| Disease |
DIABETES MELLITUS-NEPHROPATHY |
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| Quotation |
“ We have not lost faith, we have transferred it from god to the medical profession” |
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| Definition |
A Clinical syndrome charecterised by persistent albumnuria (>300mg/24hr), a progressive decline in glomerular filtrationrate, and associated rise in arterial blood pressure. |
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| Prognosis |
Without specific interventions, 80% of subjects with Type1 with sustained albuminuria develop overt nephropathy over a period of 10-15 years with hypertension developing along the way. Overt ESRD is reached within 10 years in 50% of patients and within 20 years in 75% of cases. In type 2, diabetic state has usually been present for many years before the diagnosis is made, and without specific intervention 20-40% of Type 2 with microalbuminuria, progress to overt nephropathy, but by 20 years after onset of overt nephropathy ony 20% will have progressed to ESRD. Once GFR starts faling, the rate of progress is substantially different between type 1 and 2 |
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| General Measures |
Dietary restrition to protein 0.6 – 0.8 gm/kg/gay, and increasing the intake of vegetable proteins which appear beneficial. When on low protein diet, watch out for signs of malnutrition.Salt restriction to 34 gms/d.Reduce intake of saturated fat in view of associated hyperlipadaemia.Smoking to be discouraged in view of association with micro albumnuria.Standard modalities of treatment of renal failure of any etiology like phosphate restriction, use of phosphate binders, and avoidance to extent possible use of radio-contrast material etc. |
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| Advice to Patient |
Important of glycemic control.Rise of renal glucose threshold with onset of renal failure leading to reduction in urinary glucose, and this is not be misunderstood as ‘cure of diabetic state’ by the patient.Angioedema may occur with ACE inhibitors. Inform doctors immediately.Cough or altered taste sensation following ACE therapy might need stopping the medication. |
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| Reference From |
Medicine.ucsf.edu/resources/guidelines/guidedm.html |
