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Microvascular Complication: Diabetes Nephropathy Assessment 1 Answer

Written Assignment 1- Science On-Campus Students

Word Length: 1500 words

Task Description

Choose ONE macrovascular OR ONE microvascular complication of Diabetes and address the following questions (~500 words each):

  • Describe the pathophysiology of the chosen complication.
  • Discuss the assessment and diagnostics of this complication.
  • Discuss the treatment and management of this complication.

Structure and presentation

Your response can be set out with a brief introduction, followed by the case analysis, and a brief conclusion, however this is optional. Do not use dot points, lists or tables. The use of headings are recommended for this assignment.

Referencing

You need to include in text referencing (using resources as described above) and a Reference list. APA is the required referencing style in the School of Health. Follow the link at the top right of this page for examples. 

Answer

Introduction

Diabetes is the disorder where levels of sugar in the patient’s body, are too high. This particular health issue occurs when the body is unable to process the blood glucose effectively. Diabetes is categorized in three different type; diabetes type 1, 2, and identified gestational diabetes (American Diabetes Association, 2017). Untreated diabetes can increase the risk of different complications like heart diseases and stroke. According to world health organization the number of individuals affected with this health issue risen from around 108 million to 422million between the years of 1980-2014. The worldwide prevalence of diabetes among youth over the age of 18 year has risen from 4.7 per cent to 8.5 per cent (Ezzati, et al., 2017). There two different type complications can be raised from diabetes; microvascular and microvascular (World Health Organization, 2019). In this particular assessment report the one of the microvascular complication (damage to the kidneys leads to renal failure) of diabetes will be discussed.

Microvascular complication; Kidney failure (nephropathy)

Pathophysiology

Three main histologic alterations happen in the body of individuals with the human suffering from diabetic named as glomeruli. The (MESANGIAl) development is linked to prompted by hyperglycaemias, possibly via augmented production of protein matrix. Second, condensing of the (Glomerular basement Membrane) happens. Third, intraglomerular hypertension causes  (GS) (persuaded by the renal artery dilatation or from the ischemic injury triggered by hyaline contraction of the vessels delivering the glomeruli). These dissimilar histologic outlines seem to have related prognostic implication (Gallagher & Suckling, 2016). The key alteration in glomerulopathy in diabetes is increase of the extracellular matrix. The primary morphologic indiscretion in diabetic nephropathy is the condensing of the GBM and extension of the mesangium because of build-up of extracellular matrix. The glomeruli and found kidney of humans are naturally augmented in set size primarily, therefore differentiating diabetic nephropathy from the most other type of chronic renal deficiency, in which renal size is abridged (excluding renal amyloidosis and the polycystic kidney illness) (Gnudi, 2016).

Furthermore to RH (Renal Hemodynamic) changes, individuals with the found type of different diabetic Nephropathy and lessening filtration states of glomerular (GFR) usually progress hypertension. Diabetes associated hypertension is the making the opposing factors advanced renal illnesses and appears particularly so in diabetic nephropathy (Gallagher & Suckling, 2016).

 The Central obesity encourages hypertension originally through increasing the reabsorption of sodium in renal tubule and leads to the hypertensive shift of the renal-pressure natriuresis by manifold mechanisms, counting instigation of the sympathetic type of nervous system and the renin-angiotensin-aldosterone scheme, in addition to physical density of the kidneys of the patinet. Hypertension, accompanied by upsurges pressure in the intraglomerular capillaries and the metabolic irregularities (fro example, dyslipidemia, hyperglycemia) probable to interact to speed up renal injury (Lewis's Medical-Surgical Nursing). Comparable to obesity-related glomerular hyper-filtration, kidney vasodilation, upsurges in the GFR or pressure associated with found intraglomeruar capillary, and augmented blood pressure similarly are features of related diabetic nephropathy Augmented systolic BP additionally worsens the illness progression to proteinuria issues and a deterioration in the GFR, results in end-stage renal disease (Gnudi, L., Coward & Long, 2016).

Assessment and diagnosis 

By observing the symptoms associated with the diabetic nephropathy can be difficult as this health condition do not show early symptoms. Thus it is difficult to identify whether there is protein in the urine or not. It is something which is identified by urine test. It might take numerous years for the renal damage to progress. The symptoms commonly appears only when the renal damage has worsened significantly. Even then, the symptoms have a tendency to be elusive (Bullock, Hales and Manias, 2016). If damage to the kidneys of the patient becomes serious it may cause symptoms like weight loss, a poor appetite or sick feeling, swollen of ankles and feet because of retaining fluid puffiness around the patient’s eyes, dry, itchy skin, muscle cramps, requiring to pass the urine more frequently, feeling tired, ad having problem in concentration. Although nurses must assess the patient’s vital sign such as blood pressure, heart rate, respiration rate etc. (Umanath & Lewis, 2018)


