End-Stage Renal Failure in Diabetic Nephropathy: Pathophysiology and Treatment

Abstract

Forty percent of patients with insulin-dependent diabetes will develop nephropathy during the course of their disease, thus being the most important single disorder leading to end-stage renal failure (ESRF). Intensive metabolic control delays onset of diabetic nephropathy, the first omen of which is appearance of subclinical albuminuria, also termed microalbuminuria. Moreover, it is now established that intensive treatment of hypertension reduces rate of decline in GFR and thus postpones ESRF.When uremia eventually sets in, a range of biochemical and endocrine abnormalities can be included among those characteristics of diabetes mellitus per se. These include elevated plas ma levels of growth hormone, glucagon and free fatty acids, which may participate in the uremic insulin resistance superimposed on the preexisting diabetic carbohydrate intolerance.Hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) are two established modalities of renal replacement therapy in diabetes mellitus. Controlled clinical trials for comparison of CAPD versus HD treatment of diabetics are, however, still needed. The survival rate is approximately 80 and 65-95 % in insulin-dependent diabetic patients at 1 year during treatment with HD and CAPD, respectively. However, it is general experience that diabetics on CAPD exhibit a glycemic control, superior to that attained during HD. It has not been proved that patient survival after cadaveric renal transplantation is better than on dialysis. The degree of vascular heart disease seems to be the major determinant for survival of kidney-transplanted diabetic patients.

Ultrasonographyical Study of Kidneys Length Correlation in Various Clinical Stages of Chronic Type II Diabetes

“…The study included both adult male and female population with type 2 Diabetes Mellitus, above 18 years of age and biochemically diagnosed for nephropathy. The relevant medical history and physical examination findings were entered into the questionnaire [3]. For diabetics, blood and urine samples were collected for biochemical estimation of plasma creatinine levels, HbA1c, FBS analysis.…”

Precision Medicine Approaches to Diabetic Kidney Disease: Tissue as an Issue

“…Our society guidelines, state that in patients with CKD in the presence of diabetes and albuminuria, the diagnosis of DKD can safely be made. These recommendations were developed based on observations originating back to Mogensen et al in the 1970–1980s [3•, 4, 8, 9]. Mogensen classified DKD as a progressive disease (stages I–V).…”

Aliskiren and valsartan combination therapy for the management of hypertension

“…Some of the other pathologic effects of angiotensin II include cardiac and vascular remodeling, inflammation, thrombosis, and even plaque rupture, the ultimate and lethal step in atherosclerosis 17. With regard to renal disease, angiotensin II is partially responsible for promoting albuminuria and accelerating the decrease in the glomerular filtration rate associated with diabetic nephropathy, the leading cause of end-stage renal disease in the modern world 18. Inhibitors of RAAS, such as ARBs, and, more recently, the direct renin inhibitor aliskiren, alone and in combination with an ARB, has been shown to slow the decrease in glomerular filtration rate and diminish albuminuria in patients with diabetic nephropathy 19,20.…”