A

RESEARCH PAPER
ON
DIABETIC NEPHROPATHY

WRITTEN
BY
RAGUEL TIMOTHY. N
10454382FI
DEPARTMENT OF MEDICINE AND SURGERY
FACULTY OF CLINICAL SCIENCES
UNIVERSITY OF CALABAR

SUBMITTED
TO
MR AUSTIN EDUNG
DEPARTMENT OF ENGLISH EDUCATION AND LITERARY STUDIES
FACULTY OF ARTS AND HUMANITY
UNIVERSITY OF CALABAR

(IN PARTIAL FULFILMENT OF COURSE REQUIREMENT)

USE OF ENGLISH (GSS 102)
June 2023.

1
 CHRONIC KIDNEY DISEASES
CAUSES AND PREVENTION

Narrowed Topic:
Causes and Prevention of Diabetic Nephropathy

Thesis statement:
Diabetic Nephropathy is a serious complication of diabetes that can lead to kidney failure.
However, it is possible to prevent and delay the development of diabetic nephropathy.

2
 CONTENTS
Introduction …………………………………………………………………4
Chapter 1………………………………………………………………………………...5
1.0 Definition of terms…………………………………………………………...5
1.1 What is diabetic nephropathy………………………………………………..6
1.2 History and prevalence of diabetic nephropathy in Nigeria…………………7
Chapter 2…………………………………………………………………………………9
Major causes of diabetic nephropathy…………………………………………………...9
2.1 High blood sugar levels……………………………………………………….9
2.2 High blood pressure…………………………………………………………..10
2.3 Obesity………………………………………………………………..............10
2.4 Genetics………………………………………………………………………11
2.5 Age …………………………………………………………………………..11
Chapter 3 ……………………………………………………………………………….12
Major strategies for the prevention of diabetic nephropathy…………………………...12
3.1 Control of blood sugar levels…………………………………………………12
3.2 Control of blood pressure levels……………………………………………...12
3.3 Weight management………………………………………………………….12
3.4 Exercise………………………………………………………………………13
3.5 Diet …………………………………………………………………………..13
Chapter 4……………………………………………………………………………….14
Treatment of diabetic nephropathy…………………………………………………….14
4.1 Medication …………………………………………………………………...14
4.2 Dialysis ………………………………………………………………………14
Conclusion……………………………………………………………………………..15
References …………………………………………………………………………….16

3
 INTRODUCTION
Diabetic nephropathy, also known as diabetic kidney diseases, is a complications of diabetes

in which the kidneys are damaged by high blood sugar levels. It is the leading cause of end-

stage renal disease, a condition in which the kidneys no longer function properly.

It has a significant source of morbidity and mortality in people with diabetes. In the

United States, diabetic nephropathy affects approximately 30% of people with type 1 diabetes

and 10% of people with type 2 diabetes. The risk of developing diabetic nephropathy

increases with the duration of diabetes and the severity of hyperglycemia (high blood sugar

levels). Early detection and treatment of diabetic nephropathy is important to slow the

progression of the disease and prevent the development of end-stage diseases.

Looking at the high rate of motility as a result of diabetic nephropathy, scientists has

Developed various ways of treating as well as well as preventing the drastic disaster caused

by this disease. In this research, we will look at the various ways of managing diabetic

nephropathy, its causes and prevention.

4
 CHAPTER 1

1.0 Definition of terms

Let’s take a look at the meaning of the word diabetic and nephropathy

Diabetic: The word diabetic is derived from diabetes.

According to Merriam Webster dictionary, diabetes is defined as any of various abnormal

conditions characterized by the secretion and excretion of excessive amount of urine.

Furthermore, daibetes is a disease that occurs when your blood glucose, also called blood

sugar, is too high. Blood glucose is your main source of energy and comes from the food you

eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to

be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t

use insulin well. Glucose then stays in your blood and doesn’t reach your cells.

Over time, having too much glucose in your blood can cause health problems. Although

diabetes has no cure, you can take steps to manage your diabetes and stay healthy.

Sometimes people call diabetes “a touch of sugar” or “borderline diabetes.” These terms

suggest that someone doesn’t really have diabetes or has a less serious case, but every case of

diabetes is serious.

Diabetes affects just about everyone, from the over 110 million Americans with or at risk for

the disease to the many more people who care for them.

Most common types of diabetes are: type 1, type 2, gestational, pre-diabetes etc.

