Maintenance dialysis for diabetic nephropathy with uremia

When achieved, control of hypertension and reduction of proteinuria reduced the risk for death or dialysis. In conclusion, the absolute renal risk score, determined at diagnosis, associates with risk for dialysis or death.

The major independent consensual factors are: the occurrence/presence of arterial hypertension (HT); the amount of daily proteinuria with a usual cut-off over g/d; and the presence of severe lesions on initial renal biopsy (RB) such as crescents, abundant obsolescent glomeruli, focal and segmental hyalinosis, and also tubulointerstitial fibrosis. However, at that time, there was no international classification for renal pathology in IgAN, and different groups like ours have defined their own scoring systems. The other factors are numerous and controversial or not widely confirmed: age at disease onset, gender, overweight/obesity, hypertriglyceridemia/hyperuricemia, and different immunogenetic markers (HLA antigens, cytokines polymorphisms, candidate genes for hypertension, etc.).

Fourteen patients, aged yr, with diabetic nephropathy and uremia were observed on maintenance dialysis for a total of 156.5 dialysis patient months (range: 1.5–30 months per patient). Clinical course on dialysis was eventful in most cases, though nitrogen retention and acidosis were readily controlled. Bouts of circulatory congestion and severe fluid retention were frequent in nine patients, six of whom died of acute myocardial infarction or intractable heart failure. Septic complications and hepatitis caused or contributed to the demise of four patients, and thromboembolic complications to that of one patient. Rehabilitation on dialysis was limited in nine cases, and five remained disabled. Retinopathy was not improved. Emotional problems were common in nine patients, five of whom required psychiatric care. Ten patients died between 1.5 and 21 months after the start of dialysis, and only one survived over 30 months. Three patients underwent renal transplantation 6 to 18 months after inception of dialysis. They all died 10 days to 3 months after surgery of overwhelming septic complications.

Survival rate on maintenance dialysis for the whole group was 54.8 per cent at 1 yr, and 16.4 per cent at 2 yr.

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Diabetic Kidney Disease: Preventing Dialysis and Transplantation

Diabetic nephropathy is characterized by proteinuria and progressive kidney failure. Since the late 1990s, the occurrence of diabetic nephropathy has been steadily increasing; this condition is now the dominant cause of end-stage renal disease (ESRD) in many countries. The increasing prevalence of diabetic nephropathy is primarily attributable to the growing numbers of people who have type 2 diabetes mellitus (1).

Type 2 diabetic patients have a cardiovascular risk equivalent to nondiabetic individuals with a previous acute myocardial infarction.2 More importantly and often poorly appreciated, diabetic patients with early diabetic nephropathy (proteinuria or a minimally elevated serum creatinine >1.5 mg/dl) have an even greater cardiovascular risk.3 The degree of proteinuria correlates with this risk so that patients with macroalbuminuria have an even higher risk for coronary events than those with microalbuminuria. Abnormalities in vitamin D, parathyroid hormone, and calcium metabolism in patients with even moderate kidney failure lead to vascular and particularly coronary calcification,4 and this surely contributes to the high incidence of cardiovascular events. Once a patient reaches ESRD, the average survival on dialysis in the United States is 4–5 years, with death generally resulting from cardiovascular events or infection.

In the late 1970s, dialysis for patients with diabetes, who frequently have advanced cardiovascular complications, could provide only a limited benefit because of technical problems and insufficient options for medical treatment. As a result, patient survival at that time was poor. However, improvements in medical technologies and medicines, advances in the treatment of coronary artery disease and in critical care medicine, and introduction of earlier initiation of renal replacement therapy have combined to improve outcomes, with the result that dialysis for diabetic patients is now a widely accepted standard clinical practice.

The course of diabetic nephropathy is similar in type 1 and type 2 diabetes, although the diagnosis of type 2 diabetes is frequently delayed because of its insidious nature, giving the appearance of an earlier onset of nephropathy in type 2 diabetes. Microalbuminuria predicts the progression to diabetic nephropathy in 80% of untreated patients with type 1 diabetes and is rarely seen when patients have been diagnosed <5 years. Macroalbuminuria generally develops within 10 years, followed by a progressive rise in serum creatinine, eventually leading to ESRD requiring dialysis or transplantation. In contrast, microalbuminuria is commonly seen in patients with type 2 diabetes at the time of diabetes diagnosis or shortly thereafter and signifies vascular endothelial injury and increased cardiovascular risk.6 It is considered more a feature of the insulin resistance syndrome,7 and only 20–40% of these patients will progress to macroalbuminuria and kidney failure. The diagnosis of type 2 diabetes at an older age also leaves less time for ESRD to develop.

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Diabetic Nephropathy Not Improved by Dual Regimen

Nephropathy means kidney disease or damage. Diabetic nephropathy is damage to your kidneys caused by diabetes. It is characterized by nephrotic syndrome and diffuse glomerulosclerosis. It is due to longstanding diabetes mellitus, and is a prime indication for dialysis in many developed countries. In people with diabetes, the nephrons slowly thicken and become scarred over time. The kidneys begin to leak and protein (albumin) passes into the urine. This damage can happen years before any symptoms begin.

Combination therapy with an ACE inhibitor and angiotensin-receptor blocker (ARB) is not more effective than an ARB alone in slowing renal disease progression in patients with diabetic nephropathy, but it is associated with an increased risk of acute kidney injury (AKI) and hyperkalemia, according to a recent study.

