The document discusses diabetic nephropathy, a kidney disease caused by diabetes. Uncontrolled high blood sugar can damage the kidneys over time by thickening and scarring the glomerulus, which is the part of the kidney that filters waste from the blood. This can lead to protein leakage from the kidney and reduced filtering ability. Risk factors include having type 1 diabetes diagnosed before age 20, smoking, and African American, Hispanic or American Indian descent. Treatment focuses on controlling blood sugar, blood pressure and cholesterol to prevent or slow kidney damage.

1. DIABETIC NEPHROPATHY
Presentation by Kaleigh Connors
St. Petersburg College
PCB 4723 Fall 2012

2. KIDNEY FUNCTIONS
• Primary urine: aqueous solution introduced into the kidney tubules
– Ultrafiltration
– Active solute secretion (insects and some marine fish)
• Definitive urine: modified as the solution moves through tubules and
other excretory passages, ultimately to be eliminated
Commonly under endocrine control and
hormonally modulated in regulatory ways

4. DIABETIC NEPHROPATHY
• Exact cause and mechanism unknown
– Uncontrolled high blood glucose leads to kidney damage
– Causes the glomerulus to become thickened and scarred
– Leads to leakage of the kidney structure: albumin
• Diagnosis: BUN, serum creatinine
• Commonality in those diagnosed with IDDM before age 20, smokers and
people of African-American, Hispanic and American Indian descent

7. DIABETIC NEPHROPATHY – A REVIEW OF THE NATURAL
HISTORY, BURDEN, RISK FACTOS AND TREATMENT
• Greater proportion of Type 2 individuals are diagnosed with DN
– Possibly because the disease had been present over several years
before the diagnosis of diabetes was made
• Incidence of DN increased by 150% over the last 10 years in the US
(similar to Europe and Japan)
• Patients undergoing dialysis have a 22% and 15% higher mortality at
one year and five years compared to those without diabetes
– Death from cardiovascular disease or infection

8. • Prevention of DN
– Primary: prevention of
diabetes in the population
– Secondary: strict control of
blood glucose, lipids and
blood pressure levels
– Tertiary: regular screening
for proteinuria and
appropriate treatment
DIABETIC NEPHROPATHY – A REVIEW OF THE NATURAL
HISTORY, BURDEN, RISK FACTOS AND TREATMENT

9. LITERATURE CITED
Ayodele, O.E., Alebiosu, C.O., Salako, B.L. (2004). Diabetic neuropathy
– a review of the natural history, burden, risk factors and
treatment. Journal of the National Medical Association,
96(100: 1445-1454.
Burne, P.N., Toto, R. (2012). Current update in the management of
diabetic nephropathy. Current Diabetes Review.
Chow, F., Ozols, E., Nikolic-Paterson, D.J., Atkins, R.C., Tesch, G.H.
(2004). Macrophages in mouse type 2 diabetic nephropathy:
correlation with diabetic state and progressive renal injury.
Kidney International, 65(1): 116-128.
Gross, J.L., de Azevedo, M.J., Silveiro, S.P., Canani, L.H., Caramori, M.L.,
and Zelmanovitz, T. (2005). Diabetic nephropathy: diagnosis,
prevention and treatment. Diabetes Care, 28(1):164-76.
Kiyoshi, K., Masaomi, N., Akira, S., Reiko, I. and Toshio, M. (2003).
Current issues and future perspectives of chronic renal failure.
Journal of American Society of Nephrology, 13:3-6.
Mogensen, C.E., Christensen, C.K. (1984). Predicting diabetic
nephropathy in insulin-dependent patients. The New England
Journal of Medicine, 311(2): 89-93.
Mauer, S.M., Steffes, M.W., Ellis, E.N., Sutherland, D.E.R., Brown, D.M.,
Goetz, F.C. (1984). Structural-Functional Relationships in
Diabetic Nephropathy. The American Society for Clinical
Investigation, 74: 1143-1155.
Ritz, E., Steanski, A. (1996). Diabetic nephropathy in type II diabetes.
American Journal of Kidney Diseases, 27(2): 167-194.
Strippoli, G.F., Di Paolo, S., Cincione, R., Di Palma, A.M., Teutonico, A.,
Grandaliano, G., Schena, F.P. and Gesualdo, L. (2003). Clinical
and therapeutic aspects of diabetic nephropathy. Journal of
Nephrology, 16(4): 487-99.
Stevens, L.A., Coresh, J., Greene, T., Levey, A.S. (2006). Assessing
kidney function—measured and estimated glomerular
filtration rate. The New England Journal of Medicine, 354(23):
2473-83.
Yamagishi, S., Fukami, K., Ueda, S., and Okuda, S. Molecular
mechanisms of diabetic nephropathy and its therapeutic
intervention. Current Drug Targets, 8(8): 952-9.
Young, B.A., Johnson, R.J., Alpers, C.E., Eng, E., Gordon, K., Floege, J.,
Couser, W.G., and Siedel K. (1995). Cellular events in the
evolution of experiment diabetic nephropathy. Kidney
International, 47(3): 935-944.

10. Questions?

11. IMAGES OBTAINED FROM (GOOGLE)
1. http://www.encyclopedia.com/doc/1O62-diabeticnephropathy.html
2. http://apbrwww5.apsu.edu/thompsonj/Anatomy%20&%20Physiology/2020/2020%20Exam%20Reviews/Exam%
204/CH25%20Kidney%20Anatomy.htm
3. http://medcell.med.yale.edu/histology/urinary_system_lab/diabetic_neuropathy.php
4. http://researchcenters.info/diseases/diabetic-nephropathy.html
5. https://urinalysis.publishpath.com/Default.aspx
6. http://www.nytimes.com/2012/05/11/health/policy/dialysis-rule-changes-followed-by-transfusion-
increases.html
7. http://rmsbunkerblog.wordpress.com/2011/04/13/benefits-of-patient-satisfaction-surveying-healthcare/
8. http://123freevectors.com/medical-background/
9. http://www.123rf.com/photo_2331661_kid-is-doing-a-diabetes-glucose-level-finger-blood-test-in-background-
there-are-older-bigger-devices.html
10. http://www.evroberts.com/evr_desktoptools.php