Nephropathy Recent Searches for Information

Nephropathy Recent searches for information in diabetic nephropathy yielded a limited amount of information concerning the disease, its diagnosis and its treatment. What was evident was the fact that it is another concern for those individuals who have been diagnosed with diabetes, and further, that proper (and early) treatment can do much to stop the disease's progression and in many cases will prevent the disease.

Diabetic nephropathy presents itself in individuals with diabetes but it is closely related to nephrolithiasis which is a common condition that affects "nearly five percent of U.S. men and women during their lifetimes" FN1. Nephrolithiasis includes a number of different nephropathy diseases. "Nephrolithiasis specifically refers to calculi in the kidneys (including) both renal calculi ureteral calculi (ureterolithiasis)" FN2 Ureteral calculi almost always originate in the kidneys, although they may continue to grow once they lodge in the ureter.

Nephrolithiasis is commonly referred to as kidney stones, but other problems can occur pertaining to the kidney including two of the most prevalent conditions related to nephrolithiasis, which are IgA nephropathy and diabetic nephropathy. According to the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) IgA nephropathy occurs "when IgA - a protein that helps us fight infections - settles in the kidneys" FN3. Diabetic nephropathy, on the other hand, occurs when there is too much protein and/or blood leaking from the kidney into the blood stream.

Many of the symptoms for both diseases are very similar. Symptoms can include "swelling in the hands and feet, nausea, fatigue, headaches, and sleep problems" FN3. Approximately 20-30% of individuals with diabetic nephropathy suffer kidney failure while 25% of IgA nephropathy sufferers will suffer kidney failure within 10 to 20 years of diagnosis. Nephrolithiasis produces a calculi that can "be prevented in most patients by the use of a simplified evaluation, reasonable dietary and fluid recommendations, and directed pharmacologic intervention" FN1.

Diabetic nephropathy is normally referred to as diabetic kidney disease and it can lead to kidney failure. "Diabetic nephropathy presents in its earliest stage with low levels of albumin (microalbuminuria) in the urine" FN4. Low levels of albumin can be detected by a number of methods with three of the most common being; a spot urine test, a 24-hour urine sample and a three to six-month urine sample. "The most practical method of screening for microalbuminuria is to assess the albuminto-creatinine ratio with a spot urine test" FN4.

Once the diagnosis has been made early treatment can help to control the progress of the disease and many times will stave off kidney failure for a number of years. Thorp's study showed that "there is good evidence that early treatment delays or prevents the onset of diabetic nephropathy, or diabetic kidney disease" FN4. Early treatments can include a change in diet, exercise, improved blood sugar control, pharmaceuticals and even a regime of vitamins.

A team of investigators for the journal Diabetes Care "demonstrated that vitamin sC and E, along with mineral supplementation (including magnesium) appear to improve kidney function in patients with type 2 diabetes and proved useful in addressing a common complication call diabetic nephropathy" FN5. Treatments for nephrolithiasis can also be helpful for diabetic nephropathy patients. Many physicians will recommend "aggressive fluid intake and moderated intake of salt, calcium, and meat for most patients" FN6.

American Family Physicians also reports that allopurinol can be helpful and using inhibitors can help break the cycle of infectious calculi in the kidney. In fact, evidence from Pietrow's 2006 study indicates that "increased water intake reduces the risk of recurrence of urinary calculi and prolongs the average interval between recurrences" FN1. Pietrow also showed that "recurrent calculi can be prevented in most patients by the use of a simplified evaluation, reasonable dietary and fluid recommendations, and directed pharmacologic intervention" FN1.

One of the reasons why it is important to have early diagnosis and treatment of not only diabetic nephropathy but all kidney diseases is that it can drastically affect a large number of individuals. Diabetes is one of the most prevalent diseases in America and the majority of these individuals will experience some form of kidney disease during their lifetime. One study showed that "within two to three decades of diagnosis, roughly one third of patients with diabetes will have some degree of diabetic kidney disease" FN7.

One way to address the possibility of kidney disease even before it has presented in a patient, is by ensuring that the patient control blood glucose levels, maintain a healthy lifestyle, and observe the practices necessary to regulate blood pressure and hypertension. According to a recent article in the American Family Physician journal, "many physicians in family practices and community-based clinics need to have an organized system of regular follow-up and review of patients with hypertension" FN8.

