Week 4: Diagnosis 

Welcome back to our wonderful discovery of diabetic nephropathy! Today we are going to talk about the tests, signs, and symptoms that lead to this diagnosis. Let's find out what we are in for...

Early screening..if you have diabetes it is important for you to test your blood glucose levels routinely! Not just in the moment blood glucose levels, but making sure you get your HgA1C checked at least once a year. Keep those glucose levels under control!

Check your protein levels.... your doctor is probably already checking on this but make sure your results are good. The protein this test checks for is called albumin. If you excrete more than 30 mg/24 hours then your body is excreting too much protein in your urine. If there is protein in your urine that means your kidneys aren't doing their job and this increases your chances of developing diabetic nephropathy.

Imaging... Ultrasound is used to look at you kidneys. In this test we are looking directly at kidney size. If you have early stage diabetic nephropathy your kidneys will likely be larger than normal. If you have later stage diabetic nephropathy then your kidneys are likely to appear smaller. The ultrasound is also helpful in ruling out things out...like an obstruction or renal cancer.

Staging...There are 5 stages used to describe how bad the kidney failure is. Stage 1 is the best and Stage 5 is end stage kidney failure. The tests listed above are used to determine how extensive the kidney damage is. This information is helpful because it determines what treatment options are available to you.

Check out the picture below to see a simple idea of what diabetic nephropathy is doing to your kidney. I hope to see you guys back again next week! Go hawks!!!

References

Evans, Timothy; Campbell, Peter. Clinical Diabetes: Diabetic Nephropathy. 18:1, 2008. 

Lewis, Dirksen, Heitkemper, and Bucher. Medical-Surgical Nursing: Assessment and management of Clinical Problems. 9th edition. St. Louis, Missouri: Elsevier; 2014. 

Week 3: Etiology and Pathophysiology 

Week 3 of learning about diabetic nephrology...and cheering on the Hawks of course! Today we are going to learn about some of the aspects that influence and damage the kidney. There are some great videos that explain more about the subject and are really informative below!

Etiology 

The exact cause of diabetic nephropathy is unknown. Various health concerns like genetic factors and smoking contribute to the development of the disease. However, the most significant indicators are high blood glucose levels and hypertension (high blood pressure). Genetically speaking...if a family member has diabetic nephropathy you are five times more likely to develop the disease. Smoking is also a severe risk factor for developing kidney disease because it increases blood pressure. High glucose levels, HgA1C levels above 8.0%, are the strongest causative factor for developing diabetic nephropathy. High glucose levels damage the smaller blood vessels in the kidney leading to the destruction of the filtration process. High blood pressure has both a cause and effect on diabetic nephropathy. High blood pressure impedes filtration in the kidney and contributes to downhill progression of renal damage.

Pathophysiology 

The key event in kidney degradation and diabetic nephropathy is basement membrane damage. What does that even mean?! Damage to the basement membrane means there is inflammation and and disruption in the filtration process in the kidney. The declined flow of blood being filtered causes cell death and eventually kidney degradation.

Here are some GREAT videos breaking down diabetic nephropathy pathophysiology! Just click on the title and the video will open up! I hope this will make it clear and easy to understand!

Diabetic Nephropathy

Diabetic Nephropathy Pathophysiology

I hope this week's blog was helpful! Join me next week to learn more about diabetic nephropathy!

References 
American Diabetes Association: Position statement: Diabetic nephropathy. Diabetes Care 22 (Suppl 1):S66-69, 1999.

Evans, Timothy; Campbell, Peter. Clinical Diabetes: Diabetic Nephropathy. 18:1, 2008. 

Week 2: Epidemiology

Hi everyone! Welcome back to our study of diabetic nephropathy...after an amazing Seahawks win!! This week we are going to jump into the study of epidemiology. We will be looking at the different factors that contribute to the development of diabetic nephropathy like age, race, gender, etc. It is my goal to further investigate this disease with you. So here we go....

HISTORY
Diabetic nephropathy (kidney disease) is a common complication of diabetes. The disease was first discovered by the physician Clifford Wilson in 1936 but wasn't widely noted until the 1980s (NIH). The prevalence of diabetic nephropathy increased from 1988-2008 in proportion to an increase in diabetes. In fact, recent statistics say that diabetic nephropathy affects 366 million people in the United States with type 1 and type 2 diabetes (NIH). Now that is a lot of people with kidney disease! And since so many people are affected by this disease it is important that we recognize some of the factors that can influence its' prevalence.

RISK FACTORS
Several of the greatest risk factors for developing diabetic nephropathy include...

1. Poor blood glucose control. Regulating blood glucose is a big part of controlling your diabetes. You are at an increased risk for developing diabetic nephropathy if your A1C is greater than 11% (WHO).

2. Elevated blood pressure. Having uncontrolled blood pressure- or hypertension- is also a large risk factor for developing kidney disease. Consult with your physician if you repeatedly have elevated blood pressure (WHO).

