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DIABETIC NEPHROPATHY
Case Study

Submitted by:
FONTANILLA, JUAN MIGUEL

BSN IV – B

Group 2
DIABETIC NEPHROPATHY
What is Diabetic Nephropathy?

Diabetic nephropathy is a serious complication of type 1 diabetes and type 2

diabetes. It's also called diabetic kidney disease. In the United States, about 1 in 3 people
living with diabetes have diabetic nephropathy.

Diabetic nephropathy affects the kidneys' ability to do their usual work of removing
waste products and extra fluid from your body. The best way to prevent or delay diabetic
nephropathy is by maintaining a healthy lifestyle and adequately managing your diabetes
and high blood pressure.

Kidney disease may progress to kidney failure, also called end-stage kidney
disease. Kidney failure is a life-threatening condition. At this stage, treatment options are
dialysis or a kidney transplant.

Anatomy of the Kidney (How the Kidneys Work?)

You have two kidneys, each about the size of an adult fist, located on either side of
the spine just below the rib cage. Although they are small, your kidneys perform many
complex and vital functions that keep the rest of the body in balance. For example,
kidneys:

 Help remove waste and excess fluid

 Filter the blood, keeping some

compounds while removing others

 Control the production of red blood

cells

 Make vitamins that control growth

 Release hormones that help

regulate blood pressure

 Help regulate blood pressure, red

blood cells, and the amount of
certain nutrients in the body, such
as calcium and potassium.
Here's how kidneys perform their important work:

1. Blood enters the kidneys through an artery from the heart

2. Blood is cleaned by passing through millions of tiny blood filters
3. Waste material passes through the ureter and is stored in the bladder as urine
4. Newly cleaned blood returns to the bloodstream by way of veins
5. Bladder becomes full and urine passes out of the body through the urethra.

The kidneys perform their life-sustaining job of filtering and returning to the bloodstream
about 200 quarts of fluid every 24 hours. Approximately two quarts are eliminated from
the body in the form of urine, while the remainder, about 198 quarts, is retained in the
body. The urine we excrete has been stored in the bladder for approximately one to
eight hours.
Pathophysiology

Symptoms

In the early stages of diabetic nephropathy, you would most likely not notice any signs or
symptoms. In later stages, signs and symptoms may include:

 Worsening blood pressure control  Confusion or difficulty

concentrating
 Protein in the urine
 Shortness of breath
 Swelling of feet, ankles, hands or
eyes  Loss of appetite

 Increased need to urinate  Nausea and vomiting

 Reduced need for insulin or  Persistent itching

diabetes medicine  Fatigue

Causes

Diabetic nephropathy results when diabetes damages blood vessels and other
cells in your kidneys. Diabetic nephropathy is a common complication of type 1 and type
2 diabetes.
 Over time, poorly controlled diabetes can cause damage to blood vessel clusters
in your kidneys that filter waste from your blood. This can lead to kidney damage and
cause high blood pressure. High blood pressure can cause further kidney damage by
increasing the pressure in the delicate filtering system of the kidneys.

Risk Factors

If you're living with diabetes, factors that can increase your risk of diabetic nephropathy
include:

 Uncontrolled high blood sugar (hyperglycemia)

 Uncontrolled high blood pressure (hypertension)

 Being a smoker

 High blood cholesterol

 Obesity

 A family history of diabetes and kidney disease

Complications

Complications of diabetic nephropathy may develop gradually over months or years.

They may include:

 Fluid retention, which could lead to swelling in your arms and legs, high blood
pressure, or fluid in your lungs (pulmonary edema)

 A rise in potassium levels in your blood (hyperkalemia)

 Heart and blood vessel disease (cardiovascular disease), which could lead to
stroke

 Damage to the blood vessels of the light-sensitive tissue at the back of the eye
(diabetic retinopathy)

 Reduced number of red blood cells to transport oxygen (anemia)

 Foot sores, erectile dysfunction, diarrhea and other problems related to damaged
nerves and blood vessels

 Bone and mineral disorders due to the inability of the kidneys to maintain the right
balance of calcium and phosphorus in the blood

 Pregnancy complications that carry risks for the mother and the developing fetus

 Irreversible damage to your kidneys (end-stage kidney disease), eventually

needing either dialysis or a kidney transplant for survival
Diagnostic Test

Diabetic nephropathy is usually diagnosed during routine testing that's a part of your
diabetes management. If you're living with type 1 diabetes, screening for diabetic
nephropathy is recommended beginning five years after your diagnosis. If you are
diagnosed with type 2 diabetes, screening will begin at the time of diagnosis.

Routine screening tests may include:

 Urinary albumin test. This test can detect the blood protein albumin in your urine.
Typically, the kidneys don't filter albumin out of the blood. Too much of the protein
in your urine can indicate poor kidney function.

