{"id":7741,"date":"2021-10-24T12:52:39","date_gmt":"2021-10-24T10:52:39","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/nephrology\/renal-disorders-in-diabetes-mellitus-treatment-of-diabetes-in-kidney-disease\/"},"modified":"2021-10-26T20:34:32","modified_gmt":"2021-10-26T18:34:32","slug":"renal-disorders-in-diabetes-mellitus-treatment-of-diabetes-in-kidney-disease","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/renal-disorders-in-diabetes-mellitus-treatment-of-diabetes-in-kidney-disease\/","title":{"rendered":"Renal disorders in diabetes mellitus, treatment of diabetes in kidney disease"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><div class=\"intro\">The kidney is one of the main victims of diabetes mellitus. The systemic changes caused by the disease lead to progressive glomerular and vascular damage.<\/div><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Diabetic nephropathy<\/strong> describes the  progressive fibrosis and scarring of the glomeruli, leading to albuminuria, reduced GFR, and eventually, end-stage kidney disease.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Together with hypertension, diabetes mellitus is a major cause of kidney disease.<\/li><li>Hyperglycemia leads to an array of hemodynamic and metabolic changes.<\/li><li>It is the most common cause of end-stage kidney disease, and nephrotic syndrome in adults.<\/li><li>Renal disease due to DM type 1 is more common than due to DM type 2.<\/li><li>The hallmark of the disease is <strong>glomerulosclerosis<\/strong> &#8211; the accumulation of\u00a0extracellular matrix (ECM)\u00a0proteins in the mesangial interstitial space, resulting in fibrosis and scarring.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Diabetic nephropathy begins with <strong>glomerular<\/strong> <strong>hyperfiltration<\/strong> (which soon normalizes and starts decreasing with the deterioration of the kidneys), followed by progressive proteinuria, and eventually <strong>nephrotic syndrome<\/strong> and ESRD.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It usually takes up to 10 years from the beginning of the renal disease to the development of proteinuria.<\/p>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Pathogenesis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Glomerulosclerosis<\/strong> due to <strong>thickening of the glomerular basement membrane<\/strong> (caused by the glycosylation of glomerular proteinsm, leading to mesangial proliferation and matrix expansion) and <strong>endothelial damage<\/strong>.<\/li><li>Either diffuse or nodular changes are evident in the form of <strong>Kimmelstiel-Wilson lesions<\/strong> which are nodules of pink hyaline material within the glomeruli.<\/li><li>Areteriolosclerosis (atherosclerosis of small vessels) and arteriosclerosis along with hyalinosis, and interstitial fibrosis.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Diagnosis and screening<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">Regular urinalysiss in patients with DM will help diagnose the disease early on and begin treatment to slow down its progression. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Dip-stick won&#8217;t detect low levels of proteinuria, therefore, ACR (albumin:creatinine ratio) and 24-hour urine sample are required. Renal biopsy is rarely taken.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Control of blood glucose<\/strong><ul><li>Antidiabetic medication and lifestyle modifications to maintain HbA1c below 7%<\/li><\/ul><\/li><li><strong>Aggressive blood pressure reduction<\/strong><ul><li>ACEi or ARBs (first-line)<\/li><li>Beta-blockers<\/li><li>Loop diuretics<\/li><li>CCB (verapamil)<\/li><\/ul><\/li><li><strong>Lipid-lowering medication<\/strong><ul><li>Statins<\/li><li>Ezetimibe<\/li><li>Anti-PCSK9 therapy<\/li><\/ul><\/li><li><strong>Kidney transplantation<\/strong><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">References<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/diabetes.diabetesjournals.org\/content\/57\/6\/1439\">https:\/\/diabetes.diabetesjournals.org\/content\/57\/6\/1439<\/a><\/p>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Pathogenesis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis and screening<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">References<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Diabetic nephropathy describes the progressive fibrosis and scarring of the glomeruli, leading to albuminuria, reduced GFR, and eventually, end-stage kidney disease. Together with hypertension, diabetes mellitus is a major cause of kidney disease. Hyperglycemia leads to an array of hemodynamic and metabolic changes. It is the most common cause of end-stage kidney disease, and nephrotic [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":685,"menu_order":3,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-7741","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Renal disorders in diabetes mellitus, treatment of diabetes in kidney disease &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/renal-disorders-in-diabetes-mellitus-treatment-of-diabetes-in-kidney-disease\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/nephrology\\\/renal-disorders-in-diabetes-mellitus-treatment-of-diabetes-in-kidney-disease\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/nephrology\\\/renal-disorders-in-diabetes-mellitus-treatment-of-diabetes-in-kidney-disease\\\/\",\"name\":\"Renal disorders in diabetes mellitus, treatment of diabetes in kidney disease &#8211; 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