003. 2. Abbott, KC & Bakris, GL: What have we learned from the current trials? Med Clin North Am, 88:189-207, 2004. 3. Anderson, PW, McGill, JB & Tuttle, KR: Protein kinase C beta inhibition: the promise for treatment of diabetic nephropathy. Curr Opin Nephrol Hypertens, 16:397-402, 2007. 4. Baghdasarian, SB, Jneid, H & Hoogwerf, BJ: Association of dyslipidemia and effects of statins on nonmacrovascular diseases. Clin Ther, 26:337-51, 2004. 5. Bakris, GL, Weir, MR, Shanifar, S, Zhang, Z, Douglas, J, van Dijk, DJ & Brenner, BM: Effects of blood pressure level on progression of diabetic nephropathy: results from the RENAAL study. Arch Intern Med, 163:1555-65, 2003. 6. Bando, Y, Ushiogi, Y, Okafuji, K, Toya, D, Tanaka, N & Miura, S: Non-autoimmune primary hypothyroidism in diabetic and non-diabetic chronic renal dysfunction. Exp Clin Endocrinol Diabetes, 110:408-15, 2002. 7. Berl, T, Hunsicker, LG, Lewis, JB, Pfeffer, MA, Porush, JG, Rouleau, JL Continue reading >>
Recent Advances In Management Of Diabetic Nephropathy
Determinants Of Diabetic Nephropathy In Ayder Referral Hospital, Northern Ethiopia: A Case-control Study
Determinants of diabetic nephropathy in Ayder Referral Hospital, Northern Ethiopia: A case-control study Affiliation Department of Public Health College of Health Sciences, Aksum University ksum, Ethiopia Affiliation Department of Epidemiology, College of Health Sciences, Jimma University Jimma, Ethiopia Affiliation Department of Public Health College of Health Sciences, Aksum University ksum, Ethiopia Affiliation Department of Public Health College of Health Sciences, Aksum University ksum, Ethiopia Affiliation Department of Epidemiology, College of Health Sciences, Jimma University Jimma, Ethiopia Determinants of diabetic nephropathy in Ayder Referral Hospital, Northern Ethiopia: A case-control study Diabetic nephropathy is the most serious complication of diabetes which leads to end-stage renal failure and other complication of diabetes mellitus. Determinants of Diabetic nephropathy are not consistent in different studies and associated factors to chronic complications of diabetes are not specific and there are limited studies specific to diabetic nephropathy. Thus, the aim of this study is to identify determinants of diabetic nephropathy in Ayder Referral Hospital, Northern Ethiopia. A case-control study was conducted from February 14 to May 8 2016. Diabetic patients who developed nephropathy in the last two years were the cases and diabetic patients free of nephropathy were controls. Cases and controls were identified detailed review of the chronic care follow up chart. Then simple random sampling was used to select sample of 420 (with control to case ratio of 4:1) resulting in 84 cases and 336 controls. Record review and interviewer administered questionnaire were used to collect data. Data was coded and entered in to Epi-Data version 3.1 and then exported to STA Continue reading >>
This purpose of this talk is to overview the 2017 American Diabetes Association Standards of Medical Care in Diabetes. These Standards comprise all of the current and key clinical practice recommendations of the American Diabetes Association. [SLIDE] 2 Reference American Diabetes Association. Standards of medical care in diabetesâ€”2014. Diabetes Care 2014;37(suppl 1):S1 A few notes on the Standards of Care: The Association funds development of the Standards of Care and all Association position statements out of its general revenues and does not use industry support for these purposes [CLICK] The slides are organized to correspond with sections within the 2017 Standards of Care. As we go through Iâ€™ll make note of where we are within the document. [CLICK] Though not every section in the document is represented, these slides do incorporate the most salient points from the Position Statement As with all Association position statements, the Standards of Care are reviewed and approved by the Associationâ€™s Board of Directors, which includes health care professionals, scientists, and lay people. [SLIDE] 3 These Standards of Care are revised annually by the ADAâ€™s multidisciplinary Professional Practice Committee (PPC) [CLICK] For the 2017 revision, PPC members systematically searched Medline for human studies related to each subsection and published since 1 January 2016. [CLICK] Recommendations were revised based on new evidence or, in some cases, to clarify the prior recommendations or match the strength of the word to the strength of the evidence [CLICK] A table linking the changes in the recommendations to new evidence can be reviewed at professional.diabetes.org/SOC (Standards of Care) [CLICK] The Association and the Professional Practice Committee Continue reading >>