 Albumin/creatinine ratio. Creatinine is a chemical waste product that healthy

kidneys filter out of the blood. The albumin/creatinine ratio — a measure of how
much albumin is in a urine sample relative to how much creatinine there is —
provides another indication of kidney function.

 Glomerular filtration rate (GFR). The measure of creatinine in a blood sample

may be used to estimate how quickly the kidneys filter blood (glomerular filtration
rate). A low filtration rate indicates poor kidney function.

Other diagnostic tests may include the following:

 Imaging tests. Your doctor may use X-rays and ultrasound to assess your
kidneys' structure and size. You may also undergo CT scanning and magnetic
resonance imaging (MRI) to determine how well blood is circulating within your
kidneys. Other imaging tests may be used in some cases.

 Kidney biopsy. Your doctor may recommend a kidney biopsy to take a sample of
kidney tissue. You'll be given a numbing medication (local anesthetic). Then your
doctor will use a thin needle to remove small pieces of kidney tissue for
examination under a microscope.

Treatment

The first step in treating diabetic nephropathy is to treat and control your diabetes
and high blood pressure (hypertension). This includes diet, lifestyle changes, exercise
and prescription medications. With good management of your blood sugar and
hypertension, you may prevent or delay kidney dysfunction and other complications.
Medications

In the early stages of diabetic nephropathy, your treatment plan may include
medications to manage the following:

 Blood pressure control. Medications called angiotensin-converting enzyme

(ACE) inhibitors and angiotensin 2 receptor blockers (ARBs) are used to treat high
blood pressure.

 Blood sugar control. Medications can help control high blood sugar in people
with diabetic nephropathy. Metformin (Fortamet, Glumetza, others) improves
insulin sensitivity and lowers glucose production in the liver. Glucagon-like peptide
1 (GLP-1) receptor agonists help lower blood sugar levels by slowing digestion and
stimulating insulin secretion in response to rising glucose levels. SGLT2 inhibitors
limit the return of glucose to the bloodstream, leading to increased glucose
excretion in the urine.

 High cholesterol. Cholesterol-lowering drugs called statins are used to treat high
cholesterol and reduce protein in the urine.

 Kidney scarring. Finerenone (Kerendia) disrupts molecular activity believed to

cause inflammation and tissue scarring in diabetic nephropathy. Research has
shown that the drug may reduce the risk of kidney function decline, kidney failure,
cardiovascular death, nonfatal heart attacks and hospitalization for heart failure in
adults with chronic kidney disease associated with type 2 diabetes.

Treatment for advanced Diabetic Nephropathy

If your disease progresses to kidney failure (end-stage kidney disease), your doctor
will likely discuss options for care focused on either replacing the function of your kidneys
or making you more comfortable. Options include:

 Kidney dialysis. This treatment removes waste products and extra fluid from your
blood. The two main types of dialysis are hemodialysis and peritoneal dialysis. In
the first, more common method, you may need to visit a dialysis center and be
connected to an artificial kidney machine about three times a week, or you may
have dialysis done at home by a trained caregiver. Each session takes 3 to 5 hours.
The second method may be done at home as well.

 Transplant. In some situations, the best option is a kidney transplant or a kidney-

pancreas transplant. If you and your doctor decide on transplantation, you'll be
evaluated to determine whether you're eligible for this surgery.
  Symptom management. If you choose not to have dialysis or a kidney transplant,
your life expectancy generally would be only a few months. You may receive
treatment to help keep you comfortable.

Potential future treatments

In the future, people with diabetic nephropathy may benefit from treatments being
developed using regenerative medicine. These techniques may help reverse or slow
kidney damage caused by the disease. For example, some researchers think that if a
person's diabetes can be cured by a future treatment such as pancreas islet cell
transplant or stem cell therapy, kidney function may improve. These therapies, as well as
new medications, are still under investigation.

Prevention

To reduce your risk of developing diabetic nephropathy:

 Keep regular appointments for diabetes management. Keep annual

appointments — or more-frequent appointments if recommended by your health
care team — to monitor how well you are managing your diabetes and to screen
for diabetic nephropathy and other complications.

 Treat your diabetes. With effective treatment of diabetes, you may prevent or
delay diabetic nephropathy.

 Manage high blood pressure or other medical conditions. If you have high
blood pressure or other conditions that increase your risk of kidney disease, work
with your doctor to control them.

 Follow instructions on over-the-counter medications. Follow instructions on

the packages of nonprescription pain relievers such as aspirin and nonsteroidal
anti-inflammatory drugs, such as naproxen (Aleve) and ibuprofen (Advil, Motrin IB,
others). For people with diabetic nephropathy, taking these types of pain relievers
can lead to kidney damage.

 Maintain a healthy weight. If you're at a healthy weight, work to maintain it by

being physically active most days of the week. If you need to lose weight, talk with
your doctor about weight-loss strategies, such as increasing daily physical activity
and consuming fewer calories.

