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      Nutritional Intervention for a Patient with Diabetic Nephropathy

      case-report
      Author(s):
      Publication date (Electronic):
      Journal: Clinical Nutrition Research
      Publisher: The Korean Society of Clinical Nutrition
      Keywords: Diabetic nephropathies, Diabetes mellitus, Nutrition education

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          Abstract

          In recent years, several studies have reported that the prevalence of diabetes mellitus is increasing every year, and also the acute and chronic complications accompanying this disease are increasing. Diabetic nephropathy is one of chronic complications of diabetes mellitus, and food intake which is burden to kidney function should be limited. At the same time, diet restriction could deteriorate quality of life of patient with diabetic nephropathy. According to the results of previous studies, the aggressive management is important for delaying of the progression to diabetic nephropathy. Also, the implementation of a personalized diet customized to individuals is an effective tool for preservation of kidney function. This is a case report of a patient with diabetic nephropathy who was introduced to a proper diet through nutrition education to prevent malnutrition, uremia and to maintain blood glucose levels.

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          Diabetic nephropathy: diagnosis, prevention, and treatment.

          Jorge Gross, Mirela de Azevedo, Sandra P Silveiro … (2005)
          Diabetic nephropathy is the leading cause of kidney disease in patients starting renal replacement therapy and affects approximately 40% of type 1 and type 2 diabetic patients. It increases the risk of death, mainly from cardiovascular causes, and is defined by increased urinary albumin excretion (UAE) in the absence of other renal diseases. Diabetic nephropathy is categorized into stages: microalbuminuria (UAE >20 microg/min and or =200 microg/min). Hyperglycemia, increased blood pressure levels, and genetic predisposition are the main risk factors for the development of diabetic nephropathy. Elevated serum lipids, smoking habits, and the amount and origin of dietary protein also seem to play a role as risk factors. Screening for microalbuminuria should be performed yearly, starting 5 years after diagnosis in type 1 diabetes or earlier in the presence of puberty or poor metabolic control. In patients with type 2 diabetes, screening should be performed at diagnosis and yearly thereafter. Patients with micro- and macroalbuminuria should undergo an evaluation regarding the presence of comorbid associations, especially retinopathy and macrovascular disease. Achieving the best metabolic control (A1c 1.0 g/24 h and increased serum creatinine), using drugs with blockade effect on the renin-angiotensin-aldosterone system, and treating dyslipidemia (LDL cholesterol <100 mg/dl) are effective strategies for preventing the development of microalbuminuria, in delaying the progression to more advanced stages of nephropathy and in reducing cardiovascular mortality in patients with type 1 and type 2 diabetes.
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            Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: prospective, observational study.

            K Borch-Johnsen, Aimee M. Gall, P Hougaard … (1997)
            To evaluate putative risk factors for the development of incipient diabetic nephropathy (persistent microalbuminuria) and overt diabetic nephropathy (persistent macroalbuminuria) in patients with non-insulin dependent diabetes. Prospective, observational study of a cohort of white, non-insulin dependent diabetic patients followed for a median period of 5.8 years. Outpatient clinic in tertiary referral centre. 191 patients aged under 66 years with non-insulin dependent diabetes and normoalbuminuria (urinary albumin excretion rate or = mg/24 h in two out of three consecutive collections) during follow up. The five year cumulative incidence of incipient diabetic nephropathy was 23% (95% confidence interval 17% to 30%). Cox's multiple stepwise regression analysis revealed the following risk factors for the development of incipient or overt diabetic nephropathy: increased baseline log urinary albumin excretion rate (relative risk 11.1 (3.4 to 35.9); P < 0.0001); male sex (2.6 (1.2 to 5.4); P < 0.02); presence of retinopathy (2.4 (1.3 to 4.7); P < 0.01); increased serum cholesterol concentration (1.4 (1.1 to 1.7); P < 0.01); haemoglobin A1c concentration (1.2 (1.0 to 1.4); P < 0.05); and age (1.07 (1.02 to 1.12); P < 0.01). Known duration of diabetes, body mass index, arterial blood pressure, serum creatinine concentration, pre-existing coronary heart disease, and history of smoking were not risk factors. Several potentially modifiable risk factors predict the development of incipient and overt diabetic nephropathy in normoalbuminuric patients with non-insulin dependent diabetes.
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              Diet therapy in patients of diabetic nephropathy

              JY Kim (2013)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Nutr Res
                Journal ID (iso-abbrev): Clin Nutr Res
                Journal ID (publisher-id): CNR
                Title: Clinical Nutrition Research
                Publisher: The Korean Society of Clinical Nutrition
                ISSN (Print): 2287-3732
                ISSN (Electronic): 2287-3740
                Publication date (Print): January 2014
                Publication date (Electronic): 27 January 2014
                Volume: 3
                Issue: 1
                Pages: 64-68
                Affiliations
                Department of Nutrition, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 137-701, Korea.
                Author notes
                Corresponding author: Hee Young Kim. Address: Department of Nutrition, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 137-701, Korea. Tel +82-2-2258-2586, Fax +82-2-2258-2596, 21300011@ 123456cmcnu.or.kr
                Article
                DOI: 10.7762/cnr.2014.3.1.64
                PMC ID: 3921297
                PubMed ID: 24527422
                SO-VID: e471661f-4e30-4a1c-aa3c-2440e464f588
                Copyright © © 2014 The Korean Society of Clinical Nutrition
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 June 2013
                Date revision received : 08 September 2013
                Date accepted : 14 September 2013
                Categories
                Subject: Case Report

                Keywords: diabetic nephropathies,nutrition education,diabetes mellitus
                Data availability:
                Keywords: diabetic nephropathies, nutrition education, diabetes mellitus

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