Nephropathy in Diabetes mellitus for students

DIABETIC
DIABETIC
NEPHROPATHY
NEPHROPATHY
BY:
FATIMA CHATRIWALA
8TH
BATCH

GOALS &
OBJECTIVES
 Goal:
 To educated the group about Nephropathy which is one of the
complication of diabetes.
 Objectives:
 To understand what is diabetic nephropathy.
 To understand how to identify the first sign.
 To understand the risk factor for the diabetic nephropathy.
 To know how to manage diabetic nephropathy.
 To know about other complication of nephropathy.

WHAT IS DIABETIC
NEPHROPATHY?
 Diabetic nephropathy is a complication that occurs in some
people with diabetes.
 Diabetes causes unique change in the structure of kidney.
 In this condition the filters of the kidneys, the glomeruli,
become damaged.
 Due to which kidneys 'leak' abnormal amounts of protein
from the blood into the urine.
 The main protein that leaks out from the damaged kidneys
is called albumin.

STAGES OF NEPHROPATHY
 This is when the amount
of albumin that leaks into
the urine is between 30
and 300 mg per day.
 It is sometimes called
incipient nephropathy.
 This is when the amount of
albumin that leaks into the
urine is more than 300 mg
per day.
 It is sometimes called overt
nephropathy.
MICROALBUMINURIA MACROALBIMINURIA

HOW WILL YOU
IDENTIFY????????
 Check out for the following sign in urine:
 Foamy
 Smelling
 There are no symptoms in the early stages.
 But later with presences of protein in urine these symptoms
are observed:
 Edema (swelling in abdomen, legs, hands, around eyes)
 General illness
 So it’s important to have regular urine tests to find
kidney damage early.

ARE YOU AT RISKS?
 YES!!!!!!!!!!!
 You are at risk if you have:
 Diabetes for many years.
 Inadequate glucose control.
 High blood pressure.
 Inadequate control of blood lipids.
 Overweight.
 Improper lifestyle & diet.

DIABETES
 Constant high blood glucose result in damage to the blood
vessel of kidney.
 Greater the HbA1c level, higher the risk of developing
kidney disease.
 Nearly 180,000 people are living with kidney failure as a
result of diabetes(NIDDK).
 The target value for HbA1c < 7%, but its good to keep level
<6.5%.

HYPERTENSION
 Higher the blood pressure higher is the risk.
 Slight change in the blood pressure result in damage to the
blood vessel in kidney.
 Every year, high blood pressure causes more than 25,000
new cases of kidney failure in the United States (NIDDK).
 The target value for BP is 130/80 mmHg.

OVERWEIGHT & HIGH
CHOLESTEROL
 More you are overweight more you are at risk.
 The risk of kidney failure among "overweight" participants
in a study was 90% greater that of normal weight
participants.
 High cholesterol increase the risk.
 High cholesterol worsen the damage to the kidney.

DIET & LIFESTYLE
 Diet high in refined carbohydrate, fat and salt result in
uncontrolled blood glucose, BP & blood lipids; which
accelerate the kidney damage.
 Nil physical activity also enhance the damage.
 Smoking and consumption of alcohol increases the risk of
developing disease five times than normal.

HOW WILL YOU TREAT
NEPHROPATHY?
 Treatment aims at preventing & delay of the progression of
disease. In particular, if you have microalbuminuria it
should not progress to the proteinuria phase of the disease.
 This treatment involves:
 Medication
 Diet
 Exercise

MEDICATION
 To control blood sugars (Insulin, OHA)
 Blood glucose level need to be aggressively managed. So starting
insulin in people who are unable to achieve target blood glucose
by OHA is effective.
 To control blood pressure (ACE , ARBs)
 If microalbuminuria has indicated then use of ACE & ARBs
should be started even if people have normal BP.
 To control cholesterol (Antilipemic agent)
 In some cases if lipid profile is abnormal then it is necessary to
start with antilipemic agents.