Type 1 diabetes is a chronic condition, in which the pancreas produces little or no insulin. If

you have type 1 diabetes, your body does not make insulin. Your immune system attacks and

destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in

children and young adults, although it can appear at any age. People with type 1 diabetes

need to take insulin every day to stay alive.

5
Type 2 diabetes is a chronic condition that affects the way the body processes blood sugar

(glucose). If you have type 2 diabetes, your body does not make or use insulin well. You can

develop type 2 diabetes at any age, even during childhood. However, this type of diabetes

occurs most often in middle-aged and older people. Type 2 is the most common type of

diabetes. Pre-diabetes is a chronic condition in which blood sugar is high, but not high

enough to be type 2 diabetes.

Gestational diabetes is a form of high blood sugar affecting pregnant women. Gestational

diabetes develops in some women when they are pregnant. Most of the time, this type of

diabetes goes away after the baby is born. However, if you’ve had gestational diabetes, you

have a greater chance of developing type 2 diabetes later in life. Sometimes diabetes

diagnosed during pregnancy is actually type 2 diabetes.

Nephropathy

According to Merriam Webster dictionary, nephropathy is an abnormal state of the kidney

especially; one associated with or secondary to some other pathological processes. It is a

group of diseases that result in too much sugar in the blood (high blood glucose).

Nephropathy is the deterioration of kidney function. The final stage of nephropathy is called

kidney failure, end-stage renal disease, or ESRD. According to the CDC, diabetes is the most

common cause of ESRD.

Note: Nephropathy is a broad medical term used to denote disease or damage of the kidney,

which can eventually result in kidney failure. Nephropathy is a medical term used to describe

diseases of the kidneys. It includes a variety of conditions, such as diabetic nephropathy,

which is caused by diabetes; hypertensive nephropathy, which is caused by high blood

pressure; and lupus nephritis, which is caused by systemic lupus erythematosus. Other forms

of nephropathy can be caused by autoimmune diseases, genetic disorders, infections, and

6
other conditions. Whatever the cause, nephropathy can lead to serious complications,

including renal failure.

1.1:what is diabetic nephropathy? Diabetic nephropathy is a form of kidney disease that

occurs in people with diabetes. It is characterized by progressive damage to the kidneys and

can lead to renal failure. The kidneys are responsible for filtering waste products and excess

fluid from the blood. When they are damaged, they are unable to filter properly, and the waste

and fluid can build up in the body. This can lead to serious health problems, including high

blood pressure, fluid retention, and heart failure. If left untreated, diabetic nephropathy can

eventually lead to complete renal failure and the need for dialysis or a kidney transplant.

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. Over many years, the condition slowly damages your kidneys’ delicate

filtering system. Early treatment may prevent or slow the disease’s progress and reduce the

chance of complications.

1.2 History and prevalence of diabetic nephropathy in Nigeria

History and Etymology

Middle English diabetes, diabete, borrowed from Late Latin diabētēs, borrowed from

Greek diabḗtēs, from diabē-, variant stem of diabaínein “to stride, walk or stand with legs

apart, step across, cross over” (from dia- DIA- + baínein “to step, walk”) + -tēs, suffix of

agency. The word diabáthra (Ionic diabáthrē)—also a derivative of diabaínein—has various

attested meanings: “ladder,” “gangway,” “bridge.” The suggestion has been made that

7
“bridge” or “channel” is the most appropriate sense, though the mixing of metaphors is

perhaps an indication that the text is corrupt, or that some no longer recoverable sense of the

word is in play. (See discussion in Chalmers L. Gemmill, “The Greek concept of

diabetes,” Bulletin of the New York Academy of Medicine, vol. 48, no. 8 [September, 1972],

pp. 1033-36.). The first documented case of diabetic nephropathy in Nigeria was in 1969,

when a patient was diagnosed with the condition at the University College Hospital in

Ibadan. Since then, there has been an increase in the number of cases of diabetic nephropathy

in Nigeria, likely due to the increasing prevalence of diabetes in the country. The exact

prevalence of diabetic nephropathy in Nigeria is unknown, but it is estimated to be high. This

is likely due to the fact that diabetes is often poorly managed in the country.

However, estimates vary from 10-20% in various studies. Some of the factors that contribute

to the high prevalence of diabetic nephropathy in Nigeria include: poor glycemic control,

high rates of hypertension, and limited access to healthcare. The consequences of diabetic

nephropathy are also significant in Nigeria, as the disease is a major cause of end-stage renal

disease and contributes to the high rates of premature death from cardiovascular disease.

