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Encyclopedia > Diabetic nephropathy
Diabetic nephropathy
Classification & external resources
Photomicrography of nodular glomerulosclerosis in Kimmelstein-Wilson syndrome. Source: CDC
ICD-10 E10.2, E11.2, E12.2, E13.2, E14.2
ICD-9 250.4
MeSH D003928

Diabetic nephropathy (nephropatia diabetica), also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. It is characterized by nephrotic syndrome and nodular glomerulosclerosis. It is due to longstanding diabetes mellitus, and is a prime cause for dialysis in many Western countries. Image File history File links Nodular_glomerulosclerosis. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... See the article on the kidney for the anatomy and function of healthy kidneys and a list of diseases involving the kidney. ... Angiopathy is a disease of the blood vessels (arteries, veins, and capillaries) that occurs when someone has diabetes for a long time. ... Blood flows from digestive system heart to arteries, which narrow into arterioles, and then narrow further still into capillaries. ... The kidneys are organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... Glomerulus refers to two unrelated structures in the body, both named for their globular form. ... Glomerulosclerosis refers to a hardening of the glomerulus in the kidney. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ...

Contents

History

Diabetes mellitus
Types of Diabetes
Diabetes mellitus type 1
Diabetes mellitus type 2
Gestational diabetes

Pre-diabetes:
Impaired fasting glycaemia
Impaired glucose tolerance For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Diabetes mellitus type 1 (Type 1 diabetes, Type I diabetes, T1D, IDDM) is a form of diabetes mellitus. ... See diabetes mellitus for further general information on diabetes. ... Gestational diabetes is a form of diabetes found in pregnant women. ... Impaired fasting glycaemia (IFG) is a pre-diabetic state of dysglycemia, associated with insulin resistance and increased risk cardiovascular pathology, although of lesser risk than Impaired glucose tolerance (IGT). ... Impaired Glucose Tolerance (IGT) is a pre-diabetic state of dysglycemia, that is associated with insulin resistance and increased risk of cardiovascular pathology. ...

Disease Management
Diabetes management:
Diabetic diet
•Anti-diabetic drugs
Conventional insulinotherapy
Intensive insulinotherapy
Other Concerns
Cardiovascular disease

Diabetic comas:
Diabetic hypoglycemia
Diabetic ketoacidosis
Nonketotic hyperosmolar This article is about the management of diabetes mellitus. ... The diet recommended for people who suffer from diabetes mellitus is one that is high in dietary fibre, especially soluble fibre, but low in fat (especially saturated fat) and sugar. ... An anti-diabetic drug or oral hypoglycemic agent is used to treat diabetes mellitus. ... Conventional insulinotherapy is a therapeutic regimen for diabetes mellitus treatment. ... Intensive insulinotherapy or flexible insulin therapy is a therapeutic regimen for diabetes mellitus treatment. ... Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). ... Diabetic coma is a medical emergency in which a person with diabetes mellitus is comatose (unconscious) because of one of three acute complications of diabetes: Severe diabetic hypoglycemia Advanced diabetic ketoacidosis advanced enough to result in unconsciousness from a combination of severe hyperglycemia, dehydration and shock, and exhaustion Hyperosmolar nonketotic... Diabetic hypoglycemia describes low blood glucose (hypoglycemia) occurring in a person with diabetes mellitus. ... Diabetic ketoacidosis(DKA) is a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). ... Nonketotic hyperosmolar coma is a type of diabetic coma associated with a high mortality seen in diabetes mellitus type 2. ...


Diabetic myonecrosis
Diabetic nephropathy
Diabetic neuropathy
Diabetic retinopathy Please wikify (format) this article or section as suggested in the Guide to layout and the Manual of Style. ... Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. ... Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which could eventually lead to blindness. ...


Diabetes and pregnancy For women with diabetes mellitus, pregnancy can present some particular challenges for both mother and child. ...

