Chronic kidney disease

ALONG standing diabetes mellitus and un controlled high blood pressure are the lead ing causes of dialysis worldwide. Nephropathy which is abnormality in structure and function of the kidneys is one of the microvascular complications of diabetes mellitus.

The diabetic patient is prone to develop any one or any combination of the following- with the kind indulgence of our dear readers, since the column apparently is also read by students; diabetic fatty nephrosis, pyelonephritis- infection of the kidneys, which is among the illness that gives toxic high fever and severe flank pains, with pyuria-many pus cells in the urine, with the usual TNTC findings, meaning too numerous to count, and various types of glomerular involvements.

Diabetic glomerulosclerosis, also known as Kimmelstiel-Wilson disease is a form of nodular intercapillary glomerulosclerosis. About 20-25% of diabetics have this form of kidney involvement, in which males predominate in the ratio of two to one. Then, it was believed that the occurrence in diabetics appears to be related to the duration of the disease but now, experts agree that it is the severity of the abnormally high blood sugar poorly controlled that is the more significant issue in the fast deterioration of kidney function. Patients with these kidney lesions classically have diabetes, hypertension, albuminuria and edema.

Albuminuria is a protein secreted by the liver. It is important in maintaining the so-called plasma colloid oncotic pressure, which prevents the escape of fluid from the blood into the neighboring interstitial space. In diabetes, since their glomerulus – in simple terms, serves as a filter or like a sieve, had undergone structural deformity like sclerosis or thickening, its pores now allow substances which normally should not pass through, will now leak out into the urine in massive amounts. Thus, with less albumin in the blood, it’s easier for fluid to move into the interstitial space, accumulating excess fluid in a situation called edema (pagma manas in Pilipino.) The term “bipedal edema” refers to swelling of the feet up to the ankle. Doctors have a grading system for edema, that’s why patients