Patients with diabetes as viewed by clinical nephrologist

Česká verzia

Authors: Vladimír Tesař; Jan Vachek; MUDr. PhDr. Oskar Zakiyanov, PhD.
Authors place of work: Klinika nefrologie 1. LF UK a Všeobecná fakultní nemocnice, Praha, Česká republika, prednosta prof. MUDr Vladimír Tesař, DrSc, MBA, FASN, FERA
Published in the journal: Forum Diab 2015; 4(3): 162-165
Category: Foreign Post

Summary

Diabetic nephropathy is one of the frequent complications of diabetes while also being by far the most frequent cause of chronic renal failure which necessitates substitution of their function. Patients referred by diabetologists due to diabetic nephropathy – or suspicion of having it – make up, following ischemic nephropathy, the second largest part of the clientele of nephrology outpatient clinics. In the case of the confirmed diabetic nephropathy the nephrologist initiates comprehensive measures leading to slowing of the renal disease progression with the aim of delaying the necessary substitution of the kidney function as long as possible. An important differential diagnosis of diabetic nephropathy in particular involves the other glomerulopathies (primary or secondary), for which specific therapy is available. The distinguishing between diabetic nephropathy and coinciding glomerulopathy – or possibly another non-diabetic nephropathy – may not always be easy in practice and it requires careful assessment of anamnestic data, laboratory findings and, if needed, performance of renal biopsy. The aim of this report is to give a brief overview of the situations where a different illness should be considered for a diabetic patient, based on an atypical anamnesis, unusual course or different laboratory findings and which indicate a more detailed examination.Using the attached cases we want to demonstrate the conditions in relation to which the diagnosis of non-diabetic nephropathy led to a marked improvement of renal prognosis.

Key words:
chronic kidney disease (CKD) – diabetic nephropathy (DN) – diabetes mellitus (DM) – glomerulopathy – renal biopsy

Zdroje

1. Heller T, Blum M, Spraul M et al. Diabetic co-morbidities: prevalences in Germany. Dtsch Med Wochenschr 2014; 139(15): 786–791.

2. de Boer IH, Rue TC, Hall YN et al. Temporal trends in the prevalence of diabetic kidney disease in the United States. JAMA 2011; 305(24): 2532–2539.

3. Fioretto P, Mauer M, Brocco E et al. Patterns of renal injury in NIDDM patients with microalbuminuria. Diabetologia 1996; 39(2): 1569–1576.

4. Macissac RJ, Jerums G. Diabetic kidney disease with and without albuminuria. Curr Opin Nephrol Hypertens 2011; 20(3): 246–257.

5. Heine GH, Sester U, Girndt M, Köhler H. Acanthocytes in the urine: useful tool to differentiate diabetic nephropathy from glomerulonephritis? Diabetes Care 2004; 27(1): 190–194.

6. Grunwald JE, Alexander J, Ying GS et al. Retinopathy and chronic kidney disease in the Chronic Renal Insufficiency Cohort (CRIC) study. Arch Ophthalmol 2012; 130(9): 1136–1144.

7. Yutkin V, Nisman B, Pode D. Can urinary biomarkers replace cystoscopic examination in bladder cancer surveillance? Expert Rev Anticancer Ther 2010; 10(6): 787–790.

8. Levey AS, Stevens LA, Schmid CH et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A New Equation to Estimate Glomerular Filtration Rate. Ann Intern Med 2009; 150(9):604–612.

9. Nyman U, Björk J, Lindström V et al. The Lund-Malmö creatinine-based glomerular filtration rate prediction equation for adults also performs well in children. Scand J Clin Lab Invest 2008; 68(7): 568–576.

10. Teplan V, Zima T. Posuzování renálních funkcí I. Vyšetření glomerulární filtrace. FONS 2008; 4: 37–40.

11. Casas JP, Chua W, Loukogeorgakis S et al. Effect of inhibitors of the renin-angiotensin system and other antihypertensive drugs on renal outcomes: systematic review and meta-analysis. Lancet 2005, 366(9502): 2026–2033.

12. Ryšavá R, Merta M. Indikace k provedení renální biopsie. Med Pro Praxi 2008; 5(5): 200–202.