Blood tests
Blood sugar
Fructosamine
Glucose tolerance test
Glycosylated hemoglobin

The syndrome was discovered by British physician Clifford Wilson (1906-1997) and Germany-born American physician Paul Kimmelstiel (1900-1970) and was published for the first time in 1936. In medicine, blood sugar is a term used to refer to levels of glucose in the blood. ... Fructosamine, also known as Glycated Serum Protein (GSP) or Glycated Albumin, is used primarily to identify the plasma glucose concentration over time and so assess diabetic control . ... A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ... For other uses, see Doctor. ... 1936 (MCMXXXVI) was a leap year starting on Wednesday (link will take you to calendar). ...


Epidemiology

The syndrome can be seen in patients with chronic diabetes (15 years or more after onset), so patients are usually of older age (between 50 and 70 years old). The disease is progressive and may cause death two or three years after the initial lesions, and is more frequent in men. Diabetic nephropathy is the most common cause of chronic kidney failure and end-stage kidney disease in the United States. People with both type 1 and type 2 diabetes are at risk. The risk is higher if blood-glucose levels are poorly controlled. Further, once nephropathy develops, the greatest rate of progression is seen in patients with poor control of their blood pressure. Also people with high cholesterol level in their blood have much more risk than others. In medicine, a chronic disease is a disease that is long-lasting or recurrent. ... This article is about the disease that features high blood sugar. ... For other uses, see Death (disambiguation). ...


Etiopathology

The earliest detectable change in the course of diabetic nephropathy is a thickening in the glomerulus. At this stage, the kidney may start allowing more serum albumin (plasma protein) than normal in the urine (albuminuria), and this can be detected by sensitive medical tests for albumin. This stage is called "microalbuminuria". It can appear 5 to 10 years before other symptoms develop. As diabetic nephropathy progresses, increasing numbers of glomeruli are destroyed by nodular glomerulosclerosis. Now the amounts of albumin being excreted in the urine increases, and may be detected by ordinary urinalysis techniques. At this stage, a kidney biopsy clearly shows diabetic nephropathy. You may be looking for albumen, or egg white. ... This article or section is in need of attention from an expert on the subject. ... Albuminuria is a pathological condition where albumin is present in the urine. ... A medical test is any kind of diagnostic medical procedure performed for health reasons. ... A urinalysis (or UA) is an array of tests performed on urine and one of the most common methods of medical diagnosis. ... Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ...


Signs and symptoms

Kidney failure provoked by glomerulosclerosis leads to fluid filtration deficits and other disorders of kidney function. There is an increase in blood pressure (hypertension) and of fluid retention in the body (oedema). Other complications may be arteriosclerosis of the renal artery and proteinuria (nephrotic syndrome). A sphygmomanometer, a device used for measuring arterial pressure. ... For other forms of hypertension, see Hypertension (disambiguation). ... Edema (BE: oedema, formerly known as dropsy) is swelling of any organ or tissue due to accumulation of excess fluid. ... Complication, in medicine, is a unfavorable evolution of a disease, a health condition or a medical treatment. ... // Introduction Arteriosclerosis means the hardening of the arteries in Greek. ... Human kidneys viewed from behind with spine removed The renal arteries normally arise off the abdominal aorta and supply the kidneys with blood. ... Proteinuria (from protein and urine) means the presence of an excess of serum proteins in the urine. ...


Throughout its early course, diabetic nephropathy has no symptoms. They develop in late stages and may be a result of excretion of high amounts of protein in the urine or due to renal failure: The term symptom (from the Greek meaning chance, mishap or casualty, itself derived from συμπιπτω meaning to fall upon or to happen to) has two similar meanings in the context of physical and mental health: Strictly, a symptom is a sensation or change in health function experienced by a patient. ...

