Title: Diabetic Nephropathy
1Diabetic Nephropathy
2Diabetic Nephropathy
- Over 40 of new cases of end-stage renal disease
(ESRD) are attributed to diabetes. - In 2001, 41,312 people with diabetes began
treatment for end-stage renal disease. - In 2001, it cost 22.8 billion in public and
private funds to treat patients with kidney
failure. - Minorities experience higher than average rates
of nephropathy and kidney disease
3Five Stages of Kidney Disease
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
during this stage.
4Five Stages of Kidney Disease (cont.)
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,
is 23 years.
5Screening for Diabetic Nephropathy
1American Diabetes Association Nephropathy in
Diabetes (Position Statement). Diabetes Care 27
(Suppl.1) S79-S83, 2004
6Treatment of Diabetic Nephropathy
- Hypertension Control - Goal lower blood pressure
to lt130/80 mmHg - Antihypertensive agents
- Angiotensin-converting enzyme (ACE) inhibitors
- captopril, enalapril, lisinopril, benazepril,
fosinopril, ramipril, quinapril, perindopril,
trandolapril, moexipril - Angiotensin receptor blocker (ARB) therapy
- candesartan cilexetil, irbesartan, losartan
potassium, telmisartan, valsartan, esprosartan - Beta-blockers
7Treatment of Diabetic Nephropathy (cont.)
- Glycemic Control
- Preprandial plasma glucose 90-130 mg/dl
- A1C lt7.0
- Peak postprandial plasma glucose lt180 mg/dl
- Self-monitoring of blood glucose (SMBG)
- Medical Nutrition Therapy
- Restrict dietary protein to RDA of 0.8 g/kg body
weight per day
8Treatment of End-Stage Renal Disease (ESRD)
- There are three primary treatment options for
individuals who experience ESRD - 1. Hemodialysis
- 2. Peritoneal Dialysis
- 3. Kidney Transplantation
9Hemodialysis
- Procedure
- A fistula or graft is created to access the
bloodstream - Wastes, excess water, and salt are removed from
blood using a dialyzer - Hemodialysis required approx. 3 times per week,
each treatment lasting 3-5 hrs - Can be performed at a medical facility or at home
with appropriate patient training
10Hemodialysis (cont.)
- Hemodialysis Diet
- Monitor protein intake
- Limit potassium intake
- Limit fluid intake
- Avoid salt
- Limit phosphorus intake
- Complications
- Infection at access site
- Clotting, poor blood flow
- Hypotension
11Peritoneal Dialysis
- Procedure
- Dialysis solution is transported into the abdomen
through a permanent catheter where it draws
wastes and excess water from peritoneal blood
vessels. The solution is then drained from the
abdomen. - Three Types of Peritoneal Dialysis
- Continuous Ambulatory Peritoneal Dialysis (CAPD)
- Continuous Cycler-Assisted Peritoneal Dialysis
(CCPD) - Combination CAPD and CCPD
12Peritoneal Dialysis (cont.)
- Peritoneal Dialysis Diet
- Limit salt and fluid intake
- Consume more protein
- Some potassium restrictions
- Reduce caloric intake
- Complications
- Peritonitis
13Kidney Transplant
- Procedure
- A cadaveric kidney or kidney from a related or
non-related living donor is surgically placed
into the lower abdomen. - Three factors must be taken into consideration to
determine kidney/recipient match - Blood type
- Human leukocyte antigens (HLAs)
- Cross-matching antigens
14Kidney Transplant (cont.)
- Kidney Transplant Diet
- Reduce caloric intake
- Reduce salt intake
- Complications/Risk Factors
- Rejection
- Immunosuppressant side effects
- Benefits
- No need for dialysis
- fewer dietary restrictions
- higher chance of living longer
15How Can You Prevent Diabetic Kidney Disease?
- Maintain blood pressure lt130/80 mm/Hg
- Maintain preprandial plasma glucose 90-130 mg/dl
- Maintain postprandial plasma glucose lt180 mg/dl
- Maintain A1C lt7.0
16References
- American Diabetes Association Nephropathy in
Diabetes (Position - Statement). Diabetes Care 27 (Suppl.1) S79-S83,
2004 - National Kidney and Urologic Diseases Information
Clearinghouse. - Kidney Disease of Diabetes. Bethesda, MD
National Institute of - Diabetes and Digestive and Kidney Diseases,
National Institutes of - Health (NIH), DHHS 2003.
- United States Renal Data System. USRDS 2003
Annual Data - Report. Bethesda, MD National Institute of
Diabetes and Digestive - and Kidney Diseases, National Institutes of
Health (NIH), DHHS - 2003.
- DeFronzo RA Diabetic nephropathy etiologic and
therapeutic - considerations. Diabetes Reviews 3510-547, 1995
- National Kidney and Urologic Diseases Information
Clearinghouse. - Kidney Failure Choosing a Treatment Thats Right
For You. - Bethesda, MD National Institute of Diabetes and
Digestive and