Ppt - Recent Advances In Management Of Diabetic Nephropathy Powerpoint Presentation - Id:4022938
Recent advances in management of Diabetic Nephropathy PowerPoint Presentation Recent advances in management of Diabetic Nephropathy Recent advances in management of Diabetic Nephropathy. Tiger by the tail. Normal Kidney. Diabetic Kidney. Diabetic nephropathy. Diabetic nephropathy is progressive kidney disease Most common cause of ESRD More likely to die than progress to ESRD Multi-risk factor intervention is critical I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described. PowerPoint Slideshow about 'Recent advances in management of Diabetic Nephropathy' - gitano An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - Continue reading >>
Ppt Diabetic Nephropathy Powerpoint Presentation | Free To Download - Id: 1cc35f-ntq0n
PPT Diabetic Nephropathy PowerPoint presentation | free to download - id: 1cc35f-NTQ0N The Adobe Flash plugin is needed to view this content In 2001, 41,312 people with diabetes began treatment for end-stage renal disease. ... Wastes, excess water, and salt are removed from blood using a dialyzer ... PowerPoint PPT presentation Over 40 of new cases of end-stage renal disease In 2001, 41,312 people with diabetes began In 2001, it cost 22.8 billion in public and private funds to treat patients with kidney Minorities experience higher than average rates Stage 1 Hyperfiltration, or an increase in glomerular filtration rate (GFR) occurs. Kidneys increase in size. Stage 2 Glomeruli begin to show damage and microalbuminurea occurs. Stage 3 Albumin excretion rate (AER) exceeds 200 micrograms/minute, and blood levels of creatinine and urea-nitrogen rise. Blood pressure may rise Stage 4 GFR decreases to less than 75 ml/min, large amounts of protein pass into the urine, and high blood pressure almost always occurs. Levels of creatinine and urea-nitrogen in the blood rise further. Stage 5 Kidney failure, or end stage renal disease (ESRD). GFR is less than 10 ml/min. The average length of time to progress from Stage 1 to Stage 4 kidney disease is 17 years for a person with type 1 diabetes. The average length of time to progress to Stage 5, kidney failure, Bethesda, MD National Institute of Diabetes and PowerShow.com is a leading presentation/slideshow sharing website. Whether your application is business, how-to, education, medicine, school, church, sales, marketing, online training or just for fun, PowerShow.com is a great resource. And, best of all, most of its cool features are free and easy to use. You can use PowerShow.com to find and download example online PowerPoint ppt pre Continue reading >>
Management Of Hypertension In Diabetic Nephropathy: How Low Should We Go?
Management of Hypertension in Diabetic Nephropathy: How Low Should We Go? Hypertension is a frequent comorbidity often following the development of diabetic nephropathy among individuals with type 1 diabetes and affecting most patients with type 2 diabetes at the time of diagnosis. Multiple prospective randomized placebo-controlled trials demonstrate that tight blood pressure control among patients with diabetic nephropathy reduces the rates of macrovascular and microvascular complications. While randomized trials exist and support a blood pressure goal of <140/90 mm Hg for patients with nondiabetic kidney disease, there are no prospective data regarding a specific blood pressure goal on progression of diabetic nephropathy. Retrospective data analyses from trials show a linear relationship between either baseline or achieved study blood pressure and progression of nephropathy. Very high albuminuria is a hallmark of diabetic nephropathy with reductions by either angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blocker (ARB) monotherapy associated with slowed nephropathy progression. However, combination antihypertensive therapy, while decreasing proteinuria, augments the risk of hyperkalemia, hypotension, and kidney dysfunction. Given the lack of trial data for a BP goal among patients with diabetic nephropathy, prospective trials are needed to define the optimal blood pressure necessary to preserve kidney function. At present, guideline blood pressure goals of less than 140/90 mm Hg and the use of ACEi or ARB therapy for those with more than 300 mg of albuminuria are mandated. Epidemiology of Hypertension in Diabetic Nephropathy Hypertension is twice as prevalent in patients with diabetes compared to the general population with mean blood pressur Continue reading >>
