Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria and a progressive decline in kidney function. It is the leading cause of end-stage renal disease. Risk factors include poor blood glucose control, high blood pressure, smoking, and family history of kidney disease. The pathophysiology involves changes in the kidney's small blood vessels caused by high blood glucose levels over time. Common signs and symptoms include edema, trouble sleeping, weakness, and itching skin. Medical diagnosis involves blood and urine tests to assess kidney function and detect albuminuria. Management focuses on tight blood glucose and blood pressure control through medication, diet, exercise and lifestyle changes to slow disease progression and prevent complications like heart disease.

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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