  • oedema: swelling, usually around the eyes in the mornings; later, general body swelling may result, such as swelling of the legs
  • foamy appearance or excessive frothing of the urine
  • unintentional weight gain (from fluid accumulation)
  • anorexia (poor appetite)
  • nausea and vomiting
  • malaise (general ill feeling)
  • fatigue
  • headache
  • frequent hiccups
  • generalized itching

The first laboratory abnormality is a positive microalbuminuria test. Most often, the diagnosis is suspected when a routine urinalysis of a person with diabetes shows too much protein in the urine (proteinuria). The urinalysis may also show glucose in the urine, especially if blood glucose is poorly controlled. Serum creatinine and BUN may increase as kidney damage progresses. Edema (BE: oedema, formerly known as dropsy) is swelling of any organ or tissue due to accumulation of excess fluid. ... For other uses, see Eye (disambiguation). ... Anorexia (deriving from the Greek α(ν)- (a(n)-, a prefix that denotes absence) + όρεξη (orexe) = appetite) is the decreased sensation of appetite. ... For other uses, see Nausea (disambiguation). ... Emesis redirects here. ... Malaise is a feeling of general discomfort or uneasiness, an out of sorts feeling, often the first indication of an infection or other disease. ... The word fatigue is used in everyday living to describe a range of afflictions, varying from a general state of lethargy to a specific work induced burning sensation within muscle. ... A headache (cephalalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... For information on Hydrophobic Interaction Chromatography, see Chromatography. ... An itch (Latin: pruritus) is a sensation felt on an area of skin that makes a person or animal want to scratch it. ... Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. ... Creatinine is a breakdown product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body (depending on muscle mass). ... A Swedish-style saffron bun traditionally consumed en masse with Christmas at hand. ...


A kidney biopsy confirms the diagnosis, although it is not always necessary if the case is straightforward, with a documented progression of proteinuria over time and presence of diabetic retinopathy on examination of the retina of the eyes. Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... Retinopathy is a general term that refers to some form of non-inflammatory damage to the retina of the eye. ... Human eye cross-sectional view. ... For other uses, see Eye (disambiguation). ...


Treatment

The goals of treatment are to slow the progression of kidney damage and control related complications. The main treatment, once proteinuria is established, is ACE inhibitor drugs, which usually reduces proteinuria levels and slows the progression of diabetic nephropathy. Many studies have shown that related drugs, angiotensin receptor blockers (ARBs), have a similar benefit. In fact, a combination may be best. Captopril, the first ACE inhibitor ACE inhibitors, or inhibitors of Angiotensin-Converting Enzyme, are a group of pharmaceuticals that are used primarily in treatment of hypertension and congestive heart failure, in most cases as the drugs of first choice. ... Angiotensin II receptor antagonists, or angiotensin receptor blockers (ARBs), are a group of pharmaceuticals which modulate the renin_angiotensin_aldosterone system. ...


Blood-glucose levels should be closely monitored and controlled. This may slow the progression of the disorder, especially in the very early ("microalbuminuria") stages. Medications to manage diabetes include oral hypoglycemic agents and insulin injections. As kidney failure progresses, less insulin is excreted, so smaller doses may be needed to control glucose levels. is really just water but doctors get you to pay more Not to be confused with inulin. ...


The diet may be modified to help control blood-sugar levels. Modification of protein intake can effect hemodynamic and nonhemodynamic injury. High blood pressure should be aggressively treated with antihypertensive medications, in order to reduce the risks of kidney, eye, and blood vessel damage in the body. It is also very important to control lipid levels, maintain a healthy weight, and engage in regular physical activity. In nutrition, the diet is the sum of food consumed by a person or other organism. ...


Patients with diabetic nephropathy should avoid taking the following drugs:

  • Contrast agents containing iodine
  • Commonly used non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, or COX-2 inhibitors like Celebrex, because they may injure the weakened kidney.

