Diabetic Nephropathy

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Diabetic Nephropathy News | Diabetes & Renal Research Studies

High blood pressure can further contribute to kidney damage. There are many factors that can increase your risk of developing diabetic nephropathy. These include:. Your risk is also higher if you have other problems related to your diabetes. These include diabetic retinopathy or diabetic neuropathy. The main complication of diabetic kidney disease is developing chronic kidney disease.

Chronic kidney disease can progress even further to kidney failure. People with kidney failure need treatment with dialysis or a kidney transplant. All people with diabetes are at risk of high blood pressure and cardiovascular disease e. Having kidney disease also increases the risk of these problems. So having both diabetes and kidney disease means your risk is even higher.

Having diabetic kidney disease can also make other diabetes complications such as diabetic retinopathy and diabetic neuropathy worse. If you have diabetes, your doctor will recommend regular check ups to check on your blood glucose control and to check for any complications of diabetes.

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Your doctor will ask about any symptoms you have and perform a physical examination, looking for any complications of diabetes. The main tests done to check for evidence of diabetic nephropathy and how well your kidneys are functioning include a urine test and a blood test. Urine samples are tested for a protein called albumin. The amount of albumin found in the urine indicates the amount of damage to your kidneys. Microalbuminuria tiny amounts of albumin in the urine indicates that you are at risk of developing diabetic nephropathy or may have early stage diabetic nephropathy.

Proteinuria , or macroalbuminuria, larger amounts of albumin in the urine indicates that you have more advanced diabetic nephropathy that may be affecting the ability of your kidneys to filter wastes. Blood tests are also recommended to check your kidney function. The level of creatinine, a waste product in the blood, can be measured to calculate your estimated glomerular filtration rate eGFR.

The eGFR gives an indication of how well the kidneys are working to filter waste products from your blood. It is usually recommended that people with diabetes have blood and urine tests at least once a year to check on kidney function. Early detection and treatment of diabetic nephropathy can not only stop the progression of kidney disease in people with diabetes, but during the early stages can actually reverse it.

Treatment involves controlling both your blood glucose levels and your blood pressure. Blood glucose levels should be kept in the normal range as much as possible to prevent or slow the progression of diabetic nephropathy. Lifestyle measures including diet and exercise in combination with oral diabetes medicines oral hypoglycaemics or insulin can be used to control blood glucose levels.

People with type 2 diabetes who have microalbuminuria or proteinuria evidence of some degree of diabetic nephropathy are usually also treated with medicines called angiotensin-converting enzyme inhibitors ACE inhibitors or angiotensin receptor blockers ARBs. These medicines are also used to control blood pressure, but even if your blood pressure is normal, your doctor may prescribe an ACE inhibitor or ARB because they decrease the amount of protein in the urine and can prevent or slow the progression of diabetic kidney disease.

Other medicines may also be prescribed to help control high blood pressure. Eating a healthy diet and getting regular physical activity are important in controlling your blood glucose levels and blood pressure. Your doctor and diabetes educator can provide you with advice about a healthy diet and exercise recommendations.

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You may be advised to avoid high-protein diets if you have diabetic nephropathy, as excessive dietary protein may further damage the kidneys. A reduced-protein diet may be recommended for people with advanced diabetic nephropathy, to help delay the onset of kidney failure. You should never restrict major food groups from your diet without first checking with your doctor or diabetes educator.

These measures can help reduce your risk of developing diabetic kidney disease or delay its onset. You should also have a kidney health check which involves having a urine test, blood test and blood pressure test at least once a year to check how well your kidneys are functioning. Keeping track of your blood glucose level is an important part of managing diabetes. See how to check blood glucose and blood glucose targets. Langefeld and cols. These findings were similar to those described in other studies reporting an h 2 of creatinine depuration of 0.

One approach to identify genes associated to DN is the study of candidate genes. There are many studies of candidate genes for DN but the results are inconsistent Table 1. The choice of the gene to be studied depends on knowledge concerning its actions in DN pathophysiology such as those involving blood pressure control, severity of proteinuria or insulin resistance Below we present our experience with this approach.

Type 2 DM patients with microalbuminuria have high serum levels of circulating fatty acids 50 compared to normoalbuminuric patients. Intestinal absorption of long-chain fatty acids is controlled by the intestinal fatty acid-binding protein 2 FABP2. A54T polymorphism rs in FABP2 is associated with altered protein conformation, leading to greater affinity of the FABP2 protein for intestinal fatty acids with consequent serum increase.