8
 CHAPTER 2

MAJOR CAUSES OF DIABETIC NEPHROPATHY

So let’s cover the major causes of diabetic nephropathy. There are three main causes of

diabetic nephropathy: hyperglycemia, hypertension, and genetic predisposition.

Hyperglycemia, or high blood sugar levels, is the most important risk factor for diabetic

nephropathy. High blood sugar damages the blood vessels in the kidneys and can lead to

inflammation and AGE formation. Hypertension, or high blood pressure, is another risk

factor for diabetic nephropathy. Let’s take a closer look at the causes of diabetic nephropathy

by considering the following:

2.1 High blood sugar levels

High blood sugar levels are a major risk factor for diabetic nephropathy. Hyperglycemia leads

to the production of free radicals, which damage blood vessels and other cells in the body.

This damage includes the small blood vessels in the kidneys, which can become damaged and

inflamed. High blood sugar levels also lead to the production of AGEs, which further damage

the kidneys and accelerate the progression of diabetic nephropathy. It’s important to note that

both hyperglycemia and AGEs are preventable and can be managed with lifestyle changes

and medications. High blood sugar can have causes that aren’t due to underlying disease.

Examples include recent consumption of a high carbohydrate meal or medication side effects.

9
What blood sugar level is hyperglycemia?

For people undiagnosed with diabetes, hyperglycemia is blood glucose greater than 125

mg/dL (milligrams per deciliter) while fasting (not eating for at least eight hours).

A person has prediabetes if their fasting blood glucose is 100 mg/dL to 125 mg/dL.

A person with a fasting blood glucose greater than 125 mg/dL on more than one occasion

usually receives a diabetes diagnosis — typically Type 2 diabetes. People with Type 1

diabetes usually have very high blood sugar (above 250 mg/dL) upon diagnosis. For a person

with diabetes, hyperglycemia is usually considered to be a blood glucose level greater than

180 mg/dL one to two hours after eating. But this can vary depending on what your target

blood sugar goals are. Hyperglycemia and diabetes are very common — about 1 in 10 people

in the United States has diabetes. Hyperglycemia episodes are also very common in people

with diabetes.

2.2 High blood pressure

Hypertension leads to increased pressure on the blood vessels in the kidneys, which can

damage them and contribute to inflammation. In addition, hypertension is also associated

with increased levels of proteins in the urine, another marker of kidney damage.

Hypertension can also increase the risk of other diabetes-related complications, such as heart

disease and stroke. This is why it’s so important to control blood pressure levels in people

with diabetes. There are many ways to do this, including medications, lifestyle changes, and

medical procedures. Blood pressure is an integral component of overall health and well-

being. It measures the force blood exerts against arterial walls as the heart pumps it

throughout the body. An optimal blood pressure reading indicates cardiovascular health and

can help protect against serious health conditions like heart disease, stroke and kidney

disease. A healthy reading should fall below 120/80 mmHg to be ideal. Various factors can

10
affect blood pressure, including age, weight, diet and lifestyle choices such as smoking or

alcohol consumption.

High blood pressure (hypertension) can have severe health ramifications, including damage

to blood vessels and vital organs. On the other hand, low blood pressure or hypotension can

be just as dangerous and lead to dizziness, fainting and organ damage. Awareness of both

causes and complications associated with high and low blood pressure is essential in

maintaining optimal health.

2.3 Obesity

Obesity is another risk factor for diabetic nephropathy. Obesity is associated with

inflammation and increased levels of pro-inflammatory cytokines, which can damage the

kidneys. Obesity is also linked to the development of hypertension, another risk factor for

diabetic nephropathy. In addition, obesity is a risk factor for insulin resistance, which is a

precursor to type 2 diabetes and can contribute to the development of diabetic nephropathy.

Therefore, it’s important to maintain a healthy weight and to treat obesity in people with

diabetes. This can be done through a combination of lifestyle changes and, in some cases,

medication.

2.4 Genetics

There are several genes that have been identified as playing a role in the development of

diabetic nephropathy. One of the most well-studied genes is called APOL1. This gene codes

for a protein that is involved in the body’s immune response. People with certain variants of

the APOL1 gene are at increased risk of developing diabetic nephropathy. In addition to

APOL1, other genes that have been linked to diabetic nephropathy include those that code for

proteins involved in the metabolism of fats, inflammation, and blood pressure regulation.

