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Comprehensive look at all aspects of Diabetic Nephropathy:American Diabetes Association:"In patients with type 1 diabetes, hypertension is usually caused by underlying diabetic nephropathy and typically becomes manifest about the time that patients develop microalbuminuria. In patients with type 2 diabetes, hypertension is present at the time of diagnosis of diabetes in about one-third of patients. The common coexistence of glucose intolerance, hypertension, elevated LDL cholesterol and triglycerides, and a reduction in HDL cholesterol, obesity, and susceptibility to cardiovascular disease suggests that they may relate to common underlying mechanisms, such as insulin resistance; and this complex is often referred to as syndrome X and/or the metabolic syndrome. Hypertension in type 2 patients may also be related to underlying diabetic nephropathy, be due to coexisting "essential" hypertension, or be due to a myriad of other secondary causes, such as renal vascular disease. Isolated systolic hypertension has been attributed to the loss of elastic compliance of atherosclerotic large vessels. In general, the hypertension in patients with both types of diabetes is associated with an expanded plasma volume, increased peripheral vascular resistance, and low renin activity."
American Diabetes Association
1660 Duke Street
Alexandria, VA 22314
(703) 549-1500
1-800-342-2383
http://care.diabetesjournals.org/cgi/content/full/25/suppl_1/s85

Kidney Complications From Diabetes:Gourmet Connection:"Each year in the United States, more than 50,000 people are diagnosed with end-stage renal disease (ESRD), a serious condition in which the kidneys fail to rid the body of wastes. ESRD is the final stage of a slow deterioration of the kidneys, a process known as nephropathy. Diabetes is the most common cause of ESRD, resulting in about one-third of new ESRD cases. Even when drugs and diet are able to control diabetes, the disease can lead to nephropathy and ESRD. Most people with diabetes do not develop nephropathy that is severe enough to cause ESRD. Of the more than 16 million people in the United States living with diabetes, about 50,000 people have ESRD as a result of diabetes."
Diabetic Gourmet Magazine
c/o CAPCO Marketing
PO Box 842
Baldwinsville, NY 13027
http://www.diabeticgourmet.com/Diabetes_101/Complications/Kidneys/

Diabetes and kidney failure:National Kidney and Urologic Diseases Information Clearinghouse:"Diabetes is the most common cause of kidney failure, accounting for more than 40 percent of new cases. Even when drugs and diet are able to control diabetes, the disease can lead to nephropathy and kidney failure. Most people with diabetes do not develop nephropathy that is severe enough to cause kidney failure. About 16 million people in the United States have diabetes, and about 100,000 people have kidney failure as a result of diabetes. People with kidney failure undergo either dialysis, which substitutes for some of the filtering functions of the kidneys, or transplantation to receive a healthy donor kidney. Most U.S. citizens who develop kidney failure are eligible for federally funded care. In 1997, the Federal Government spent about $11.8 billion on care for patients with kidney failure."
National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3580
nkudic@info.niddk.nih.gov
http://www.niddk.nih.gov/health/kidney/pubs/kdd/kdd.htm

Dabetic Nephropathy a comprehensive overview:Renal Unit at the Royal Infirmary of Edinburgh:"Diabetic Nephropathy" is the kidney disease that occurs as a result of diabetes. It is the leading cause of kidney failure in Europe and the USA. After many years of diabetes the delicate filtering system in the kidney becomes destroyed, initially becoming leaky to large blood proteins such as albumin which are then lost in urine. This is more likely to occur if the blood sugar is poorly controlled. The overall risk of developing diabetic nephropathy varies between about 10% of type II diabetics (diabetes of late onset) to about 30% of type I diabetics (diabetes of early onset). There are many factors, some known and others not, that affect the individual risk of developing diabetic nephropathy. Some of the factors that are known to increase the likelihood of getting diabetic nephropathy include"
Renal@ed.ac.uk
http://renux.dmed.ed.ac.uk/EdREN/EdRenINFObits/Diabetic_nephLong.html

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What causes diabetic nephropathy?:UNIVERSITY OF MARYLAND MEDICINE:"Hypertension, or high blood pressure, is a complication of diabetes that is believed to contribute most directly to diabetic nephropathy. Hypertension is believed to be both the cause of diabetic nephropathy, as well as the result of damage that is created by the disease. As kidney disease progresses, physical changes in the kidneys often lead to increased blood pressure. Uncontrolled hypertension can make the progress toward stage five diabetic nephropathy occur more rapidly. Treatment may include any, or a combination of, the following: proper diet exercise strict monitoring and controlling of blood glucose levels, often with medication and insulin injections medication (to lower blood pressure) Treatment for ESRD often initially includes dialysis to cleanse the blood, and, eventually, kidney transplantation."
UNIVERSITY OF MARYLAND MEDICINE
22 South Greene Street
Baltimore, MD 21201
ph: 1-800-492-5538
TDD: 410-328-9600
Contact University of Maryland Medicine
http://www.umm.edu/diabetes-info/kidney.htm

