Diabetic Nephropathy

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Frederikke Steffensen
7 år siden
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1 Diabetic Nephropathy

2 Steno Diabetes Center

3 The magnitude of the problem Total number of people with diabetes (age 20-79) Prevalence of diabetes (age 20-79) 285 million 438 million 6.6 % 7.8 %

4 Diabetes Mellitus 2010 Skøn over udbredelse i Danmark Type 1 Type 2 Insulin behandlet Type 2 Diæt/tbl. behandlet Type 2 Ikke diagnosticeret

5 Critically important to protect this woman David Savage, Belfast

6 Diabetisk nefropati overblik.. Mikro-albuminuri a call for action Hvilke undersøgelser hvornår? Hvilken behandling? Kliniske udfordringer Leucopatch..

7 Urinary albumin excretion rate normo micro macro < 30 mg/24h mg/24h > 300 mg/24h

8 Albuminuria (µg/min) Progression of Diabetic Renal Disease in Patients with Diabetes 2000 Overt nephropathy 40% Microalbuminuria Normoalbuminuria Time (Years) 60%

12 U alb/cr (mg/g) Urinary albumin / creatinine (mg/g) day-to day variation Follow-up (days)

13 2 min? Taler I med patienterne om nyresygdom? Hvad spørger I dem om?

14 Microalbuminuria is NOT only a test result, but a call for ACTION! 14 PHG, MS

16 Prevalence of late complications in 549 NIDDM patients aged < 76 years attending Hvidöre Hospital Normo- Micro- Macro- albuminuria Albuminuria Hypertension Retinopathy

17 Diabetic Maculopathy

18 Central vision loss

19 Prevalence of late complications in 549 NIDDM patients aged < 76 years attending Hvidöre Hospital Normo- Micro- Macro- albuminuria Albuminuria Hypertension Retinopathy CHD

20 Proteinuria Predicts Stroke and CHD Events in Type 2 Diabetes 1 Survival curves for CVD mortality 40 Incidence of CVD (%) A B p< Overall: p<0.001 C Stroke CHD Months events A: U-Prot <150 mg/l B: U-Prot mg/l C: U-Prot >300 mg/l Miettinen H et al. Stroke. 1996;27:

21 Hjertekar sygdom findes ikke kun ét sted i kroppen

22 Prevalence of late complications in 549 NIDDM patients aged < 76 years attending Hvidöre Hospital Normo- Micro- Macro- albuminuria Albuminuria Hypertension Retinopathy CHD Foot ulcers Neuropathy

23 Diabetisk neuropati - symptomer Somatisk neuropati Autonom neuropati Smerte Hyperfølsomhed Nedsat følesans Føleforstyrrelser Kramper Muskelsvækkelse Svimmelhed Gastroparese Diarre / Forstoppelse Blære forstyrrelser Abnorm sved tendens Impotens Pulsændringer Manglende føling ved lavt BS

24 The kidney

25 Glomerulus = the filtration unit

27 Normal glomerulus

28 Diabetic nephropathy

30 Måling af nyrefunktion = GFR

31 Glomerular filtration rate (ml/min/1.73 m 2 ) Progression of renal failure i 9 diabetic patients End stage renal disease Jones et al, The Lancet 1979

32 Hæmodialyse

33 35 In c id e n c e o f d ia b e tic p a tie n ts s ta r tin g re n a l re p la c e m e n t th e r a p y fro m (p m p ) 30 Danish Kidney Database 25 T y p e 1 a n d T y p e T y p e 1 5 T y p e

34 behandling?

35 Cardiovascular disease in diabetic nephropathy BP reduction (< 120/80) Diuretics Stop smoking ASA 75 mg x 1 Statins

36 Effective long-term antihypertensive treatment in diabetic nephropathy Reduces albuminuria Reduces the rate of decline in kidney function Postpones end stage renal disease Improves survival

37 Cumulative mortality (%) Mortality Knowles 1971 Andersen 1983 Parving 1996 Rossing 1996 Astrup et al Duration of nephropathy (years)

39 Kliniske udfordringer hypotension og perifer perfusion ødemer

40 Epo mangel!?

41 Kliniske udfordringer hypotension og perifer perfusion ødemer haemoglobin

42 Kliniske udfordringer hypotension og perifer perfusion ødemer haemoglobin AK / magnyl behandling

43 Kliniske udfordringer hypotension og perifer perfusion ødemer haemoglobin AK / magnyl behandling fodsår dicillin!!

45 Kliniske udfordringer hypotension og perifer perfusion ødemer haemoglobin AK / magnyl behandling fodsår dicillin!! urinsyre gigt - allopurinol

47 Dagens budskaber.. Microalbuminuria a call for action Behandling af blodtryk og UAE Ødemer Lav hæmoglobin Dicillin Urinsyregigt

51 Patienter diabetes kroniske sår god blodforsyning optimal aflastning

53 Helingsrate i kroniske diabetiske fodsår

54 Teamwork i fodklinikken Date Presentation title 54

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