Kidney Sludge Diabetes Diabetes is not a disease of the kidneys; but as we discussed in our exploration of the endocrine systemit is a disease of the pancreas. But that said, diabetes nevertheless has a huge impact on the health of your kidneys. The basics in terms of diabetes and the kidneys are simple.
Growing evidence suggests that fetal exposure to an abnormal intrauterine environment leads to an increased risk of chronic disease later in life. For example, children of diabetic mothers are prone to obesity and diabetes at a young age, and intrauterine growth retardation can lead to ischemic heart disease, diabetes, hypertensionand kidney disease.
Disadvantaged racial minorities in developed countries and the impoverished in developing countries are at risk of intrauterine growth retardation caused by malnutrition Nelson ; Nelson, Morgenstern, and Bennett Attention to maternal nutrition and other factors that would reduce low birthweight and impaired nephron development may have long-term implications for the development of CKD.
In low-income countries, poverty is associated with increased exposure to infectious diseases that increase susceptibility to CKD, including glomerulonephritis and parasitic diseases.
Obesity caused by a diet rich in saturated fats and high in salt are risk factors for diabetic nephropathy and hypertensive kidney disease. Change in dietary habits and physical activity can reduce the overall incidence of diabetes see chapter Smoking and excessive alcohol consumption increase the risk of ESRD McClellan and Flandersand analgesic abuse and exposure to toxic substances such as lead may affect progressive renal insufficiency Lin and others The notion of renoprotection has resulted in a dual approach to renal diseases based on effective and sustained pharmacological control of blood pressure and reduction of proteinuria.
Lowering blood lipids, stopping smoking, and maintaining tight glucose control for diabetes form part of the multimodal protocol for managing renal patients monitored by specific biological markers Ruggenenti, Schieppati, and Remuzzi Abnormal urinary excretion of protein is strongly associated with the progression of CKD in both diabetic and nondiabetic renal diseases.
Clinical studies have established that a reduction in proteinuria is associated with a decreased rate of kidney function loss. A specific category of drugs that lower blood pressure, the angiotensin-converting enzyme ACE inhibitors or angiotensin receptor blockers, appear to be more effective than other antihypertensive drugs in slowing the progression of both diabetic and nondiabetic CKDs Brenner and Zagrobelny The administration of an ACE inhibitor or of an angiotensin receptor blocker is an important treatment for controlling blood pressure and slowing the rate of progression of chronic kidney failure.
Concurrent diuretic therapy is often necessary in patients with renal insufficiency, because fluid overload is an important determinant of hypertension in such cases.
Dyslipidemia accelerates atherosclerosis and may promote the progression of renal disease. Careful control of the blood glucose level in diabetic patients can be beneficial and may limit other complications.
Obesity has not been directly linked to the progression of CKD but is an important risk factor for diabetes and cardiovascular morbidity and mortality.
Many patients and health care professionals do not appreciate the benefits of smoking cessation, an important measure in protecting the kidneys from progressive disease resulting from cardiovascular disease CVD.
Additional elements of secondary prevention measures include the treatment of anemia and of abnormal calcium and phosphorus metabolism. The International Society of Nephrology is developing a program that can be implemented according to the specific needs of a given developing country.
The program has two objectives: The Kidney Help Trust of Chennai, India, has undertaken a screening program for a population of 25, All those who tested positive for high blood pressure, diabetes, or both about 15 percent were further studied and then treated with inexpensive antihypertensive and antidiabetic drugs.
A similar program in Bolivia examined a population of 14, and also found that 15 percent were hypertensive, diabetic, or both. An extremely successful program of detection and treatment of renal and cardiovascular diseases among Australian Aborigines was conducted from to Treatment consisted of long-acting ACE inhibitors to lower blood pressure.
After an average of 3. Trained staff members can carry out screening programs inexpensively. Economic analysis, however, suggests that large-scale programs should be restricted to screening and treating only specific high-risk populations.
Screening programs can be implemented using simple, cheap, and reliable tests consisting of measurements of bodyweight, blood pressure, blood glucose, and creatinine. Screening includes testing urine for hemoglobin, glucose, leukocytes, and protein repeat tests may be necessary on a spot urine sample ; calculating albumin to creatinine ratios; testing positive results for increased serum creatinine and fasting glucose or glycosylated hemoglobin A1c test ; and reassessing the urine protein excretion rate, a cornerstone of kidney assessment.
Resulting albumin to creatinine ratio categories would indicate a scale of severity of glomerular disease, with a cardiovascular risk score based on body mass index, hypertensionfasting glucose level, microalbuminuria or gross albuminuria, and serum creatinine. Patients with positive markers for kidney disease would receive the best treatment available at the screening center.
Incorporating screening for kidney disease within screening programs developed for CVD and diabetes is important because proteinuria and renal dysfunction are early sensitive markers of vascular dysfunction and CVD patients are at significantly higher risk of kidney disease than the general population.
The greater the level of proteinuria, the more treatment is required; thus, the ACE inhibitor dose would be titrated up as proteinuria levels increased. Diuretics and other antihypertensives would be added to meet blood pressure targets.
Efforts should be made to obtain low-cost off-patent ACE inhibitors or other low-cost antihypertensives.Diseases and Disorders of the Urinary System Renal Disease and Failure Renal failure uremia is a syndrome of renal failure characterized by elevated levels of urea and creatinine in the blood.
Renal system disease, any of the diseases or disorders that affect the human urinary urbanagricultureinitiative.com include benign and malignant tumours, infections and inflammations, and obstruction by calculi.. Diseases can have an impact on the elimination of wastes and on the conservation of an appropriate amount and quality of body fluid.
Generally, renal diseases progress to a final stage as end-stage renal disease (ESRD) and function is substituted by renal replacement therapy (RRT), hemodialysis, peritoneal dialysis, or transplantation.
Kidneys and Urinary System See all Kidneys and Urinary System topics Renal Cancer see Kidney Cancer; Renal Dialysis Renal Disease see Kidney Diseases; Renal Failure see Kidney Failure; Renal Transplantation. The urinary system, also known as the renal system, produces, stores and eliminates urine, the fluid waste excreted by the kidneys.
The kidneys make urine by filtering wastes and extra water from. Diseases and Disorders of the Urinary System Renal Disease and Failure Renal failure uremia is a syndrome of renal failure characterized by elevated levels of urea and creatinine in the blood.