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Genetic Link to Diabetic Kidney Complications:Joslin Kidney Study:"Joslin scientists are searching for genetic components that may make some people with Type 1 diabetes more susceptible to kidney complications. Dr. Andrzej Krolewski and his team of investigators have over a decade of experience researching diabetic kidney disease (nephropathy), and in this time have found strong evidence that genetics plays a role in who will develop nephropathy and who will not. Diabetic nephropathy affects about one-third of people with diabetes, and is caused by a combination of clinical factors (such as blood sugar control and high blood pressure) and inherited factors. Nephropathy often first manifests as protein spilled into the urine, and may progress to end-stage renal disease, which must be treated by dialysis or kidney transplant. By identifying a genetic link, doctors hope to be able to more effectively treat and prevent nephropathy. Dr. Krolewski's research project, entitled the Joslin Kidney Study, aims to locate such a link."
Project Manager
Kellie Andersont
toll-free (877) 264-2739
kidneygene@Joslin.harvard.edu.
http://www.mendosa.com/joslin.htm

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Diabetic nephropathy description of the damage to a person's kidneys:Discovery Communications Inc:"The kidney is made up of several million filtering units. Each filtering unit contains a membrane to filter the blood, which is how urine is made. Diabetes, which is a condition that causes high blood sugar levels, can slowly damage these filtering membranes. The exact mechanism of this kidney damage is unknown. As this condition gets worse over time, kidney failure may occur. Three primary methods are recommended to prevent or at least delay the onset of diabetic nephropathy: close or tight control of blood sugar levels control of blood pressure. People with diabetes may even benefit from having blood pressure that is lower than normal. the use of medications known as angiotensin-converting enzyme (ACE) inhibitors, such as captopril or lisinopril In addition, materials that can damage the kidneys should be avoided if possible. These materials include contrast dyes that are injected into a vein during some X-ray tests and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Any urinary tract infections should be treated with antibiotics. People should also be careful to keep themselves properly hydrated by drinking enough fluids."
http://health.discovery.com/diseasesandcond/encyclopedia/601.html

NEPHROPATHY and diabetic kidney disease. Includes links to numerous resources:DiabetesPortal:"At birth, healthy kidneys are capable of filtering 120 milliliters of creatinine per minute. With each passing year their filtration rate is reduced by one milliliter per minute, but in people with diabetes, the filtration rate declines more quickly. ... Here I was, just one month shy of my twentieth anniversary with diabetes and, just as the statistics had warned I might, I had joined the 30 percent of diabetics who succumb to kidney failure after twenty years with the disease. ... When I called Mom and told her about my prognosis, the little seed of hope she had protected all those years burst open. "Maybe some good will come of all this. If you have kidney disease, you can get a new pancreas and be cured of diabetes at the same time. Why don't you call a pancreas transplant specialist?"
http://www.diabetesliving.com/comps/cmps_nephro.htm

Hypertension and Diabetic Nephropathy:The World Hypertension League:"Nearly 20 years ago, Dr. B. Brenner and colleagues from Boston revised Dr. N. Bricker's "surviving nephron" concept and formulated the "hyperfiltration hypothesis" to account for the progressive nature of proteinuric renal diseases including diabetic nephropathy [1]. This group demonstrated in a series of elegant basic studies that reductions in renal mass and/or diabetes was accompanied by increases in single nephron glomerular filtration rate (SNGFR) as well as increases in glomerular hydrostatic pressure (Pgc). Angiotensin II was implicated as a major factor in these increases in SNGFR and Pgc, and ACE inhibitors were found to be protective [2;3]. Since these seminal studies, a number of other "adverse" effects of angiotensin II have been catalogued which are too numerous to cite in this brief review. Suffice it to say that whether the mechanisms proposed by Brenner, et al are the "correct" ones, reductions in angiotensin II clearly ameliorate experimental renal failure."
http://www.mco.edu/org/whl/prof/shapiro.html

Prevention and slowing down the progression of the diabetic nephropathy through antihypertensive therapy:PubMed:"Randomized clinical trials indicate that antihypertensive therapy is beneficial in preventing and slowing down the progression of diabetic nephropathy. There is now increasing evidence that angiotensin-converting enzyme inhibitors and certain calcium antagonists produce a more beneficial effect on diabetic nephropathy in terms of reducing proteinuria and slowing the progression to diabetic renal failure. These drugs are attributed nephroprotective capacity beyond their blood pressure lowering capacity and initial clinical trials with combinations have revealed even additive protective effects on end organs."
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9101397&form=6&db=m&Dopt=r

Renal disease-a complication of diabetes:Methodist Health Care System:"Renal disease (kidney/urinary tract disease) Ten to twenty-one percent of all people with diabetes develop kidney disease. Diabetes is the leading cause of end-stage renal disease (ESRD), a condition in which the patient requires dialysis or a kidney transplant in order to live. According to the latest recorded statistics from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), in 1995, 98,872 persons with diabetes underwent dialysis or transplantation."
http://www.methodisthealth.com/diabetes/gdcomps.htm



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Last updated by Andrew Lopez, RN on Wednesday, September 29, 2010


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