UNCONTROLLED DIABETES IS THE LEADING CAUSE OF ESRD.

1. DIABETIC NEPHROPATHY
PAA KWESI HACKMAN
RD, LD, MSC DIETETICS, BSC NUTRITION AND FOOD
SCIENCE
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2. Outline
DEFINITION
EPIDEMIOLOGY
RISK FACTORS
PATHOPHYSIOLOGY
SIGNS & SYMPTOMS
COMPLICATIONS
MEDICAL Dx
MANAGEMENT
MNT
CONCLUSION
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3. Definition
It is a clinical syndrome characterized
by:
• Persistent albuminuria (>300 mg/d or >200
μg/min) confirmed on at least 2 occasions
3-6 months apart.
• Progressive decline in GFR.
• Elevated BP.
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4. Epidemiology
382m (8.3%) adults with DM by 2013.
592m projected by 2035.
Global mortality – 6%.
Almost a third of people with DM develop DN
DN 35-40% T1DM Pts.
15-20% T2DM Pts.
Leading cause of ESRD.
(6th IDF Atlas, 2013; ADA, 2007) 4

5. Risk Factors
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6. Pathophysiology /I
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7. Pathophysiology /II
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8. S/S
Oedema
Troubled sleep or concentration
Poor appetite
Nausea
Weakness
Itching and extremely dry skin
Arrhythmia
Muscle twitching
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9. Complications
HTN
Anaemia
Bone abnormalities
CVD
Malnutrition
Metabolic acidosis
Uremia
Hyperlipidaemia
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10. Medical Dx
 Blood tests
 Urine tests
• Dipstick
• Alb:Cr ratio > 2.5 in males and > 3.5 in females is
abnormal.
• Confirmed with AER of 20-200ug/min or 30-
300mg/24hrs & eGFR.
 Imaging tests
 Kidney biopsy
(ADA, 2004) 10

11. Management
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12. MNT
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13. MNT Goals
 Achieve and maintain:
• BGL in the normal or safe.
• Lipid profile that reduces CVD risk.
• BP normal or safe.
 To maintain good nutritional status, slow
progression, and to treat complications.
 To achieve weight loss in overweight or obese states.
 To Enhance health through food choices and physical
activity.
(ADA, 2008)
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14. MNT: Nutrition Assessment
 Anthro’s
 Biochemical
 Client Hx
 Diet Hx
 Nutrition-focused Physical findings
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15. MNT: Nutrition Dx /I
 Inadequate energy intake
 Inappropriate intake of types of CHO
 Inadequate fibre intake
 Excessive mineral intake (Na+ or K+)
 Altered GI function (gastroparesis)
 Altered nutrition-related Lab values
 Food-medication interaction
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16. MNT: Nutrition Dx /II
Food-medication Interaction
Underweight
Food- and Nutrition-related Knowledge Deficit
Not Ready For Diet/Lifestyle Change
Self-monitoring Deficit
Undesirable Food Choices
Physical Inactivity
Inability or Lack of Desire to Manage Self-care
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17. MNT: Intervention /I
 Nutritional education
 Modified DASH Diet employed
 Rx: CHO: 50-60%
Protein: 10-20%
Fat: < 30% (<10% Sats)
 Protein: 0.8 - 1g; 0.8g (in ESRD) & 1.2g/kg/d (dialysis)
 Sodium: max = 2g/d
(NKF KDOQI, 2007; ADA, 2008)
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18. MNT: Intervention /II
 To limit K+-rich foods in hyperkalemia
 Fluid: 600-1000ml (severe oedema & dialysis)
 Micronutrient supplementation may be
necessary
 Adequate PAL as tolerated
(NKF KDOQI, 2007; ADA, 2008)
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19. MNT: M & E
 Weight
 Intake
 Labs
 BP
 Nutrition-focused physical findings
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20. Conclusion
 DN develops over a long duration.
 Timely screening is paramount.
 Aggressive mgt. of BGL, BP & Lipids helps in
preservation of renal function and can improve the
outcome.
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21. References
 KDOQI Clinical Practice Guidelines and Clinical Practice
Recommendations for Diabetes and Chronic Kidney Disease. Am
J Kidney Dis. 2007;49(2 suppl 2):S12-S154.)
 American Diabetes Association: Nephropathy in Diabetes
(Position Statement). Diabetes Care 27 (Suppl.1): S79-S83, 2004
 American Diabetes Association Standards of medical care in
diabetes. Diabetes Care 30:S4-S36, 2007
 American Diabetes Association Nutrition recommendations and
interventions for diabetes. Diabetes Care 31:S61-S78, 2008
 Hansen HP, Tauber-Lassen E, Jensen BR, et al. Effect of dietary
protein restriction on prognosis in patients with diabetic
nephropathy. Kidney Int.2002;62(1):220-228.
 IDF Atlas (2013).
 Pedrini MT, Levey AS, Lau J, et al. The effect of dietary protein
restriction on the progression of diabetic and nondiabetic renal
diseases: meta-analysis. Ann Intern Med. 1996;124:627-632.
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22. •THANK YOU
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