Diabetic nephropathy with photos videos 447_450_3.JPG

Diabetic nephropathy with photos videos Diabetic-Nephropathy.jpg

Diabetic nephropathy is the commonest cause of premature death in type 1 diabetes
and in the UK it accounts for a quater of all patients with end stage renal failure
requiring dialysis. Diabetic nephropathy is a specific microvascular disease affecting
the renal glomerulus. Nephropathy is one facet of generalised microvascular damage
and it is almost always associated with retinopathy.
The kidneys are the bodies purifying system and our entire blood volume passes
through them many times a day. The kidneys role is to filter the waste products of
metabolism out of the blood, excreting them in the form of urine, whilst at the same
time retaining potentially useful substances such as proteins. The principle site of this
filtration is a highly specialised capillary structure called the renal glomerulus and as
described above its filter is comprised of the glomerular basement membrane and
mesangial cells. In diabetes this filter becomes seriously disrupted with two
consequences; it starts to let proteins through which are lost in the urine (proteinuria),
and it fails to excrete waste products efficiently. This microvascular disruption of the
kidneys renal glomeruli is known as diabetic nephropathy, and the most reliable
clinical indicator of diabetic kidney damage is whether or not the kidneys are
constantly leaking proteins. Typically once diabetic nephropathy is established the
picture is one of a slow decline of progressive protein leakage (as more mesangial cells
are lost) and eventually “renal failure” when the kidneys are no longer able to excrete
the bodies waste products.
End stage diabetic nephropathy can have a profound effect on vision. Patients with
diabetes who are in renal failure, tend to progress rapidly to proliferative retinopathy,
and once this is established it is often very resistant to treatment. Patients with
diabetic nephropathy also have a peculiar propensity to macular oedema and this too
often proves refractory to treatment.
There are now numerous large epidemiological studies, which show that the speed of
progression of renal failure in those patients who are going to develop it can be slowed
by aggressively treating high blood pressure (2-5). This probably represent one of the
biggest advances in diabetic care of the last decade and it is now standard practice
within the diabetic clinics to measure patients blood pressure regularly.
Once end stage renal failure has intervened patients have to be maintained on renal
dialysis treatment; often requiring hospital treatment every 2 or 3 days, to clear the
bodies waste products. Renal transplant surgery can be very successful in selected
patients, but typically premature death is 10 times higher in diabetic than non-diabetic
patients receiving renal transplant therapy.

Videos:


Pathophysiology of Diabetic Nephropathy Video




Diabetic Nephropathy Video




Diabetic Nephropathy (The Highlights) Video