| Diabetic nephropathy Classification and external resources |
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| Photomicrography of nodular glomerulosclerosis in Kimmelstein-Wilson syndrome. Source: CDC | |
| ICD-10 | E10. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings 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. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases 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 Nephrology (from Greek nephros, " Kidney " and λόγος Logos, "speech" lit Angiopathy is the generic term for a disease of the Blood vessels ( arteries, Veins and capillaries) Capillaries are the smallest of a body's Blood vessels measuring 5-10 μm in diameter which connect Arterioles and Venules and enable the interchange The kidneys are complicated organs that have numerous biological roles A glomerulus is a Capillary tuft surrounded by Bowman's capsule in Nephrons of the vertebrate Kidney. It is characterized by nephrotic syndrome and nodular glomerulosclerosis. Not to be confused with Nephritic syndrome Nephrotic syndrome is a nonspecific disorder in which the Kidneys are damaged to leak large It is due to longstanding diabetes mellitus, and is a prime cause for dialysis in many Western countries. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc In Medicine, dialysis (from Greek "dialusis" meaning dissolution "dia" meaning through and "lusis" meaning loosening is primarily
Contents |
History
| Diabetes mellitus
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| Types of Diabetes |
| Diabetes mellitus type 1 Diabetes mellitus type 2 Gestational diabetes Pre-diabetes: |
| Disease Management |
| Diabetes management: •Diabetic diet •Anti-diabetic drugs •Conventional insulinotherapy •Intensive insulinotherapy |
| Other Concerns |
| Cardiovascular disease
Diabetic comas: Diabetic myonecrosis |
| 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. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Diabetes mellitus type 1 (Type 1 diabetes Type I diabetes T1D T1DM IDDM juvenile diabetes is a form of Diabetes mellitus. Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non - Insulin -dependent Diabetes mellitus (NIDDM or adult-onset diabetes is a metabolic Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood Impaired fasting glycaemia (IFG is a pre-diabetic state of dysglycemia associated with insulin resistance and increased risk of cardiovascular pathology although of lesser risk than Impaired Glucose Tolerance (IGT is a pre- Diabetic state of dysglycemia that is associated with Insulin resistance and increased risk of cardiovascular pathology Diabetes is a Chronic disease with no cure As of 2008. It is associated with an impaired Glucose cycle, altering Metabolism. The diet most often recommended for people who suffer from Diabetes mellitus is high in Dietary fiber, especially soluble fiber but low in fat (especially Saturated fat Anti-diabetic drugs treat Diabetes mellitus by lowering Glucose levels in the blood Conventional insulinotherapy is a therapeutic regimen for treatment of Diabetes mellitus which contrasts with the newer Intensive insulinotherapy. Intensive insulinotherapy is a therapeutic regimen for Diabetes mellitus treatment Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Diabetic coma is a Medical emergency in which a person with Diabetes mellitus is Comatose (unconscious because of one of the acute complications Diabetic hypoglycemia describes a low blood glucose level occurring in a person with Diabetes mellitus. Diabetic ketoacidosis (DKA is a life-threatening complication in patients with diabetes mellitus Nonketotic hyperosmolar coma (nonketotic Hyperglycaemia) is a type of Diabetic coma associated with a high mortality seen in Diabetes mellitus type 2. Diabetic myonecrosis is a rare complication of Diabetes. It is caused by Infarcted Muscle tissue usually in the thigh 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 can eventually lead to Blindness For women with Diabetes mellitus, Pregnancy can present some particular challenges for both mother and child Blood sugar, used in a physiological context is a misnomer and misleading Fructosamine is a compound that can be considered the result of a reaction between Fructose and Ammonia or an Amine (with a molecule of water being released 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, or HbA1c) is a form of Hemoglobin used primarily to identify the average The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located A physician, medical practitioner or medical doctor who practices Medicine, and is concerned with maintaining or restoring human Health Germany, officially the Federal Republic of Germany ( ˈbʊndəsʁepuˌbliːk ˈdɔʏtʃlant is a Country in Central Europe. The United States of America —commonly referred to as the Year 1936 ( MCMXXXVI) was a Leap year starting on Wednesday (link will display the full calendar of the Gregorian 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). In Medicine, a chronic disease is a Disease that is long-lasting or recurrent Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc The disease is progressive and may cause death two or three years after the initial lesions, and is more frequent in men. Death is the termination of the biological functions that define living Organisms It refers both to a specific 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.
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. Serum albumin, often referred to simply as albumin, is the most abundant Plasma protein in humans and other Mammals Albumin is essential for maintaining Urine is a liquid waste product of the body secreted by the Kidneys by a process of filtration from Blood and Excreted through the Urethra. Albuminuria is a pathological condition where albumin is present in the Urine. A medical test is a kind of Medical procedure performed to detect, diagnose, or evaluate Disease, disease processes susceptibility and determine 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. A urinalysis (or "UA" is an array of tests performed on Urine and one of the most common methods of Medical Diagnosis. At this stage, a kidney biopsy clearly shows diabetic nephropathy. A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues
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). Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated Oedema (or Edema in American English formerly known as dropsy or hydropsy, is the increase of Interstitial fluid in any organ &mdash swelling Other complications may be arteriosclerosis of the renal artery and proteinuria (nephrotic syndrome). Complication, in Medicine, is an unfavorable evolution of a Disease, a Health condition or a medical treatment Arteriosclerosis refers to a hardening of medium and large Arteries. The renal arteries normally arise off the side of the Abdominal aorta, immediately below the Superior mesenteric artery, and supply the Kidneys with Proteinuria (from protein and urine) means the presence of anexcess of serum Proteins in the Urine.