 Don't smoke. Cigarette smoking can damage your kidneys and make existing
kidney damage worse. If you're a smoker, talk to your doctor about strategies for
quitting smoking. Support groups, counseling and some medications can all help
you to stop.
Lifestyle and Home Remedies

Diet, exercise and self-management are essential for controlling blood sugar levels and
high blood pressure. Your diabetes care team will help you with the following goals:

 Monitor your blood sugar level. Your health care provider will advise you on how
often to check your blood sugar level to make sure you remain within your target
range. You may, for example, need to check it once a day and before or after
exercise. If you take insulin, you may need to check it multiple times a day.

 Be active most days of the week. Aim for at least 30 minutes or more of
moderate to vigorous aerobic exercise — such as brisk walking, swimming, biking
or running — on most days for a total of at least 150 minutes a week.

 Eat a healthy diet. Eat a high-fiber diet with lots of fruits, nonstarchy vegetables,
whole grains and legumes. Limit saturated fats, processed meats, sweets and
sodium.

 Quit smoking. If you're a smoker, talk with your doctor about strategies for quitting
smoking.

 Maintain a healthy weight. If you need to lose weight, talk with your doctor about
weight-loss strategies. For some people, weight-loss surgery is an option.

 Take a daily aspirin. Talk with your doctor about whether you should take a daily
low-dose aspirin to lower the risk of cardiovascular disease.

 Be vigilant. Alert doctors unfamiliar with your medical history that you have
diabetic nephropathy. They can take steps to protect your kidneys from further
damage by avoiding medical tests that use contrast dye, such as angiograms and
computerized tomography scans.

Coping and support

If you have diabetic nephropathy, these steps may help you cope:

 Connect with other people who have diabetes and kidney disease. Ask your
doctor about support groups in your area. Or contact organizations such as the
American Association of Kidney Patients, the National Kidney Foundation or the
American Kidney Fund for groups in your area.

 Maintain your usual routine, when possible. Try to maintain your usual routine,
doing the activities you enjoy and continuing to work, if your condition allows. This
may help you cope with feelings of sadness or loss that you may experience after
your diagnosis.
 Talk with someone you trust. Living with diabetic nephropathy can be stressful,
and it may help to talk about your feelings. You may have a friend or family member
who is a good listener. Or you may find it helpful to talk with a faith leader or
someone else you trust. Consider asking your doctor for a referral to a social
worker or counselor.
 DRUG STUDY
ACE Inhibitors

Drug Class: The class of drugs Indicated for: Any patient with a history  control of blood  Give potassium
called angiotensin converting
pressure, supplements
of angioneurotic edema,  congestive heart and potassium-
Angiotensin Converting
enzyme (ACE) inhibitors, as the
 control of blood pressure, whether related to an failure, and sparing diuretics
Enzyme (ACE) Inhibitors class name suggests, reduces the
 congestive heart failure, ACE inhibitor,  prevention of cautiously
activity
and stroke and because ACE
of angiotensin converting enzyme. angiotensin receptor
 prevention of stroke and hypertension, or inhibitors can
ACE converts angiotensin I blockers, or another diabetes-related cause potassium
hypertension, or diabetes-
produced by the body to kidney damage. retention and
related kidney damage. cause, should not be
angiotensin II in the blood.  ACE inhibitors are hyperkalemia.
ACE inhibitors are especially given an ACE inhibitor.
Angiotensin II is a very potent
important because they have been
especially Warn the
chemical that causes the muscles shown to prevent
Other contraindications important because patient to avoid
surrounding blood vessels to include pregnancy, renal they have been potassium-
 early death resulting from
contract and narrow the blood shown to prevent containing salt
hypertension, artery stenosis, and
 early death substitutes. Give
vessels. Narrowing of blood
 heart failure, or heart previous allergy to ACE resulting from captopril and
vessels increases the pressure attacks; in studies of
inhibitors. hypertension, moexipril 1 hour
within the blood vessels and may patients with
 heart failure, or before meals.
lead to high blood hypertension, heart
heart attacks; in
failure, or prior heart
pressure (hypertension). studies of patients
attacks, patients who
By reducing the activity of received an ACE inhibitor with hypertension,
ACE, ACE inhibitors decrease the survived longer than heart failure, or
formation of angiotensin II which patients who did not prior heart attacks,
receive an ACE inhibitor. patients who
leads to widening (dilation) of received an ACE
 ACE inhibitors may be
blood vessels, and thereby combined with other inhibitor survived
reduces blood pressure. By drugs to achieve optimal longer than
lowering blood pressure against blood pressure control. patients who did
which the heart must pump, the not receive an ACE
amount of work that the heart
inhibitor.
 ACE inhibitors may
must do is reduced. ACE inhibitors
be combined with
also reduce blood pressure in the
other drugs to
kidneys, slowing the progression
achieve optimal
of kidney disease due to high
blood pressure
blood pressure or diabetes. control.