2.5 Age

11
Age is also a risk factor for diabetic nephropathy. The risk of developing diabetic

nephropathy increases with age, with people over the age of 40 having the highest risk. This

is likely due to the fact that the risk of other conditions that can lead to kidney damage, such

as hypertension and obesity, also increases with age. In addition, the kidneys may become

less able to repair themselves as people age, making them more susceptible to damage from

hyperglycemia and other factors. As a result, it’s important to screen people with diabetes

regularly for signs of kidney damage as they get older.

Chapter 3

MAJOR STRATEGIES FOR THE PREVENTION OF DIABETIC NEPHROPATHY

This chapter is focused on the prevention of diabetic nephropathy. To prevent diabetic

nephropathy, it’s important to control blood sugar levels, blood pressure, and weight. This can

be done through diet, exercise, and medication. In addition, regular monitoring of kidney

function is important to detect early signs of damage. Early detection can lead to earlier

treatment and prevention of further damage. It’s also important to avoid exposure to other

risk factors, such as smoking and excessive alcohol consumption.

3.1 Control of blood sugar levels

Control of blood sugar levels is essential for preventing and treating diabetic

nephropathy. This can be achieved through a combination of lifestyle changes and

12
medication. Lifestyle changes include eating a healthy diet, exercising regularly, and avoiding

excessive amounts of alcohol. In terms of medication, there are several classes of medications

that can help to control blood sugar levels, including metformin, sulfonylureas, and insulin.

These medications work in different ways to lower blood sugar levels and help to prevent the

damage to the kidneys that can occur from high levels of sugar in the blood.

3.2 control of blood pressure levels

In addition to controlling blood sugar levels, it’s also important to control blood

pressure levels in order to prevent and treat diabetic nephropathy. This can be done through

lifestyle changes, such as exercising and limiting salt intake, as well as medication. Several

classes of medications are available to help control blood pressure, including angiotensin-

converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These

medications work by relaxing the blood vessels and lowering blood pressure, which can help

to reduce the stress on the kidneys and prevent further damage.

3.3 weight management: In addition to controlling blood sugar and blood pressure levels,

it’s also important to maintain a healthy weight in order to prevent and treat diabetic

nephropathy. This can be done through a combination of diet and exercise. A diet that is low

in calories and rich in fruits, vegetables, and whole grains can help to maintain a healthy

weight. Regular exercise, such as walking or swimming, can also help to manage weight.

Losing weight can reduce the stress on the kidneys and help to prevent further damage. In

some cases, bariatric surgery may be an option for people with severe obesity and type 2

diabetes.

3.4 exercise: Exercise is an important part of preventing and treating diabetic nephropathy. It

can help to control blood sugar and blood pressure levels, and it can also reduce stress on the

kidneys. Exercise also has many other health benefits, including improving cardiovascular

health, increasing energy levels, and reducing the risk of other health conditions, such as

13
heart disease and stroke. A combination of aerobic exercise, such as walking or swimming,

and strength training is recommended for people with diabetes. It’s important to start slowly

and gradually increase the intensity and duration of exercise over time.

3.5 Diet: A healthy diet is another key factor in preventing and treating diabetic nephropathy.

A diet that is rich in fruits, vegetables, and whole grains can help to control blood sugar levels

and reduce the risk of other health conditions, such as heart disease and stroke. It’s also

important to limit the intake of saturated fat, cholesterol, and sodium. These can contribute to

high blood pressure, which can further damage the kidneys.

CHAPTER 4

TREATMENT OF DIABETIC NEPHROPATHY

4.1 Medication: The first category of medications used to treat diabetic nephropathy is ACE

inhibitors. These medications work by blocking the production of a hormone called

angiotensin II, which causes blood vessels to constrict and can lead to high blood pressure.

By blocking the production of angiotensin II, ACE inhibitors can help to relax the blood

vessels and lower blood pressure. In addition, ACE inhibitors can help to slow the

14
progression of kidney damage. Common ACE inhibitors used to treat diabetic nephropathy

include Lisinopril and Enalapril.

4.2 Dialysis: When the kidneys are no longer able to filter the blood properly, a person may

need dialysis. Dialysis is a process that filters the blood and removes waste products from the

body. There are two main types of dialysis: hemodialysis and peritoneal dialysis.

Hemodialysis is the most common type of dialysis and involves the use of a machine to filter

the blood. Peritoneal dialysis is less common and involves the use of a special solution that is

placed in the abdomen to filter the blood. If the kidneys stop working effectively, dialysis

may be necessary. Kidney dialysis is a procedure that typically uses a machine to separate

waste products from the blood and remove them from the body. Dialysis acts as a substitute

for a healthy kidney.