Throughout its early course, diabetic nephropathy has no symptoms. A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from 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:
- 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. Oedema (or Edema in American English formerly known as dropsy or hydropsy, is the increase of Interstitial fluid in any organ &mdash swelling Eyes are organs that detect Light, and send signals along the Optic nerve to the visual areas of the brain Anorexia (deriving from the Greek "α(ν-" ( a(n-, a prefix that denotes absence + "όρεξη (orexe = appetite is the decreased sensation Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Malaise is a feeling of general discomfort or uneasiness an "out of sorts" feeling often the first indication of an infection or other disease A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted A hiccup or hiccough (normally pronounced "HICK-up" ˈhɪkʌp also known as a condition of singulitis is the Spasmodic contraction of the diaphragm Itch ( Latin: pruritus) is an unpleasant Sensation that evokes the desire or Reflex to scratch 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. Glucose (Glc a Monosaccharide (or simple Sugar) also known as grape sugar, is an important Carbohydrate in Biology. Serum creatinine and BUN may increase as kidney damage progresses. Creatinine is a break-down product of Creatine phosphate in Muscle, and is usually produced at a fairly constant rate by the body (depending on muscle mass
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. A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues Retinopathy is a general term that refers to some form of non-inflammatory damage to the Retina of the Eye. The vertebrate retina is a light sensitive part inside the inner layer of the Eye. Eyes are organs that detect Light, and send signals along the Optic nerve to the visual areas of the brain
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. ACE inhibitors, or inhibitors of '''A'''ngiotensin-'''C'''onverting '''E'''nzyme, are a group of Pharmaceuticals that are used primarily in treatment of Hypertension Several effects of the ACEIs that may contribute to renal protection have been related to the association of rise in Kinins which is also responsible for some of the side effects associated with ACEIs therapy such as dry cough. The renal protection effect is related to the antihypertensive effects in normal and hypertensive patients, renal vasodilatation resulting in increased renal blood flow and dilatation of the efferent arterioles. [1] Many studies have shown that related drugs, angiotensin receptor blockers (ARBs), have a similar benefit. Angiotensin II receptor antagonists, also known as angiotensin receptor blockers (ARBs AT1-receptor antagonists or sartans, are a group of In fact, a combination may be best.
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. Insulin is a Hormone with intensive effects on both metabolism and several other body systems (eg vascular compliance As kidney failure progresses, less insulin is excreted, so smaller doses may be needed to control glucose levels.
The diet may be modified to help control blood-sugar levels. This article is primarily about the human diet For a discussion of animal diets see List of feeding behaviours. 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.
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. Iodine (ˈaɪədaɪn ˈaɪədɪn or /ˈaɪədiːn/ from ιώδης iodes "violet" is a Chemical element that has the symbol I and Atomic Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Ibuprofen ( INN) (ˌaɪbjuːˈpɹəʊfɛn (from the now outdated nomenclature i so- bu tyl- pro panoic- phen olic acid is a Non-steroidal Naproxen ( INN) (nəˈprɒksən is a Non-steroidal anti-inflammatory drug (NSAID commonly used for the reduction of moderate to severe Pain, Fever cyclooxygenase Prostaglandin-endoperoxide synthase 2 (prostaglandin G/H synthase and cyclooxygenase, also known as PTGS2, is a human Gene. Celecoxib ( INN) (sɛlɨˈkɒksɪb is a Non-steroidal anti-inflammatory drug (NSAID used in the treatment of Osteoarthritis, Rheumatoid arthritis
Urinary tract and other infections are common and can be treated with appropriate antibiotics. The urinary system (also called Excretory system or the genitourinary system (GUS is the Organ system that produces stores and eliminates Urine. An infection is the detrimental Colonization of a host Organism by a foreign Species. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa
Dialysis may be necessary once end-stage renal disease develops. In Medicine, dialysis (from Greek "dialusis" meaning dissolution "dia" meaning through and "lusis" meaning loosening is primarily At this stage, a kidney transplantation must be considered. Kidney transplantation or renal transplantation is the Organ transplant of a Kidney in a patient with End-stage renal disease. Another option for type 1 diabetes patients is a combined kidney-pancreas transplant.
C-peptide, a by-product of insulin production, 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 (from decreased excretion of insulin)
- rapidly progressing chronic kidney failure
- end-stage kidney disease
- hyperkalemia
- severe hypertension
- complications of hemodialysis
- complications of kidney transplant
- coexistence of other diabetes complications
- peritonitis (if peritoneal dialysis used)
- increased infections
References
- Kimmelstiel P, Wilson C. Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of Glucose ( sugar) in the blood Renal failure or kidney Chronic kidney disease (CKD also known as chronic renal disease, is a progressive loss of renal function over a period of months or years Hyperkalemia ( AE) or Hyperkalaemia ( BE) is an elevated blood level of the Electrolyte Potassium. Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated In Medicine, hemodialysis (also haemodialysis) is a method for removing waste products such as Potassium and Urea, as well as free water Kidney transplantation or renal transplantation is the Organ transplant of a Kidney in a patient with End-stage renal disease. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Peritonitis is defined as Inflammation of the Peritoneum (the Serous membrane which lines part of the abdominal cavity and some of the Viscera An infection is the detrimental Colonization of a host Organism by a foreign Species. Benign and malignant hypertension and nephrosclerosis. A clinical and pathological study. Am J Pathol 1936;12:45-48.
References
External links
- Diabetic nephropathy. HealthCentral.
- Diabetic nephropathy. MedlinePlus Medical Encyclopedia. Text from this public domain article was partially used here.
- Texas University Classification
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