Reasoning behind this type of assertion is that hypertension is a precursor of kidney disease especially in regards to individuals suffering from diabetes. The same article states that "antihypertensive drug therapy should be implemented by means of a vigorous, stepped care approach when patients do not reach target blood pressure levels" FN8. Targeting blood pressure levels, hypertension and controlling glucose levels is important because "diabetes has become the leading cause of end-stage renal disease in the United States" FN9.

One method for ensuring that diseases such as diabetic nephropathy does not overwhelm the medical community or the individuals suffering from those diseases is by continuing to implement preventive medicines. One of the methods that has been most efficient in controlling the diabetic's glucose levels is by the injecting of insulin. This is the most common method of controlling glucose and the hassle of injecting oneself on a daily basis has now been enhanced. Patients needing insulin can now administer the medicine through inhalation procedures.

Recent studies that have been published in the Annals of Internal Medicine provided findings that "researchers noted a significant improvement in sugar control...by adding inhaled insulin therapy (currently awaiting FDA approval) to the diabetic regimen" FN5. In the article, Julio Rosenstock, M.D., from the Dallas Diabetes and Endocrine Center at Medical City states "patients with type 2 diabetes who do not achieve glycemic control with oral therapy eventually require insulin.

Compared with injected regular insulin, inhaled insulin is more rapidly absorbed and eliminated and has a more rapid glucose-lowering effect" FN5. Controlling glucose levels is an important aspect to preventing kidney disease and regular monitoring of those levels is of equal importance. Also important is the monitoring of the diabetic's A1C levels. Screening for microalbuminuria is also an important consideration in determining whether a diabetic is showing symptoms of kidney disease. According to Micah L.

Thorp, D.O., M.P.H., Lake Road Nephrology Clinic, "the most practical method of screening for microalbuminuria is to assess the albumin-to-creatinine ratio with a spot urine test" FN4. Thorp asserts that results of two or three of these screenings for microalbuminuria should be more than 30 mg per day or 20 meg per minute in a three- to six-month period. Similar results such as these are useful in diagnosing diabetic nephropathy. At its earliest stages diabetic nephropathy presents with low-level albumin which increases until the patient develops overt nephropathy.

When the patient has reached this level, a problem develops that can be overlooked by the diagnosing physician. The problem is that overt nephropathy often coincides with a high-filter period when both the creatinine clearance and glomerular filtration rates are high. According to Thorp this is the point when deception is high as well. The elevated clearance is replaced by a decrease in glomerular filtration that may ultimately lead to kidney failure FN4. Other interventions can be implemented that will slow the onslaught of kidney disease.

Besides those mentioned above (i.e., regulating blood pressure and glucose levels) other important interventions such as "lowering low-density lipoprotein cholesterol, aspirin therapy, influenza vaccination...are recommended for patients with diabetes, even those with A1C levels less than seven percent" FN10. When the patient reaches the overt nephropathy stage screening is no longer necessary when looking for microalbuminuria. The reason for this is because there is a high enough level of protein in the urine to be detected on a routine urinanalysis.

Just as there is no cure for diabetes, there also is no cure for diabetic kidney disease. This does not mean that every diabetic patient with high microalbuminuria will experience diabetic nephropathy, and in fact, some recent studies have show that "patients with low systolic blood pressure, low levels of cholesterol, and low levels of glycosylated hemoglobin were more likely to experience regression" FN4 after being diagnosed with high microalbuminuria levels.

Previous studies have also shown the effectiveness of prescribing an angiotension-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB). One recent study concluded that "compared with placebo or controls, angiotensin-converting enzyme (ACE) inhibitors (captopril, lisinopril, enalapril, perindopril, and ramipril) reduced progression to microalbuminuria and increased regression to normoalbumin-uria in normotensive persons with type 1 diabetes and microalbuminuria" FN11. Physicians should be aware, however, that introducing ACE inhibitors can sometimes trigger acute episodes of hyperkalemia.

"Hyperkalemia is a potentially life-threatening metabolic problem caused by inability of the kidneys to excrete potassium, impairment of the mechanisms that move potassium from the circulation into the cells, or a combination of these factors "FN12. The article states that acute episodes of hyperkalemia are commonly triggered by the introduction of a medication affecting potassium, and that illnesses and dehydration can also be factors. The physician must also be aware therefore that a common positive response by patients in these circumstances was to a sodium bicarbonate supplementation.

