Check and test if you suspect...diabetic nephropathy!

Generally, patients with either type 1 and 2 diabetes should be screen yearly for any complications. 

What you would check if you suspect diabetic nephropathy?
There are the following things you can do: blood tests, urinalysis, renal imaging, renal function testing, and a kidney biopsy. 
Blood test and urinalysis are commonly done on patients to check kidney function. However, since it is not sufficient enough to see the severity the kidney damage, serum creatinine and the glomerular filtration rate (GFR) is also measured in the renal function testing.

Blood test: It is a comprehensive panel that can checks if your kidneys are functioning within the normal range. 

Urinalysis: Urine samples is a good indicator of how the kidneys are filtering the body waste. If there are high levels of microalbuminia in your urine, this may indicated renal problems. Furthermore, a urinalysis is a good indicator, but it is not accurate. The urinary albumin excretion can change and 2-3 samples may be collected over a course of time. This is to avoid any false-positive results that may be caused by something else beside kidney disease. 

Renal imaging: Magnetic resonance imaging (MRI) or ultrasound imaging may be used to see how well the blood is perfusing in the kidneys. X-ray may also be used to see if the kidneys look abnormal. 

Renal function testing: The kidney's filtering function are determined using renal analysis testing. The glomerular filtration rate calculated, which is a accurate measure of how well the kidneys/renal system is functioning. 

**Remember the glomerular is the filtration function unit of the kidneys that help the body filter the blood and excretes the waste through urine. **

Kidney biopsy: The doctor will perform a procedure called percutaneous kidney biopsy that uses a needle to extract pieces of the kidney tissue. This sample will undergo lab tests to check for any signs of disease or damage. 

Depending on the severity of kidney damage, a few or all of the following tests may be done. 

Citations:

Gross, J., De Azevedo, M., Silveiro, S., Canani, L., Caramori, M., & Zelmanovitz, T. (2005). Diabetic Nephropathy: Diagnosis, Prevention, And Treatment. Diabetes Care, 164-176. Retrieved February 1, 2015, from http://care.diabetesjournals.org/content/28/1/164.full

Bakris, G. (n.d.). Recognition, Pathogenesis, and Treatment of Different Stages of Nephropathy in Patients With Type 2 Diabetes Mellitus. Mayo Clinic Proceedings, 444-456.

Diabetic nephropathy. (n.d.). Retrieved February 1, 2015, from http://www.mayoclinic.org/diseases-conditions/diabetic-nephropathy/care-at-mayo-clinic/tests-diagnosis/con-20035589

Kidney biopsy. (n.d.). Retrieved February 1, 2015, from http://www.mayoclinic.org/tests-procedures/kidney-biopsy/basics/definition/prc-20018979

Pathophysiology of Diabetic Nephropathy-What causes nephropathy!

As we know, diabetic nephropathy occurs when the kidneys do not function properly on a microvascular level. We already know it is caused by diabetes, but it is is due to a variety of factors on a microscopic level. Mainly, hypertension and hyperglycemia damages the glomerulus (a functional unit of the kidney) is under a lot of pressure to filter the blood. This is a hemodynamic change of the glomerular hyperperfusion and hyperfiltration, resulting in microalbuminuria. 

What do all theses words mean?

Hemodynamic is of or relating to the flow of blood within the body system. 

Hyperperfusion means an increase of blood flow. 

Hyperfiltration is an increase of an abnormal increase in filtration. 

Continuing on....

The glomerulus is under a lot of stress, and eventually leaks albumin from the capillaries. Albumin is a major protein found in the blood and we don't want lose it! It's important.  If that is excreted out of the body, instead of kept, it can lead to the glomerular basement membrane thickening. The thickening of the basement membrane slow down the filtration rate since there's less room for the blood to bypass. This will also increase the levels of albumin when excreted in the urine (microalbuminiuria). 

Below is a complicated image that gives you an image of increase hypertension to the glomerular, leads to mesangial expansion, thickening of the glomerular basement membrane (GBM), and podocyte injury (podocypathy). Podocyte is a fucntion unit of the kidney that helps filtrate the blood. The basement membrane is composed of mesangial cells, that make up bowman's capsule of the glomerulus. When all these various functional units are affected, it leads to dysfunction.

Image from Nature.com. Link below. http://www.nature.com/nrneph/journal/v10/n2/images_article/nrneph.2013.272-f1.jpg

Furthermore, the mesangial cells that hold the capillaries in the glomerulus together, respond to injury by releasing cytokines. Cytokines lead to inflammation and mesangial cell expansion. In diabetic nephropathy, mesangial cells respond with increased pressure and injury that is caused by high blood glucose. This later can cause kidney failure leading to ERSD (previous mentioned earlier posts). This is definitely not good so we will talk about how you can diagnose this disease!

Here's a video link for those who are interested!

Next week, we will discuss how you diagnose the disease!

Citations:

1. Bakris, G. (n.d.). Recognition, Pathogenesis, and Treatment of Different Stages of Nephropathy in Patients With Type 2 Diabetes Mellitus. Mayo Clinic Proceedings, 444-456. Retrieved January 25, 2015.

2. Schena, F. (2005). Pathogenetic Mechanisms of Diabetic Nephropathy.Journal of the American Society of Nephrology, S30-S33.

3. Diabetic Nephropathy. (2000, January 1). Retrieved January 25, 2015, from http://journal.diabetes.org/clinicaldiabetes/v18n12000/Pg7.htm

4. Lewis, S. (2014). Medical-surgical nursing: Assessment and management of clinical problems. (8th ed.). St. Louis, Mo.: Elsevier/Mosby.