3. The older you are the greater your risk of developing kidney disease. And so are the perils of life...Having diabetes for a longer period of time in coordination with getting older will increase your chance of developing diabetic nephropathy (WHO).

A combination of any of these risk factors even further increases your risk of developing diabetic nephropathy. So make sure you are paying attention to your health!

AGE 
The mean age of people affected by diabetic nephropathy is 60. Most people develop diabetic nephropathy after having diabetes for 10-20 years so like I said earlier the older you are the greater the risk.  In general, the incidence of kidney disease is higher among the elderly in general (NIH).

GENDER
Males and females have the same incidence of diabetic nehpropathy. So no matter what sex you identify with make sure you understand the risks relative to all (NIH).

RACE
African Americans, Mexican Americans and Pima Indians have a 3-6 fold higher incidence rate. This suggests that socioeconomic factors like diet, hypertension, obesity, and poor control of blood glucose levels have a primary role in the development of diabetic neuropathy. These results also show a possible genetic of familial contribution (NIH). So pay attention to your past. Does diabetic nephropathy run in your family? If so, talk to your provider sooner rather than later.

LOCATION
The United States has one of the lowest rates for kidney replacement surgery which is an indication for progressive diabetic nephropathy. Countries like Germany, Denmark and Australia have higher incidences of kidney replacement surgery for issues like diabetic nephropathy. This means that if you live in the United States you have lower risk of developing diabetic nephropathy.

It is also important to notice distribution of kidney disease throughout the United States. The southern states are more affected by diabetic nephropathy which can be attributed to higher incidences of diabetes and obesity.

MORTALITY AND MOBIDITY
As of 2013, it has beed shown that only 34% of patients live longer than five years following treatment for diabetic nephropathy and end-stage kidney disease (UpToDate). This data shows that survival rates are poor.

Okay guys...thanks again for joining me on our path to discovering diabetic nephropathy! I hope you learned from this blog post and I can't wait to see you next week! Go Hawks!



This information was provided to you from the following sources...

"Dialysis in Diabetic Nephropathy." Dialysis in Diabetic Nephropathy. N.p., n.d. Web. 13 Jan. 2015.
"About Diabetes." WHO. N.p., n.d. Web. 13 Jan. 2015.
Lewis, Dirksen, Heitkemper, and Bucher. Medical-Surgical Nursing: Assessment and management of Clinical Problems. 9th edition. St. Louis, Missouri: Elsevier; 2014. 

Chen, Jing. Diabetic Nephropathy: The Scope of the Problem. Diabetes and Kidney Disease. 2014, XIV, p. 256. 2013. 

Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. US Department of Health and Human Services. Atlanta, GA: Centers for Disease Control and Prevention; 2011. 

Week 1: DEFINE YOUR DISEASE 

Hey guys! Welcome to my blog! I am currently in nursing school at the University of Washington and I am developing this blog for one of my classes. I want to start a blog about diabetic nephropathy because I am passionate about health, kidneys, and diabetes. In fact, last quarter I was in charge of developing community classes for people diagnosed with diabetes to learn about the basics of the disease. So on this blog I am going to do my best to break down difficult medical language and explain the basics of diabetic nephrology. I hope you have fun...

Diabetic nephropathy is a common complication of diabetes. But what does nephropathy mean? Medical words can be so confusing. So here we go...

Nephropathy means kidney damage. So diabetic nephropathy means damage to your kidneys caused by diabetes. The kidneys are full of tiny blood vessels that filter waste from your blood and deliver oxygen to your kidneys. High blood sugar from uncontrolled diabetes destroys these tiny blood vessels. Once these vessels are destroyed the kidney can't work properly. If this continues the kidney will stop working altogether and fail. 

Now, not everyone with diabetes has diabetic nephropathy. However, there are certain things that will put you at risk for kidney damage. If you smoke, have high blood pressure, or have high cholesterol you have a greater risk of damaging your kidneys. Native Americans, African Americans and Hispanics also have increased risk. 

Here are some steps you can take to prevent diabetic nephropathy...

• Keep your blood sugar levels in the target range. This will help keep the tiny blood vessels in your kidney healthy. 
• Work with your provider to keep your blood pressure under 140/80. 
• Eat healthy foods and exercise regularly. Keeping yourself in good health will protect those tiny vessels in the kidney. 
• Don't smoke or use tobacco products. 

I hope you find this first post helpful! As the weeks go by I will be posting more in depth information about diabetic nephropathy and I hope you will join me. If you have any questions or comments you want me to specifically address please post in the comments section below. 

Talk to you soon! 

Lewis, Dirksen, Heitkemper, and Bucher. Medical-Surgical Nursing: Assessment and management of Clinical Problems. 9th edition. St. Louis, Missouri: Elsevier; 2014.