diabetic nephropathy l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Diabetic Nephropathy PowerPoint Presentation
Download Presentation
Diabetic Nephropathy

Loading in 2 Seconds...

play fullscreen
1 / 16

Diabetic Nephropathy - PowerPoint PPT Presentation


  • 508 Views
  • Uploaded on

Diabetic Nephropathy. Diabetic Nephropathy. Over 40% of new cases of end-stage renal disease (ESRD) are attributed to diabetes. In 2001, 41,312 people with diabetes began treatment for end-stage renal disease.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Diabetic Nephropathy' - Gabriel


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
diabetic nephropathy2
Diabetic Nephropathy
  • Over 40% of new cases of end-stage renal disease (ESRD) are attributed to diabetes.
  • In 2001, 41,312 people with diabetes began treatment for end-stage renal disease.
  • In 2001, it cost $22.8 billion in public and private funds to treat patients with kidney failure.
  • Minorities experience higher than average rates of nephropathy and kidney disease
five stages of kidney disease
Five Stages of Kidney Disease

Stage 1: Hyperfiltration, or an increase in glomerular filtration rate (GFR) occurs. Kidneys increase in size.

Stage 2: Glomeruli begin to show damage and microalbuminurea occurs.

Stage 3: Albumin excretion rate (AER) exceeds 200 micrograms/minute, and blood levels of creatinine and urea-nitrogen rise. Blood pressure may rise during this stage.

five stages of kidney disease con t
Five Stages of Kidney Disease (con’t.)

Stage 4: GFR decreases to less than 75 ml/min, large amounts of protein pass into the urine, and high blood pressure almost always occurs. Levels of creatinine and urea-nitrogen in the blood rise further.

Stage 5: Kidney failure, or end stage renal disease (ESRD). GFR is less than 10 ml/min. The average length of time to progress from Stage 1 to Stage 4 kidney disease is 17 years for a person with type 1 diabetes. The average length of time to progress to Stage 5, kidney failure, is 23 years.

screening for diabetic nephropathy
Screening for Diabetic Nephropathy

1American Diabetes Association:Nephropathy in Diabetes(Position Statement). Diabetes Care 27 (Suppl.1): S79-S83, 2004

treatment of diabetic nephropathy
Treatment of Diabetic Nephropathy
  • Hypertension Control -Goal: lower blood pressure to <130/80 mmHg
    • Antihypertensive agents
      • Angiotensin-converting enzyme (ACE) inhibitors
        • captopril, enalapril, lisinopril, benazepril, fosinopril, ramipril, quinapril, perindopril, trandolapril, moexipril
      • Angiotensin receptor blocker (ARB) therapy
        • candesartan cilexetil, irbesartan, losartan potassium, telmisartan, valsartan, esprosartan
      • Beta-blockers
treatment of diabetic nephropathy cont
Treatment of Diabetic Nephropathy (cont.)
  • Glycemic Control
    • Preprandial plasma glucose 90-130 mg/dl
    • A1C <7.0%
    • Peak postprandial plasma glucose <180 mg/dl
    • Self-monitoring of blood glucose (SMBG)
    • Medical Nutrition Therapy
  • Restrict dietary protein to RDA of 0.8 g/kg body weight per day
treatment of end stage renal disease esrd
Treatment of End-Stage Renal Disease (ESRD)

There are three primary treatment options for individuals who experience ESRD:

1. Hemodialysis

2. Peritoneal Dialysis

3. Kidney Transplantation

hemodialysis
Hemodialysis
  • Procedure
    • A fistula or graft is created to access the bloodstream
    • Wastes, excess water, and salt are removed from blood using a dialyzer
    • Hemodialysis required approx. 3 times per week, each treatment lasting 3-5 hrs
    • Can be performed at a medical facility or at home with appropriate patient training
hemodialysis cont
Hemodialysis (cont.)
  • Hemodialysis Diet
    • Monitor protein intake
    • Limit potassium intake
    • Limit fluid intake
    • Avoid salt
    • Limit phosphorus intake
  • Complications
    • Infection at access site
    • Clotting, poor blood flow
    • Hypotension
peritoneal dialysis
Peritoneal Dialysis
  • Procedure
    • Dialysis solution is transported into the abdomen through a permanent catheter where it draws wastes and excess water from peritoneal blood vessels. The solution is then drained from the abdomen.
    • Three Types of Peritoneal Dialysis
      • Continuous Ambulatory Peritoneal Dialysis (CAPD)
      • Continuous Cycler-Assisted Peritoneal Dialysis (CCPD)
      • Combination CAPD and CCPD
peritoneal dialysis cont
Peritoneal Dialysis (cont.)
  • Peritoneal Dialysis Diet
    • Limit salt and fluid intake
    • Consume more protein
    • Some potassium restrictions
    • Reduce caloric intake
  • Complications
    • Peritonitis
kidney transplant
Kidney Transplant
  • Procedure
    • A cadaveric kidney or kidney from a related or non-related living donor is surgically placed into the lower abdomen.
    • Three factors must be taken into consideration to determine kidney/recipient match:
      • Blood type
      • Human leukocyte antigens (HLAs)
      • Cross-matching antigens
kidney transplant cont
Kidney Transplant (cont.)
  • Kidney Transplant Diet
    • Reduce caloric intake
    • Reduce salt intake
  • Complications/Risk Factors
    • Rejection
    • Immunosuppressant side effects
  • Benefits
    • No need for dialysis
    • fewer dietary restrictions
    • higher chance of living longer
how can you prevent diabetic kidney disease
How Can You Prevent Diabetic Kidney Disease?
  • Maintain blood pressure <130/80 mm/Hg
  • Maintain preprandial plasma glucose 90-130 mg/dl
  • Maintain postprandial plasma glucose <180 mg/dl
  • Maintain A1C <7.0%
references
References

American Diabetes Association:Nephropathy in Diabetes(Position

Statement). Diabetes Care 27 (Suppl.1): S79-S83, 2004

National Kidney and Urologic Diseases Information Clearinghouse.

Kidney Disease of Diabetes. Bethesda, MD: National Institute of

Diabetes and Digestive and Kidney Diseases, National Institutes of

Health (NIH), DHHS; 2003.

United States Renal Data System. USRDS 2003 Annual Data

Report. Bethesda, MD: National Institute of Diabetes and Digestive

and Kidney Diseases, National Institutes of Health (NIH), DHHS;

2003.

DeFronzo RA: Diabetic nephropathy: etiologic and therapeutic

considerations. Diabetes Reviews 3:510-547, 1995

National Kidney and Urologic Diseases Information Clearinghouse.

Kidney Failure: Choosing a Treatment That’s Right For You.

Bethesda, MD: National Institute of Diabetes and Digestive and

Kidney Diseases, National Institutes of Health (NIH), DHHS; 2003.