The multicenter, double-blind Veterans Affairs Nephropathy in Diabetes study included 1,448 patients with proteinuric diabetic kidney disease (urinary albumin-to-creatinine ratio of at least 300) and an estimated glomerular filtration rate (eGFR) of 30.0-89.9 mL/min/1.73 m2. The investigators, led by Linda F. Fried, MD, MPH, of the VA Pittsburgh Healthcare System in Pittsburgh, randomly assigned patients to receive the ARB losartan plus placebo or losartan plus the ACE inhibitor lisinopril. The patients had a median follow-up of 2.2 years. The primary endpoint was the first occurrence of a change in eGFR (a decline of 30 or more if the initial eGFR was 60 or greater or a decline of 50% or more if the initial eGFR was less than 60), end-stage renal disease, or death.

Last but not least, if kidney damage has been formed by diabetes, the medical treatment should be applied as early as possible. In our Chronic Kidney Disease (CKD) Center, we do use Blood Pollution Therapy to deal with kidney damage. The treatment aims at treating the polluted blood not the kidneys. Under help of various techniques of cleaning blood, the wastes and toxins in blood can be discharged effectively and in the way, the internal environment of the body can be cleaned. Then, some effective reprative medicine and different elements can be supplied.

Primary endpoint events occurred in 152 (21%) of the 724 patients in the monotherapy arm and 132 (18.2%) of the 724 patients in the combination-therapy, a non-significant difference between the groups, the researchers reported in the New England Journal of Medicine (2013;369:1892-1903).

Compared with the monotherapy arm, the combination-therapy arm had significantly higher rates of AKI (12.2 vs. 6.7 events per 100 person-years) and hyperkalemia (6.3 vs. 2.6 events per 100 person-years). kidneyhospitalabroad@hotmail.com

Further Data on Diabetic Retinopathy Drug Requested

Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia). Prevention and treatment involve a healthy diet, physical exercise, not using tobacco and being a normal body weight.

Eli Lilly and Company has received an approvable letter from the FDA requesting additional supporting data for its new drug application for ruboxistaurin mesylate (proposed trade name: Arxxant), Lilly's investigational oral therapy for diabetic retinopathy.

The company plans to meet with the FDA to determine whether a new study is required to meet the request or if data from an ongoing study will suffice.

“We will be working closely with the FDA to address issues outlined in the approvable letter and to define the pathway forward,” said Timothy R. Franson, MD, the company's vice president of global regulatory affairs.

Last but not least, if kidney damage has been formed by diabetes, the medical treatment should be applied as early as possible. In our Chronic Kidney Disease (CKD) Center, we do use Blood Pollution Therapy to deal with kidney damage. The treatment aims at treating the polluted blood not the kidneys. Under help of various techniques of cleaning blood, the wastes and toxins in blood can be discharged effectively and in the way, the internal environment of the body can be cleaned. Then, some effective reprative medicine and different elements can be supplied.

kidneyhospitalabroad@hotmail.com

Proteinuric Diabetic Kidney Disease More Likely in Minorities

Kidney damage from diabetes is called diabetic nephropathy. If the damage continues, your kidneys could fail. Failing kidneys lose their ability to filter out waste products, resulting in kidney disease. In fact, diabetes is the most common cause of kidney failure in the United States. Other complications may be arteriosclerosis of the renal artery and protein in the urine.

Racial and ethnic minorities are more likely than non-Hispanic whites to have proteinuric diabetic kidney disease (DKD), according to new findings published online in Diabetes Care.

In a study of 15,683 individuals by Vivek Ghalla, MD, of Stanford University School of Medicine in Stanford, Calif., and colleagues, Hispanic men and women had a significant 34% and 46% increased odds of proteinuric DKD, respectively, compared with non-Hispanic whites, in adjusted analyses. Chinese men and women had a 56% and 39% increased odds of DKD, and Filipino men and women had an 85% and 57% increased odds. Non-Hispanic black women had a significant 50% increased odds. Our Email is kidneyhospitalabroad@hotmail.com.

The Reason of bubble in urine for Diabetic Nephropathy Patients

Bubble urine is one of common symptoms of kidney disease. And Diabetic Nephropathy is no exception. So The problem is occur, is it same the cause of bubble in urine for Diabetic Nephropathy with other kind of kidney disease? And What is the cause of bubble in urine for Diabetic Nephropathy patients?

The reason of bubble in urine for Diabetic Nephropathy patients

Diabetes can cause damage to multiple organs, one of which is the kidneys. High blood sugar is the culprit in the developing course. By slowing down blood flow, causing deposits of excellular matrix and blocking nutrient supply to the kidneys, the high blood sugar can gradually impair renal capillaries and cause glomerular sclerosis. Over time, kidney filters can no longer effectively block proteins from being leaked into urine, resulting in increasing protein in urine. In this process, Diabetic Nephropathy aggravates progressively and continuously.

Treatment for Diabetic Nephropathy patients 

Blood Purification technology is one of feasible therapy. In our hospital There are many therapy in the scope of Blood Purification technology like Plasma Exchange,Immune Adsorption, all these therapy will treat your kidney disease for the polluted blood. And have get many good grades in the clinic. In other hand in the treatment progress we will also combine the Traditional Chinese Medicine with the blood purification.

If you have any questions want to consult me. Send an email to kidneyfailuretreat@hotmail.com.