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Diabetic Kidney Disease - ECAB

Diabetic Kidney Disease - ECAB

K V Dakshinamurty

(2013)

Additional Information

Abstract

The prevalence of Diabetes Mellitus is increasing rapidly all over the world and more so in the developing countries. The global burden of diabetes is expected to double between 2000 and 2030, with the greatest increases in prevalence occurring in the Middle East, sub-Saharan Africa and India. Moreover, the development of type 2 diabetes during the childbearing years is also likely to increase, primarily in the developing countries. It has already been established that Diabetes is the most common primary cause leading to end stage renal disease (ESRD) and Diabetic Nephropathy is the leading cause of chronic kidney disease (CKD) in India.

The cornerstones of management of Diabetic Kidney Diseases include early diagnosis of diabetic nephropathy, prevention of its progression and treatment of the co-morbid conditions. Substantial under-diagnosis of both diabetes and chronic kidney disease leads to lost opportunities for prevention. An inadequate or inappropriate care of patients with diabetic kidney disease contributes to disease progression eventually up to a stage that requires renal replacement therapy, which is not a feasible option for many on a long-term basis, especially in a developing country like ours.

This book covers various aspects of diabetic kidney disease in detail and attempts to familiarize the reader with the existing aspects of the conditions as well as touch upon the new advances in the field. The first chapter outlines the extent to which the condition affects the population globally as well as in our country. The second chapter explores the underlying mechanism by which the disease starts and progresses and the pathological markers of the same. The third chapter delineates the clinical and diagnostic markers of the condition. The fourth and fifth chapters speak of the non-diabetic glomerular and non-glomerular diseases in diabetics. The sixth chapter addresses the most important and desirable goal of preventing the progression and ideally the onset of the disease. The seventh chapter puts together the various treatment modalities available and the subsequent chapter explores the management options for cases requiring renal replacement. In addition to the emphasis to Indian literature at the end of each chapter, the ninth chapter is specially included to highlight the salient aspects of this condition from the Indian perspective.

This book will be beneficial not only for the nephrologists, but also for the epidemiologists, medical students, diabetologists and every doctor who deals with diabetes mellitus.