Endocrine Practice Vol 21 No. 4 April 2015
American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan Writing Committee Cochairpersons Yehuda Handelsman MD, FACP, FACE, FNLA Zachary T. Bloomgarden, MD, MACE George Grunberger, MD, FACP, FACE Guillermo Umpierrez, MD, FACP, FACE Robert S. Zimmerman, MD, FACE 1 Copyright Â© 2015 AACE. May not be reprinted in any form without express written permission from AACE. AACE Clinical Practice Guidelines for Diabetes Mellitus Writing Committee Task Force 2 Timothy S. Bailey, MD, FACP, FACE, ECNU Lawrence Blonde MD, FACP, FACE George A. Bray, MD, MACP, MACE A. Jay Cohen MD, FACE, FAAP Samuel Dagogo-Jack, MD, DM, FRCP, FACE Jaime A. Davidson, MD, FACP, MACE Daniel Einhorn, MD, FACP, FACE Om P. Ganda, MD, FACE Alan J. Garber, MD, PhD, FACE W. Timothy Garvey, MD Robert R. Henry, MD Irl B. Hirsch, MD Edward S. Horton, MD, FACP, FACE Daniel L. Hurley, MD, FACE Paul S. Jellinger, MD, MACE Lois JovanoviÄ, MD, MACE Harold E. Lebovitz, MD, FACE Derek LeRoith, MD, PhD, FACE Philip Levy, MD, MACE Janet B. McGill, MD, MA, FACE Jeffrey I. Mechanick, MD, FACP, FACE, FACN, ECNU Jorge H. Mestman, MD Etie S. Moghissi, MD, FACP, FACE Eric A. Orzeck, MD, FACP, FACE Paul D. Rosenblit, MD, PhD, FACE, FNLA Aaron I. Vinik, MD, PhD, FCP, MACP, FACE Kathleen Wyne, MD, PhD, FNLA, FACE Farhad Zangeneh, MD, FACP, FACE Â Reviewers Lawrence Blonde MD, FACP, FACE Alan J. Garber, MD, PhD, FACE Copyright Â© 2015 AACE. May not be reprinted in any form without express written permission from AACE. AACE DM CPG Objectives and Structure This CPG aims to provide the following: An evidence-based education resource for the development of a diabetes comprehensive care plan Easy-to-follow structur Continue reading >>
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Diabetic Nephropathy Ppt
diagnosis and treatment of diabetic nephropathy presentation Diabetic Nephropathy PPT All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you. Diagnosis and Treatment of Diabetic NephropathySFM Didactics January 14, 2003 Carol Cordy, MD1.Why should you screen for diabetic nephropathy? 2. How should you screen for diabetic nephropathy? 3. What should you do with the results of your screening tests?Why screen? Why treat? Prevention and treatment of diabetic nephropathy can reduce the incidence of end stage renal disease and deathDiabetic Nephropathy and ESRD Diabetic nephropathy is the leading cause of end stage renal disease in the United States accounting for over 40% of dialysis patients The 5-year mortality rate for a dialysis patient is 93% Dialysis for one patient costs over $50,000 annually Continue reading >>
Diabetic nephropathy (diabetic kidney disease) (DN) is the chronic loss of kidney function occurring in those with diabetes mellitus. It is a serious complication, affecting around one-quarter of adult diabetics in the United States. It usually is slowly progressive over years.  Pathophysiologic abnormalities in DN begin with long-standing poorly controlled blood glucose levels. This is followed by multiple changes in the filtration units of the kidneys, the nephrons. (There are normally about 3/4-1 1/2 million nephrons in each adult kidney). Initially, there is constriction of the efferent arterioles and dilation of afferent arterioles, with resulting glomerular capillary hypertension and hyperfiltration; this gradually changes to hypofiltration over time. Concurrently, there are changes within the glomerulus itself: these include a thickening of the basement membrane, a widening of the slit membranes of the podocytes, an increase in the number of mesangial cells, and an increase in mesangial matrix. This matrix invades the glomerular capillaries and produces deposits called Kimmelstiel-Wilson nodules. The mesangial cells and matrix can progressively expand and consume the entire glomerulus, shutting off filtration. The status of DN may be monitored by measuring two values: the amount of protein in the urine - proteinuria; and a blood test called the serum creatinine. The amount of the proteinuria is a reflection of the degree of damage to any still-functioning glomeruli. The value of the serum creatinine can be used to calculate the estimated glomerular filtration rate (eGFR), which reflects the percentage of glomeruli which are no longer filtering the blood. Treatment with an angiotensin converting enzyme inhibitor (ACEI) or angiotensi Continue reading >>