DIET
 To prevent further complication, proper balance diabetic,
salt restricted diet planned by a registered dietician must
be followed.
 Diet must contains:
 High complex carbohydrate foods like whole grains, vegetables, etc.
 0.8 – 1.0 gm/kg body weight proteins can be given to the person,
which includes 1st
class proteins source like milk & milk products,
egg whites & lean meat.
 Atleast 5 – 6 servings of vegetables & fruits.
 Low in fats, which means avoid all the fried foods, items made of
ghee, use of butter, margarine, etc.
 Low in salt, which means 5.8gm of salt or less than that must
be consume to avoid raise in BP.
 Avoid smoking and alcohol consumption completely.

EXERCISE
 Exercise such as aerobics, brisk walking, cardio, yoga,
weight training, swimming, cycling, etc. has shown different
effect on reducing weight, blood sugar, BP and lipids.
 Studies has shown that exercise results in absolute decrease
of 1.0 % in HbA1c value and a 25 % to 40 % decrease in risk
of diabetes-related eye disease or kidney disease.
 Hence you must exercise daily and make it your habit.

COMPLICATION OF
NEPHROPATHY
 Hypoglycemia
 Most of the medication of diabetes including insulin is metabolized by
kidney, thus hypoglycemia becomes a risk for people.
 Thus dose of the medication must be reduce or regime must be
switched to rapid acting insulin to avoid build up and prevent
hypoglycemia.
 Anemia
 Kidney damage results decrease in production of erythropoietin,
which leads to anemia.
 This can be manageable with regular injection of erythropoietin.
 Edema (Fluid volume excess)
 Loss of albumin results in fluid retention in body.
 Since kidney is damage there is fluid retention due to reduction in
urine output.

TAKE HOME MESSAGE
 To prevent diabetic nephropathy always remember:
 Keep your blood glucose always in normal range
 Check HbA1c level every 3 month and it should be less than 7%.
 Keep your blood pressure less than 130/80 mmHg.
 Check your BP atleast 3 times a week or whenever visit to doctor.
 Weight loss is important if you are overweight
 Keep your blood lipids in normal range, LDL-Cholesterol
<100mg/dL.
 Quit addiction like smoking & alcohol completely.
 Follow proper balanced diet & exercise regime to loose weight &
keep your blood glucose, BP normal.
 Do routine urine test for early detection of albumin in urine.

REFERENCE
1. The Microalbuminuria Collaborative Study Group: Predictors of the development of microalbuminuria in patients
with type 1 diabetes mellitus: a seven-year prospective study. Diabet Med 16:918–925, 1999
2. Ravid M, Brosh D, Ravid-Safran D, Levy Z, Rachmani R: Main risk factors for nephropathy in type 2 diabetes
mellitus are plasma cholesterol levels, mean blood pressure, and hyperglycemia. Arch Intern Med 158:998–1004, 1998
3. Appel GB, Radhakrishnan J, Avram MM, DeFronzo RA, Escobar-Jimenez F, Campos MM, Burgess E, Hille DA,
Dickson TZ, Shahinfar S, Brenner BM: Analysis of metabolic parameters as predictors of risk in the RENAAL study.
Diabetes Care 26:1402–1407, 2003
4. Obesity Is A Risk Factor For Kidney Failure - University Of California, San Francisco
5. The association among smoking, heavy drinking, and chronic kidney disease, Am J Epidemiol. 2006 Aug
1;164(3):263-71. Epub 2006 Jun 14.
6. UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin
compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
Lancet 352:837–853, 1998.
7. Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, Menard J, Rahn KH, Wedel H, Westerling
S: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results
of the Hypertension Optimal Treatment (HOT) randomised trial: HOT Study Group. Lancet 351:1755–1762, 1998
8. Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC Jr, Stone
NJ: Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III
guidelines. Circulation 110:227–239, 2004
9. Pedrini MT, Levey AS, Lau J, Chalmers TC, Wang PH: The effect of dietary protein restriction on the progression of
diabetic and nondiabetic renal diseases: a meta-analysis. Ann Intern Med
10. Effects of Proper Nutrition Education on BMI Reduction and Changes on FBS, Chol and TG Rates of Type 2 Diabetic
Patients G.H. Heydari , S. Moslemi , Q. Heydari and A. Kebriaei Journal of Medical Sciences Year: 2006, Volume: 6 ,
Issue: 3, Page No.: 374-377.

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