Urinary tract and other infections are common and can be treated with appropriate antibiotics. For the record label, see Iodine Recordings. ... Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ... Ibuprofen (INN) (IPA: ) (from the earlier nomenclature iso-butyl-propanoic-phenolic acid) is a non-steroidal anti-inflammatory drug (NSAID) originally marketed as Nurofen and since under various trademarks including Act-3, Advil, Brufen, Dorival, Herron Blue, Panafen, Motrin, Nuprin and Ipren or Ibumetin (Sweden), Ibuprom (Poland), IbuHEXAL, Moment (Italy... Naproxen (INN) (IPA: ) is a non-steroidal anti-inflammatory drug (NSAID) commonly used for the reduction of mild to moderate pain, fever, inflammation and stiffness caused by conditions such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, gout, ankylosing spondylitis, injury (like fractures), menstrual cramps, tendonitis, bursitis, and the treatment of primary... Cyclooxygenase (COX) is an enzyme that is responsible for formation of important biological mediators called prostanoids (including prostaglandins, prostacyclin and thromboxane). ... Celecoxib is a medicinal drug best known as a Pfizer product with the brand name Celebrex. ... The urinary system is a system of organs, tubes, muscles, and nerves that work together to create, store, and carry, urine. ... Infection is also the title of an episode of the television series Babylon 5; see Infection (Babylon 5). ... An antibiotic is a drug that kills or slows the growth of bacteria. ...


Dialysis may be necessary once end-stage renal disease develops. At this stage, a kidney transplantation must be considered. Another option for type 1 diabetes patients is a combined kidney-pancreas transplant. In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ...


C-peptide, a by-product in the forming of insulin, may provide new hope for patients sufering from diabetic nephropathy [1],[2]. C-peptide is a peptide which is made when proinsulin is split into insulin and C-peptide. ...


Prognosis

Diabetic nephropathy continues to get gradually worse. Complications of chronic kidney failure are more likely to occur earlier, and progress more rapidly, when it is caused by diabetes than other causes. Even after initiation of dialysis or after transplantation, people with diabetes tend to do worse than those without diabetes.


Complications

Possible complications include:

Hypoglycemia (hypoglycaemia in British English) is a medical term referring to a pathologic state produced by a lower than normal level of glucose (sugar) in the blood. ... Renal failure is when the kidneys fail to function properly. ... Chronic renal failure (CRF, or chronic kidney failure, CKF, or chronic kidney disease, CKD) is a slowly progressive loss of renal function over a period of months or years and defined as an abnormally low glomerular filtration rate, which is usually determined indirectly by the creatinine level in blood serum. ... Hyperkalemia is an elevated blood level (above 5. ... For other forms of hypertension, see Hypertension (disambiguation). ... It has been suggested that Artificial kidney be merged into this article or section. ... This article is about the disease that features high blood sugar. ... Infection is also the title of an episode of the television series Babylon 5; see Infection (Babylon 5). ...

References

  • Kimmelstiel P, Wilson C. Benign and malignant hypertension and nephrosclerosis. A clinical and pathological study. Am J Pathol 1936;12:45-48.

References

  1. ^ http://www.springerlink.com/content/v0n23h2m02026465/
  2. ^ http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&list_uids=17235526&cmd=Retrieve&indexed=google

External links

  • Diabetic nephropathy. HealthCentral.
  • Diabetic nephropathy. MedlinePlus Medical Encyclopedia. Text from this public domain article was partially used here.
  • Texas University Classification

  Results from FactBites:
 
MedlinePlus Medical Encyclopedia: Diabetic nephropathy (1152 words)
The earliest detectable change in the course of diabetic nephropathy is a thickening in the glomerulus.
Diabetic nephropathy is the most common cause of chronic kidney failure and end-stage kidney disease in the United States.
Diabetic nephropathy generally goes along with other diabetes complications including hypertension, retinopathy, and blood vessel changes, although these may not be obvious during the early stages of nephropathy.
FG-3019 for Diabetic Nephropathy (835 words)
Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD), which requires dialysis or transplant.
During the initial stages of diabetic nephropathy, hyperglycemia and hypertension damage the main structures of the kidney causing hyperfiltration, hypertrophy (increased kidney weight) and microalbuminuria, or the presence of low but abnormal levels of proteins (mainly albumin) in the urine.
FibroGen expects the therapeutic benefit of anti-CTGF therapy in diabetic nephropathy would be to extend life and the time to dialysis by reducing early-stage pathologies related to hyperglycemia and hypertension, including hyperfiltration and kidney hypertrophy, and by preventing the development of proteinuria and chronic fibrosis.
  More results at FactBites »

 
 

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