Keterangan
Individuals with diabetes often develop kidney disease or damage over time. We refer to this kind of kidney disease as diabetic nephropathy. Nephrons in diabetics gradually thicken and get damaged over time. Urine starts to contain protein (albumin) due to nephron leaks. This damage may occur years before kidney disease symptoms appear. When type 2 diabetes develops slowly, kidney damage may already be present in some patients when they are first diagnosed.
Ringkasan
- Dr. Shuman Nauhan from Troll 3 presented a webinar on diabetes and renal impairment, highlighting the increasing burden of chronic diseases like hypertension and diabetes in India and Bangladesh. India has a diabetic population of around 61.3 million, while Bangladesh has 13.1 million. A significant percentage (25-40%) of these individuals develop end-stage renal disease (ESRD). Key features of diabetic nephropathy include increasing urinary albumin expression, rising blood urea nitrogen (BUN), and declining renal functionalities.
- Genetic factors, inadequate glucose control, high blood pressure, altered lipid phenotype, smoking, long-standing diabetes, and pregnancy are risk factors that interplay in the pathogenesis of diabetic nephropathy. The pathophysiology involves both hemodynamic (increased pressure, activation of vasoactive hormones) and metabolic factors (glucose-dependent pathways, oxidative stress, polyol formation). These factors result in increased albumin permeability, accumulation of extracellular matrix, proteinuria, glomerulosclerosis, and tubulointerstitial fibrosis.
- Kidney disease progresses through five predictable stages: early hyperfunction, glomerulosclerosis without clinical findings, incipient stage, overt diabetic nephropathy, and end-stage renal failure. Each stage is characterized by varying degrees of glomerular filtration rate (GFR), blood pressure, and albumin excretion. Stages 1 and 2 are potentially reversible with blood sugar control. The normal kidney function involves filtering blood, maintaining fluid and electrolyte balance, controlling blood pressure, excreting drugs, producing erythropoietin, and forming 1,25-dihydroxyvitamin D.
- Screening for microalbuminuria is crucial. Type 2 diabetes patients should be screened at the time of diagnosis, while type 1 diabetes patients should be screened after five years, or one year if glycemic control is poor. The recommended method is to measure albumin in a spot urine sample, expressed as urinary albumin concentration or albumin-to-creatinine ratio (ACR). Alternative tests are used when positive results are potentially due to urinary tract infections or hyperglycemia.
- Management includes ACE inhibitors or ARBs as first-line treatment, targeting a blood pressure of 130/80 mmHg and HbA1c less than 6.5%. Protein intake should be reduced to 0.8 g/kg body weight in early stages. SGLT2 inhibitors have shown promise in reducing kidney disease progression. Timely referral to a nephrologist is recommended when eGFR is less than 60 ml/min, proteinuria exceeds 1 g/24 hours, or hypertension is difficult to control.
- Prevention and delayed progression can be achieved through glucose level control, blood pressure management, and timely specialist referral. Achieving normal glucose levels can delay the start or progression of microalbuminuria, as evidenced by landmark trials like the DCC and UPPADAS. A multidisciplinary team approach involving nephrologists, cardiologists, nutritionists, and diabetes educators is crucial.
Contoh Sertifikat
Tentang Pembicara
Dr. Sumon Chowdhary
Ahli endokrinologi, Rumah Sakit Umum Diabetes Chittagong, Bangladesh
Pengungkapan Keuangan
Komentar
Komentar
Anda harus login untuk meninggalkan komentar.