There are different types of dialysis:

Hemodialysis: Blood leaves the body through a needle in the forearm and passes through a

tube to a dialysis machine. The machine filters the blood outside the body, and the blood

returns through another tube and needle.

A person may need to do this from three to seven times a week and spend from 2 to 10 hours

Trusted Source in a session, depending on the option they choose.

An individual can undergo dialysis at a dialysis center or at home, and overnight options are

available in some places. Flexible options increasingly allow people to fit dialysis in with

work and personal schedules. Peritoneal dialysis: This uses the lining of the abdomen Trusted

Source, or peritoneum, to filter blood inside the body. In continuous ambulatory peritoneal

dialysis (CAPD), dialysis fluid enters the abdomen through a catheter. The fluid stays inside

for several hours, filtering waste products before draining out. Draining takes 30–40 minutes.

15
In continuous cycler-assisted peritoneal dialysis (CCPD), or automated peritoneal dialysis, a

person spends 8–10 hours overnight connected to a dialysis machine, while they sleep. The

machine controls the drainage of the fluid.

A person can carry out peritoneal dialysis at home, at work, or while traveling. It offers

flexibility and allows the person some control over their condition. A person will need to

learn how to use the necessary equipment and ensure they have all the supplies they need if

they are to travel, for example.

Kidney transplant

A doctor may recommend a kidney transplant if diabetic nephropathy reaches the final stages

and if a suitable donor can provide a kidney. Finding a donor may take some time.

A person can survive with one working kidney only, so some people offer to donate a kidney,

for example, to a loved one.

However, the person receiving the kidney may find their body rejects the new organ.

A transplant from a family member usually gives the body the best chance of accepting the

kidney. The person with the kidney transplant will need to take medication Trusted Source to

reduce the risk of the body rejecting the new kidney. This can have some side effects, such as

increasing the risk of developing an infection.

Conclusion

The best means of handling and avoiding kidney diseases is by maintaining good

diet, keeping feet through exercise , regular check up on blood pressure levels as well as

blood sugar levels. With this in place, the rate of motility as a result of diabetic nephropathy

will be drastically reduced.

16
 References
©1998-2023 Mayor Foundation For Medical Education and Research (MFMER).
https://www.google.com/url?sa=t&source=web&rct=j&url=https://

www.mayoclinic.org/diseases-conditions/diabetic-nephropathy/symptoms-causes/syc-

20354556%23:~:text%3DDiabetic%2520nephropathy%2520is%2520a

%2520common,and%2520cause%2520high%2520blood

%2520pressure.&ved=2ahUKEwjqgvnr5J__AhWERUEAHbNbDREQFnoECCAQBQ

&usg=AOvVaw0pYy2J5K_YugIDdLEOCFiJ

Seen 31st may, 2023

Diabetic nephropathy or kidney diseases

Medically reviewed by Deborah Weatherspoon, Ph.D., MSN — By Tom

Seymour — Updated on January 19, 2022. Seen 31st may 2023.

Proplete Family of IDPN/IPN Therapy ©2023 by Pentec Health.

https://www.google.com/url?sa=t&source=web&rct=j&url=https://

www.medicalnewstoday.com/articles/

319686&ved=2ahUKEwjqgvnr5J__AhWERUEAHbNbDREQFnoECEgQAQ&usg=AOvVa

w2IBJnCOv1SZxm5bnQjQNGc seen 31st may, 2023.

Stages of Chronic Kidney Diseases ©2016-2023- Fresenius Medical Centre

https://www.googleadservices.com/pagead/aclk?

sa=L&ai=DChcSEwiWkqntvaT_AhXD8O0KHYsbDrMYABAEGgJkZw&ohost=www.

google.com&cid=CAESa-D2-

WP3xHByT7pADio6Gsj6pvFVQRoHpA2ves20j7v8qxyOR9N_0kvQVWghI-

q5s7odyLv3Iq-

5FhuvyHQdisfivRtzJSnKxkY7ZUf6NyUW11tDVWcoistmPcVHAcOEnbfUe5nOF4nm2

lHt&sig=AOD64_1VT7H31Qi4cfecrMy0nMuHjaE9wA&q&adurl&ved=2ahUKEwjip6

LtvaT_AhXYSkEAHVTAC8QQ0Qx6BAgGEAE seen 1st June, 2023.

17