5. Plasma. (n.d.). Retrieved January 25, 2015, from http://www.redcrossblood.org/learn-about-blood/blood-components/plasma

6. (n.d.). Retrieved January 25, 2015, from http://www.rjme.ro/RJME/resources/files/530112023027.pdf

(Epidemiology) Prevalence of Diabetic Nephropathy!

Diabetes nephropathy (Diabetic kidney disease) is the leading cause of chronic kidney disease (CKD) and end stage renal disease (ESRD) as mention in the earlier post.  According to the Centers for Disease Control and Prevention and the National Diabetes Statistic reports that adults with diabetes are 2-3 times as likely to have CKD and make up 44% of new ESRD cases.  Furthermore, the American Diabetes Association states about 20-30% of the patients with type 1 or type 2 diabetes will develop nephropathy. However, with type 2 diabetes, these people are more susceptible to ESRD.  Therefore, people with diabetics must monitor their blood sugar before it damages the kidneys.  An early start to taking care of oneself will decrease your risk of complications in the future.

Diabetic nephropathy varies by racial/ethnic background. Native Americans, Hispanics (especially Mexican Americans), and African Americans are at higher risk of developing ESRD with type 2 diabetes compared those to non-Hispanic whites. You can see it here according to this data from CDC (click on the pdf link to see http://www.cdc.gov/nchs/data/hus/2011/051.pdf ). This shows how diabetes is the leading cause of kidney ESRD. Hypertension is the second diagnosis in relation to ESRD.

Below is a kidney disease mortality from the CDC and National Vital Statistics System . In Washington state alone (2012), there were 482 deaths who suffered from kidney disease. There were a total of 45,622 deaths in the USA. 

 I couldn't find a chart with the morbidity of kidney disease so below is a summary of morbidity and mortality from the CDC. Please click on this link (http://www.cdc.gov/nchs/fastats/kidney-disease.htm) to see more information. As summarized below, about 1.7 percent of adults are diagnosed with kidney disease, which is the frequency of the disease. However, mortality is the number of deaths caused of kidney disease, which is 9 total from 2011.

Prevention and detection are key to avoid any complication with the kidney for those with diabetes. 

Tune in to next week for etiology and pathophysiology of the disease! Stay happy and healthy!  




Citations: 

1. Diabetes Care. (n.d.). Retrieved January 18, 2015, from http://care.diabetesjournals.org/content/25/suppl_1/s85.full

2. Van Buren, P., & Toto, R. (n.d.). Hypertension In Diabetic Nephropathy: Epidemiology, Mechanisms, And Management. Advances in Chronic Kidney Disease, 28-41.

3. (n.d.). Retrieved January 18, 2015, from http://www.cdc.gov/nchs/data/hus/2011/051.pdf 

4. (n.d.). Retrieved January 18, 2015, from http://www.cdc.gov/nchs/data/series/sr_10/sr10_260.pdf

5. (n.d.). Retrieved January 18, 2015, from http://www.cdc.gov/nchs/data/hpdata2020/hp2020_D_CKD_progress_review_presentation.pdf  

6. Kidney Disease. (2014, July 14). Retrieved January 18, 2015, from http://www.cdc.gov/nchs/fastats/kidney-disease.htm

WHAT IS DIABETIC NEPHROPATHY?!?!

Hi all, I posted a cute picture of a kidney dog. Let’s be like the kidney dog, happy and healthy. Before we get into the topic of diabetic nephropathy, look to the photo of the kidney dog to keep your spirits up.

When you have diabetes, you are at risk for a variety of things including diabetic nephropathy.

What is diabetic nephropathy, you ask?

Definition: nephropathy means there is damage to the kidney (kidney disease). Diabetes can cause damage to your kidney and obviously….that’s not cool. (BOOOoOOoooo!)

How does that happen you ask?

            Something malfunctions with the blood vessels and the glomeruli (plural for glomerulus) in the kidneys.  Before we get started, we should understand what the glomerulus is. Glomerulus is a circular structure that is vital to the kidney filtration process of the blood. The kidneys help filtrate the blood and removes waste by emptying it urine that excretes out of the body.  Glomeruli is one of the key components that make up a nephron, which is a functional unit of the kidney. Hence, when the glomerulus of the nephron of the kidney is damaged, then it is called nephropathy.

Basically, the kidney of the body is constantly filtering waste from the blood. Diabetes increases your blood sugar, which slowly destroys the kidneys from functioning properly.  Eventually, it will be lead to some SERIOUS stuff called KIDNEY FAILURE or IRREVERSIBLE END STAGE KIDNEY DISEASE. So you better check yourself before you wreck yourself.  (Don’t cry though/ Just look at the cute kidney dog!)

Does everyone with diabetes get it?

No! Only some people who have diabetes gets kidney damage.  And it depends on risk factors such as high blood pressure; high cholesterol/triglyceride levels, smoking history and certain ethnicities will increase your chances. With proper management of your blood sugar levels, and happy kidneys, you can reduce your chances of diabetic nephropathy.

Don’t despair. I’m here! (Yes, that was incredibly lame.) Look to next week and we will get into more details of this disease!



Citations:
1. Kidney Disease (Nephropathy). (n.d.). Retrieved January 10, 2015, from http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html

2. Diabetes and kidney disease: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved January 10, 2015, from http://www.nlm.nih.gov/medlineplus/ency/article/000494.htm


3.Diabetic Nephropathy . (n.d.). Retrieved January 10, 2015, from http://emedicine.medscape.com/article/238946-overview

4. Kidney dog image: Google images, http://www.kidneystoners.org/wp-content/uploads/2012/02/kidney-dog.jpg


5. Lewis, S. (2014). Medical-surgical nursing: Assessment and management of clinical problems. (8th ed.). St. Louis, Mo.: Elsevier/Mosby.