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Diabetic Nephropathy

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In 2001, 41,312 people with diabetes began treatment for end-stage renal disease. ... captopril, enalapril, lisinopril, benazepril, fosinopril, ramipril, quinapril, ... – PowerPoint PPT presentation

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Title: Diabetic Nephropathy


1
Diabetic Nephropathy
2
Diabetic 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

3
Five 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.
4
Five 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.
5
Screening for Diabetic Nephropathy
1American Diabetes Association Nephropathy in
Diabetes (Position Statement). Diabetes Care 27
(Suppl.1) S79-S83, 2004
6
Treatment 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

7
Treatment 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

8
Treatment 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

9
Hemodialysis
  • 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

10
Hemodialysis (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

11
Peritoneal 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

12
Peritoneal Dialysis (cont.)
  • Peritoneal Dialysis Diet
  • Limit salt and fluid intake
  • Consume more protein
  • Some potassium restrictions
  • Reduce caloric intake
  • Complications
  • Peritonitis

13
Kidney 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

14
Kidney 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

15
How 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

16
References
  • 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
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