Another bit of information that might be important to the diagnosing physician would be that "elevated serum aldosterone causes the renal cortical collecting ducts to excrete potassium and retain sodium, further lowering serum potassium" FN13. Potassium levels should be monitored in an ongoing fashion to determine whether they are stable or not. Additional monitoring should take place for hypertension since twenty to sixty percent of diabetics are affected by it.

Antihypertensive agents are used to treat the hypertension and the physician should be aware when prescribing calcium channel blockers or ACE inhibitors, even though most studies have shown that ACE inhibitors do reduce the progression towards microabluminuria. One recent study showed that "a significant reduction in the risk of developing microalbuminuria in patients with diabetes and normoalbuminuria has been demonstrated for ACE inhibitors only" FN14.

This particular study showed that the affects of ACE inhibitors is independent to baseline blood pressure, renal function and type of diabetes, but that the data was no comprehensive enough to say that there other modifiers might not be present. The study concluded that and individual patient data meta-analysis would be required in order to ensure that the stated results were not skewed in any manner. Other studies have also attempted to compare the use of ACE inhibitors or ARBs with placebos.

One recent study "found no mortality benefit in patients with diabetic kidney disease" FN15 when comparing their use. However, a different study concluded that "there were too few trials comparing ACE inhibitors with ARB's to draw clear conclusions" FN16. Pain is an additional factor when considering treatment of diabetic patients who are experiencing kidney failure or diabetic nephropathy. Diabetic patients oftentimes have other medical problems that have contributed to their kidney problems, including diabetic neuropathy, retinopathy, gasteoparesis, kidney and liver diseases.

Diabetics may also experience ulcers (especially on their feet) and have a higher occurrence rate of infections than those patients without diabetes. Recent studies have also shown that many physicians and medical personnel maintain poor attitudes towards those individuals who are experiencing diabetes and that could "contribute to the poor treatment outcomes observed in people with type 2 diabetes" FN17. The study was conducted in Argentina but additional studies have been recorded in developed countries with similar results.

Some of the studies have come to the same conclusion that changing attitudes by educating health care professions could contribute to an improvement in the lives and the quality of care for individuals suffering from diabetes. Educating patients and professionals alike would likely lower the cost of the disease as well. Knowing the effects and costs of different pharmaceuticals would also be beneficial for both the physician and the patient.

Many times diabetics are bombarded with various medicines to not only alleviate the pain they are experiencing but to also help maintain the various illnesses and diseases they are besought with. One favorite pharmaceutical that has helped in the management of pain associated with diabetic neuropathy as well as other diseases is Pregablin (Lyrica). A recent study showed that "pregabalin seems to decrease the presynaptic release of neurotransmitters (e.g., substance P, glutamate) that are involved with pain sensation and transmission" FN18.

After considering the cost, many physicians will be more likely to prescribe Lyrica than they would in prescribing other similar pharmaceuticals. Lyrica is less expensive than both Neurotin and generic gabapentin, two medicines used to control pain in lieu of Lyrica. If, after all treatments have been implemented, a diabetic patient experiences kidney failure a transplant might be the only remaining viable option for that patient.

The bad news on this front is that there are currently about 65,000 individuals with severe kidney disease who are candidates for a transplant and that there is a shortage of good kidneys available for transplant. Only about 16,000 of the 65,000 patients will receive kidneys this year, and most of those will only receive one, instead of two. There is some good news on this front however. Some scientists have been testing the blood-purifying capacity of kidneys obtained for transplant from people 60 years and older.

A recent study has show that "culling the worn-out kidneys - scientists have identified organs likely to last in their new hosts" FN19. The study also attempted to bolster a recipient's odds by 'transplanting the older kidneys in pairs." This is important news because these measures could expand the number of available kidneys for transplant purposes. The study showed that currently nearly two-thirds of the transplanted kidneys fail within the first decade.

With additional kidneys available for this procedure, not only will more individuals be helped, the kidneys will last longer and prolong the patient's life as well. Doctors in the new study gave transplant candidates two options. The first was to get on a waiting list for a single kidney from a person of unknown age, the second was to receive one or two kidneys from a person age 60 or older. According to the study, there were 62 patients who elected to get the.