Table of Contents

Section Title Page Action Price
Font Cover \r Front Cover
Front Matter \r ia
Copyright id
ECAB Clinical Update:Nephrology ie
Diabetic Kidney Disease if
About the Authors ig
Contents im
ECAB Clinical Update InformationDiabetic Kidney Disease i
Epidemiology and Demography of Diabetic Kidney Disease 1a
ABSTRACT: 1a
KEYWORDS 1b
Prevalence of Diabetes 1
Diabetic Nephropathy- A Global Overview 2
Indian Scenario of Diabetic Nephropathy 3
Conclusion 5
Pathophysiology and Pathology of Diabetic Nephropathy 8a
Abstract 8a
Keywords 8b
Pathophysiology of Diabetic Nephropathy 8
Role of Genetic Factors in the Development of Diabetic Nephropathy 8
Role of Animal Models in Understanding the Pathophysiology of Diabetic Nephropathy 10
Role of Hyperfiltration 10
Role of Hyperglycemia 12
Role of Advanced Glycosylation End Products 13
Role of Reactive Oxygen Species 17
Role of Polyol Pathway 18
Role of Hexosamine Pathway 19
Role of Protein Kinase C 21
Role of Transforming Growth Factor- 24
Role of Renin- Angiotensin System in the Pathogenesis of Diabetic Nephropathy 26
Final Common Pathway in the Pathogenesis of Diabetic Nephropathy 28
Pathology of Diabetic NePhroPathy 29
Gross Pathology 30
Microscopic Features 30
Light Microscopic Changes 30
Immunofluorescence 33
Electron Microscopy 34
Staging System for Glomerular Pathology 35
Conclusion 35
Acknowledgments 35
Clinical Presentation and Diagnosis of Diabetic Nephropathy 41a
ABSTRACT 41a
KEYWORDS 41b
Introduction 41
Clinical Stages of Diabetic Nephropathy 42
Stage 1 43
Stage 2 43
Stage 3 43
Stage 4 43
Stage 5 44
Screening and Diagnosis 44
Timing of Screening 44
Methods of Screening 44
Prospective Future Markers 49
Retinol-Binding Protein 4 49
Adiponectin 49
Connective Tissue Growth Factor 49
Urinary 1-Microglobulin 50
Urinary Transforming Growth Factor-1 50
Liver-type Fatty acid Binding Protein 50
Conclusion 50
Non-Diabetic Glomerular Diseases in Diabetic Patients 54a
ABSTRACT 54a
KEYWORDS 54b
Introduction 54
When to Suspect Non-Diabetic Glomerular Diseases in Diabetic Patients 55
Types of Non-Diabetic Glomerular Diseases 56
Differentiation of non-diabetic Glomerulonephritis from diabetic Nephropathy 56
Mesangial-Proliferative Glomerulonephritis 57
Minimal Change Nephropathy 57
Differences between biopsy findings of glomerular lesions In non-diabetic glomerular diseases and diabetic nephropathy 58
Occurrence and Pattern of glomerular lesions in Non-Diabetic glomerular diseases in diabetes mellitus 59
Global Published Literature 59
Indian published literature 60
Unpublished Data from the Nizam's Institute of Medical Sciences 61
Conclusion 62
Nephrologic Problems Other Than Diabetic Nephropathy in Diabetes Mellitus 64a
ABSTRACT 64a
KEYWORDS 64b
Introduction 64
Pathogenesis21 65
Urinary Tract Infections in Diabetes-Clinical Importance 66
Urinary Tract Infections in Diabetes 68
Asymptomatic bacteriuria 68
Papillary Necrosis 70
Emphysematous Pyelonephritis 72
Xanthogranulomatous Pyelonephritis 74
Renal Abscess 74
Renal Cortical Abscess 76
Renal Corticomedullary Abscess 76
Perirenal Abscesses 77
Fungal Infections 78
Indian Experience 78
Published Data From Nizam's Institute of Medical Sciences (Nims), Hyderabad 79
Conclusion 80
Acknowledgments 80
Prevention of Diabetic Nephropathy 85
Abstract 85a
Keywords 85b
Introduction 85
Global Perspective 87
United States Native Indian Health Service Diabetes Care 87
Aboriginal Populations in Australia 88
Aboriginal Populations in Canada 89
Update in the Indian Context 91
Kidney Help Trust of Chennai-A Model to Emulate 93
Nipping in the Bud 93
Strategies for Prevention of Diabetic Nephropathy 94
DREAM Studies 94
Disease Management Strategies 96
Chronic Care Model 97
Care Delivery Models 97
Intervention strategies 98
Monitoring and Measurement 99
Prevention of Diabetic Nephropathy 99
Preventing the Onset of Diabetes 100
Preventing the Appearance of Diabetic Nephropathy 101
Primary Prevention 102
Secondary Prevention 106
Multifactorial Intervention 108
New Potential Therapeutic Strategies 109
Conclusion 110
Case Study 116
Discussion and Rationale of Preventive Treatment 116
Diabetic Nephropathy-Treatment Modalities 119
Abstract 119a
Keywords 119b
Introduction 119
The Indian Scenario of Diabetic Nephropathy 120
Overview of Treatment 120
Glycemic Control in Treatment of Diabetic Nephropathy 121
Benefits of Glycemic Control 121
Role of Pancreas Transplantation in Diabetic Nephropathy 123
Choice of Medication and Dose Modification in Diabetic Chronic Kidney Disease Patients 124
Blood Pressure Control in Diabetic Nephropathy 124
Role of Blood Pressure Control in Treatment of Diabetic Nephropathy 125
Choice of Antihypertensive Agents 126
Blockade of the Renin-Angiotensin-Aldosterone System 127
Management of Dyslipidemia in Diabetic Nephropathy 132
Animal Model Studies 132
Clinical Studies on Lipid Lowering Therapy 133
Role of Dietary Protein Restriction 134
Cardiovascular Risk Reduction 134
Other Innovative Strategies 135
InteGrated manaGement of dIabetIc nephropathy 135
Conclusion 135
Case Discussion 143
Case 1: Case Presentation 143
Management and Discussion 145
case 2: case presentation 148
Management and Discussion 149
Management of End Stage Renal Disease in Diabetic Nephropathy 151a
Abstract 151a
Keywords 151b
Introduction 151
Special Issues in Management of CKD in Diabetics 152
Options of Renal Replacement 154
Bidirectional Influence of Diabetic Comorbidities and Renal Replacement Therapy 155
Influence of Comorbidities on Choice of Renal Replacement Therapy 155
Influence of Dialysis on Various Diabetic Comorbidities 157
Specific Problems in Diabetics who Undergo Renal Replacement Therapy 157
Problems in Hemodialysis 157
Vascular Access-Related Issues 157
Hypotension27 161
Hypertension and Interdialytic Weight Gain28 161
Problems in Peritoneal Dialysis 162
Peritonitis 162
Metabolic Bone Disease33,34 162
Malnutrition35 162
Hyperglycemia 163
Transplantation-Related Issues 163
Cardiovascular Disease 163
Evaluation for Cystopathy 163
Evaluation for Other Complications 163
Glycemic Control and Recurrence of Diabetic Nephropathy 164
Comparison of Outcome in Different Renal Replacement Modalities 164
Hemodialysis Versus Peritoneal Dialysis 164
Transplantation and Survival 165
Kidney-Pancreas Transplantation45 166
Surgical Issues47 166
Advantages of Pancreatic Transplantation48 167
Conclusion 167
Indian Perspective of Diabetic Kidney Disease 171
KEYWORDS 171a
Historical Perspective and Early Studies 171
Chronic Renal Failure and Diabetes 173
Morbidity and Mortality Due to Diabetic Nephropathy 174
Need of Biomarkers for Nephropathy 175
Urinary Albumin/Creatinine Ratio 175
Genome-Wide analysis in diabetes with nephropathy 176
DiabetOmics-Glycoproteome and Nephropathy 177
Conclusion 178
Acknowledgments 178
Other Books in This Series 180