Diagnosis 

Screening for the diabetic nephropathy should be commenced at the period of diagnosis in individuals with diabetes type 2, as nearly 7 per cent of them previously have the microalbuminuria at that particular time. For individuals with diabetes type 1, the primary screening has been suggested at five years afterward diagnosis. Though, the occurrence of microalbuminuria beforehand five years in this patient group can extent 18 per cent, particularly in patients with deprived glycemic and lipid regulation and increased levels of normal blood pressure (Kim, Kim & Kim, 2016). Additionally, puberty is considered as the specific risk factor for the microalbuminuria. Consequently, in diabetes type 1, screening for the microalbuminuria can be done 1 year afterward the diagnosis of diabetes, particularly in patients with deprived metabolic regulation and after the beginning of puberty. If the microalbuminuria is inattentive, the screening should be recurring yearly for both type one and two diabetic patients (Marieb, and Hoehn, 2018).

Certain tests for the diagnosis of diabetes can be done to identify diabetic nephropathy are 

Blood tests; if the patient have diabetes, he or she will require tests to identify the condition and control how fine the kidneys are functioning.

Urine tests; Urine specimens provide the information related to the kidney function of the patient and whether he or she have excessive protein in the urine. Increased levels of the protein named microalbumin might specify if the kidneys are being exaggerated by disease.

Imaging tests; the physician might also consider X-ray and the ultrasound to evaluate the structure and size of the kidneys. The patient might similarly  CT scan, (MRI) to define how well the blood is flowing inside the kidneys. Other different imaging tests can be applied in certain cases (Qi,et al., 2017).

Renal function test; the physician can evaluate the kidneys' filtering capability by using renal analysis testing.

Kidney biopsy; the physician might suggest biopsy of kidney to take away a section of tissues (Kidney tissues). The patients are given a local anaesthetic. Then the physician doctor will apply the needle to extract the small parts of kidney tissue for inspection under the microscope (Papadopoulou‐Marketou, Chrousos & Kanaka‐Gantenbein, 2017).

Treatment and management 

There is no cure has been identified for the diabetic nephropathy, however treatments can postponed or stop the development of the illness. Treatments comprise of maintaining the levels of blood sugar normal and levels of blood pressure within the particular range by using medications and changes to the lifestyle. The physician may also prescribe distinctive diet alterations. More invasive treatments might be required If the kidney disease progresses (Xue, et al., 2017)

Medications

To Control the blood pressure:- It is medication which is termed angiotensin-converting enzyme (ACE) and the angiotensin II receptor blockers (ARBs) are prescribed to treat the increased pressure of blood. Although the physician usually no recommend to use both of these due to augmented side effects.

Managing increased blood sugar; numerous medicines have been exposed to help in controlling the sugar levels in individuals suffering from diabetic nephropathy. Scientific Studies identified that average hemoglobin A1C (HbA1C) should be less than seven percent (Ahmad, 2015).

Reducing high cholesterol; drugs used to lower the Cholesterol levels and make the reduction of protein in the urine called stains.  

Foster bone health. It is system treatment which helps to manage the identified calcium phosphate balance. It is used to strengthen the bones. 

Control protein present in urine; Medicines can frequently decrease the protein albumin level in the patient’s urine and recover kidney function (Eboh & Chowdhury, 2015).

Lifestyle changes 

The doctor or dietitian might help the patient to plan a distinctive diet that is favourable for kidneys. These particular diets are additionally restrictive than the normal diet for individuals with diabetes. The doctor may suggest to: limiting protein consumption, consuming healthy fats, however limiting intake of oils and the saturated fatty acids, decreasing the intake of sodium to nearly 1,500 to 2,000 mg/dL or in a smaller amount. Limiting the potassium intake, which could comprise decreasing or limiting the consumption of foods with high potassium such as bananas, avocados, and spinach, limiting intake of high phosphorus foods, for example yogurt, milk, and processed meats can be beneficial for the patients (Brown, D. and Edwards, H.,2015).

Other options

If the kidney functioning issues are deteriorates, the patient will probably require to undergo dialysis or the transplant of kidney, additionally to treatments for the initial stages of the kidney disease. Dialysis is the process that support to filter the left-over material out of the blood. There are two different kinds of dialysis can be used for the patient; haemodialysis and the peritoneal dialysis. The doctor can help the patients to decide which one is best for them. Another option for the treatment is a transplant of kidney. For the kidney transplant, the patient’s kidney are replaced with the donor’s kidney through surgery. The achievement of the dialysis and kidney transfers varies with individual person (Satirapoj & Adler, 2015).

Conclusion 

After assessing the gathered information, it could be found that symptoms associated with the diabetic nephropathy can be difficult as this health condition do not show early symptoms. However, proper treatment and care support the patients to fight with this issue. It is considered that screening for the diabetic nephropathy should be commenced at the period of diagnosis in individuals with diabetes type 2. Therefore, patients should take proper treatment and medicines to postpone or stop the development of the illness.

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