Medical history (history of illness) represents an important component in the diagnosis of diabetic nephropathy. Family history Do you have a family history of common conditions such as diabetes mellitus or kidney disease? Social history Current medical history/systemic history (somatic and psychological complaints). How long have you had diabetes mellitus (diabetes)? Have you noticed water … Diabetic Nephropathy: Medical History
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Alport syndrome (also called progressive hereditary nephritis) – genetic disorder with both autosomal dominant and autosomal recessive inheritance with malformed collagen fibers that can lead to nephritis (inflammation of the kidneys) with progressive renal failure (kidney weakness), sensorineural hearing loss, and various eye diseases such as a cataract … Diabetic Nephropathy: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by diabetic nephropathy: Endocrine, nutritional, and metabolic diseases (E00-E90). Dyslipoproteinemia (ratio of lipoprotein fractions in blood serum, especially the disproportion of HDL to LDL cholesterol). Circulatory system (I00-I99) Hypertension (high blood pressure; development or exacerbation of hypertension). Symptoms and abnormal clinical … Diabetic Nephropathy: Complications
Stages of diabetic nephropathy. Stage Description I Renal hyperfiltration (the kidney works more) II Only histological changes are visible; the affected person has no symptoms III Onset of diabetic nephropathy with microalbuminuria (protein in urine) and, in many patients, hypertension (high blood pressure) IV Manifest nephropathy with hypertension (high blood pressure), edema (water retention in … Diabetic Nephropathy: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin, mucous membranes, and sclerae (white part of the eye) [peripheral edema (water retention in tissues)?; signs of anemia (anemia)?] Peripheral pulse status (palpation of the foot pulses of … Diabetic Nephropathy: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count (hemoglobin* , hematocrit* ). Fasting glucose (fasting blood glucose). HbA1c (long-term blood glucose value) Urine status (rapid test for: pH, leukocytes, nitrite, protein, glucose, ketone, blood), sediment, if necessary urine culture (pathogen detection and resistogram, that is, testing suitable antibiotics for sensitivity/resistance), albumin (microalbuminuria?)Note: … Diabetic Nephropathy: Test and Diagnosis
Therapy goals Prevention or slowing of progression (progression) of renal changes (nephroprotection), ie. Avoidance of chronic hyperglycemia (hyperglycemia). Optimal blood pressure values Adjust blood lipids (blood fats) to low levels [primary prevention depending on risk LDL cholesterol levels < 100 mg/dl; if CHD exists, aim for LDL cholesterol < 70 mg/dl (< 1.798 mmo/l)] Weight … Diabetic Nephropathy: Drug Therapy
Pathogenesis (disease development) Diabetic nephropathy is a secondary disease of diabetes mellitus (diabetes). Due to inadequately controlled blood glucose metabolism, the clinical picture develops over many years (on average 15-30 years), and approximately 20-30% of all patients with diabetes develop it during their lifetime. The exact pathophysiology of diabetic nephropathy is not yet fully understood. … Diabetic Nephropathy: Causes
General measures Avoid chronic hyperglycemia. Blood pressure should be optimally adjusted. Blood lipids (blood fats) should be controlled and, if necessary, brought to a low level. Any concomitant medical conditions should be carefully monitored and treated. Nicotine restriction (abstaining from tobacco use). Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 … Diabetic Nephropathy: Therapy
Diabetic nephropathy is diagnosed by laboratory diagnostics. Mandatory medical device diagnostics (under therapy). Monitoring of blood pressure (including self-monitoring and possibly 24-h blood pressure measurement) [at least twice a year]. Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic … Diabetic Nephropathy: Diagnostic Tests
Kidney transplantation (NTx, NTPL) is the surgical transfer of a kidney. Along with dialysis, it represents an option in renal replacement therapy and is performed in cases of terminal renal insufficiency (= permanent failure of kidney function before, leading to an increase in urinary substances in the blood) or loss of both kidneys. Indications (areas … Kidney Transplant
At the end of the therapeutic options, only renal replacement procedures remain in stage V diabetic nephropathy. These include renal transplantation (NTx, NTPL) and dialysis (blood washing). In dialysis, blood is drained from the body through large vascular accesses at regular intervals, every two to three days, and cleansed of harmful substances in a machine … Diabetic Nephropathy: Surgical Therapy