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| LETTER TO EDITOR |
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| Year : 2022 | Volume
: 22
| Issue : 3 | Page : 181-182 |
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Seeking action for diabetic nephropathy patient care
Megha Nataraj
Department of Physiotherapy, Centre For Diabetic Foot Care & Research (CDFCR), Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| Date of Submission | 21-Feb-2022 |
| Date of Acceptance | 22-Apr-2022 |
| Date of Web Publication | 22-Jul-2022 |
Correspondence Address:
Dr. Megha Nataraj
Department of Physiotherapy, Centre For Diabetic Foot Care & Research (CDFCR), Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Manipal-576104, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jesnt.jesnt_10_22
How to cite this article:
Nataraj M. Seeking action for diabetic nephropathy patient care. J Egypt Soc Nephrol Transplant 2022;22:181-2 |
Sir,
Diabetic nephropathy (DN) is a rapidly expanding problem that has emerged as a primary cause of end-stage renal disease around the world. DN is a metabolic disorder caused by structural and functional changes in the kidney. Clinical renal-function measures such as albumin–creatinine ratio and glomerular-filtration rate are used to diagnose DN. The gold-standard kidney-biopsy approach, on the other hand, is used to detect structural alterations. Most individuals with type-2 diabetes are not assessed with kidney biopsy, which is an invasive procedure. The suspicion of nondiabetic renal disease in DN is when nephrologists usually reserve the option of doing a renal biopsy.
Based on structural and functional alterations, DN is divided into five stages. Stage-1 DN is characterized by glomerular hyperfiltration and hypertrophy, as well as normoalbuminuria or an estimated glomerular-filtration rate greater than 90 ml/min/1.73 m2. In Stage-2 DN, the loss of kidney function continues, with an estimated glomerular-filtration rate in the range of 60–89 ml/min/1.73 m2 and modest glomerular basement-membrane thickening. A vast majority of individuals develop microalbuminuria or macroalbuminuria by the time they visit the nephrologists [1]. Routine examinations of renal-function parameters are recommended by worldwide guidelines such as KDIGO for early screening, diagnosis, and timely care of patients.
Hypertension, lipid abnormalities, cardiac autonomic function, the underlying systemic inflammation, and obesity coexist with type-2 diabetes mellitus. Both type-1 and type-2 diabetic individuals have shown a relationship between the existence of cardiac autonomic neuropathy and a faster advancement of diabetic kidney disease. The parasympathetic dysfunction and sympathetic overdrive have been responsible for promotion and acceleration of renal damage [2].
The early research on diabetic kidney disease was conducted under the auspices of the WHO from 1975 to 1978 as a multinational project with India as one of the participating countries. The Indian Chronic Kidney Disease research group has identified DKD (24.9%) as a common cause for CKD among Indian population [3]. The majority of participants in the Indian Chronic Kidney Disease study had a sedentary lifestyle, with only 43% being physically active, which corresponded to a brisk walk of 30 min on at least 5 days [3]. These studies at the national level give light on the global burden of renal disease. Future research incorporating lifestyle-modification interventions, dietary and nutrition counseling, exercise/physical-activity adoption, and renal-specific health-literacy programs are all urgently needed among low-income and low–middle-income countries.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Khan MZ, Hussain M, Khan AA, Hassan U, Akhter N, Hameed M, et al. Frequency of non-diabetic renal disease in type 2 diabetes mellitus patients undergoing renal biopsy. J Ayub Med Coll 2021; 33(Suppl 1 4): S757–S762.  |
| 2. | Laursen JC, Rasmussen I, Zobel EH, Hasbak P, von Scholten BJ, Holmvang L, et al. The association between cardiovascular autonomic function and changes in kidney and myocardial function in type 2 diabetes and healthy controls. Front Endocrinol 2021; 12:780679. |
| 3. | Kumar V, Yadav AK, Sethi J, Ghosh A, Sahay M, Prasad N, et al. The Indian Chronic Kidney Disease (ICKD) study: baseline characteristics. Clin Kidney J 2021; 15:60–69. |
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