We genotyped this polymorphism in 1, Brazilian patients with type 2 DM. An association of the T allele was found at different stages of DN Figure 1 This association was replicated in an independent sample of white American subjects with type 2 DM Besides, several studies used longer duration of DM as an inclusion criterion, which might predispose to survival bias, insofar as the possible genes associated with DN could also be associated with increased mortality.

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On the other hand, in patients with longer disease duration no increased risk for DN was seen associated with allele D Gene candidates for insulin resistance can also be considered DN candidates since insulin resistance is a common characteristic of patients with type 1 and type 2 DM who present increased UAE 51, The proportion of patients with the variant Q was This association was confirmed using TDT, which showed that this association was not due to population stratification GLUT1 is a glucose transporter in the kidneys and it has been associated with early kidney alterations leading to proteinuria.

We studied controls patients with DM1, disease duration of at least 15 years and normoalbuminuria , and cases patients with persistent proteinuria and with ESRD. The homozygosis for the XbaI - allele was associated with a discrete increased risk for DN when compared to other genotypes combined [OR 1. There was an excess of genotype AA among the cases Other studies analyzed different genes and did not find an association with DN Table 1.

Our experience with candidate genes allowed us to identifying some genes that can be related to the development and severity of DN. Table 2 shows the studies using a GWS approach. Two other susceptibility loci were also found in chromosomes 20 LOD score of 1. Genes located in chromosomes 22q, 5q, and 7q might be involved in the determination of UAE severity in patients with and without DM In a genome-wide association study, regions in chromosomes 19 and 2q were identified as associated with proteinuria and ESRD in patients with type 1 DM A locus in chromosome 1q was associated with ESRD only, while a locus in chromosome 20p was associated with proteinuria only Two independent loci were identified in chromosome 3q, 59 cM from each other, one associated with proteinuria and the other with ESRD A genome-wide association study with , SNPs using the microarray Affymetrix 5.

SNPs that were highly significant in the two cohorts were selected for further analyses. Three of the 11 initial SNPs had their association confirmed, two were borderline and the remaining did not show a significant association with the development of DN proteinuria or CKD 25 Table 4. Other authors have reported an association of different chromosomal regions using GWS approach to search for DN related genes Table 2 , In conclusion, clinical and epidemiological studies have evidenced a genetic component of DN.

However, no specific gene has been able to explain most DN cases yet. The results of studies that identified genes or genome regions associated with DN were quite inconsistent. The lack of more consistent results is probably due to different factors. Most genetic studies have been performed in selected populations but they are heterogeneous between them. It should also be pointed out that an isolated candidate gene is sought when various genes are probably involved and possibly interlinked. Joint efforts are essential to achieve robust findings in the study of genetics of DN.

In the light of remarkable advances in this area of study, we hope that in the near future patients at high risk for developing DN could be identified and benefited with earlier specific therapies. We also expect to see a consequent reduction in disease burden and mortality due to this serious complication.

New pharmacogenomic developments will contribute to better treatment choices for DN and, more importantly, will help preventing it based on an individual's genetic characteristics. Disclosure: no potential conflict of interest relevant to this article was reported. Global prevalence of diabetes: estimates for the year and projections for Diabetes Care.

Kidney Int. Arq Bras Endocrinol Metabol. Diabetic nephropathy. Bloomgarden ZT.

The Pathology of Diabetic Kidney Disease

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Vasc Med. Prognostic factors in Brazilian diabetic patients starting dialysis: a 3. Evidence for different susceptibility genes for proteinuria and ESRD in type 2 diabetes. Adv Chronic Kidney Dis. Deciphering diabetic nephropathy: progress using genetic strategies. Curr Opin Nephrol Hypertens. Segregation analysis of diabetic nephropathy in Pima Indians.

Segregation analysis of urinary albumin excretion in families with type 2 diabetes. APOE polymorphisms and the development of diabetic nephropathy in type 1 diabetes: results of case-control and family-based studies. Identifying genes for diabetic nephropathy - current difficulties and future directions.

Diabetes and kidney disease

Nephrol Dial Transplant. Genome-wide association scan for diabetic nephropathy susceptibility genes in type 1 diabetes.

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    Can familial aggregation of disease be explained by familial aggregation of environmental risk factors? Am J Epidemiol. Is endogenous creatinine clearance still a reliable index of glomerular filtration rate in diabetic patients? Braz J Med Biol Res. Clinical and laboratory profile of patients with type 2 diabetes with low glomerular filtration rate and normoalbuminuria.

    Symptoms of diabetic nephropathy

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