Diabetes and the Kidney provides endocrinologists and nephrologists of all levels with expert clinical diagnosis and management guidance for this extremely common diabetic complication.
Practical and accessible, chapters contain text features such as case histories, potential pitfall boxes, key points, management algorithms, and useful weblinks to fully engage the reader and provide expert guidance to help clinicians best manage their patients. In addition, all relevant international society guidelines and recommendations are fully included.
After an initial analysis of the epidemiology and pathogenesis of kidney complications in diabetes, it quickly moves on to the following core sections:
- Special Situations, Risk factors and Complications - examining diabetic nephropathy in relation to each other diabetic complication, ie cardiovascular disease
- Prevention and Therapy - focusing on the most up to date information regarding prevention, diagnosis, treatment, and management of kidney disease in diabetes.
Expertly edited, and with contributions from an experienced international team, Diabetes and Kidney Disease will be the perfect tool to consult when managing diabetic patients with associated kidney problems.
Gunter Wolf is Professor and Chairman, Department for Internal Medicine III (Nephrology, Rheumatology, Osteology, Endocrinology and Diabetology) at the Friedrich Schiller University in Jena, Germany. Professor Wolf is well known both in Europe and America, and is involved in many editorial boards and journals such as Kidney International, Journal American Society of Nephrology, European Journal of Clinical Investigation, Hypertension and the renal section of the American Journal of Physiology. Professor Wolf is also the author of Obesity and the Kidney, Karger, 2006.
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ISBN-13
978-1-118-49410-3 (9781118494103)
Schweitzer Klassifikation
1 - Title page [Seite 5]
2 - Copyright page [Seite 6]
3 - Contents [Seite 7]
4 - Contributors [Seite 9]
5 - Preface [Seite 12]
6 - Part I: Introduction and Pathophysiology [Seite 13]
6.1 - Chapter 1: History of diabetic nephropathy: a personal account [Seite 15]
6.1.1 - Introduction [Seite 15]
6.1.2 - References [Seite 23]
6.2 - Chapter 2: Epidemiology of chronic kidney disease in diabetes [Seite 26]
6.2.1 - Introduction [Seite 26]
6.2.1.1 - Epidemiological measures and pitfalls [Seite 26]
6.2.2 - Chronic kidney disease without end-stage renal disease [Seite 28]
6.2.2.1 - Incidence of chronic kidney disease in individuals with diabetes [Seite 28]
6.2.2.2 - Prevalence of chronic kidney disease in individuals with diabetes [Seite 29]
6.2.3 - Renal replacement therapy [Seite 32]
6.2.3.1 - Incidence of renal replacement therapy in diabetes [Seite 36]
6.2.3.2 - Prevalence of renal replacement therapy in diabetes [Seite 37]
6.2.4 - Summary and perspectives [Seite 37]
6.2.5 - References [Seite 38]
6.3 - Chapter 3: Genetic risk factors for diabetic nephropathy [Seite 41]
6.3.1 - Genetic risk for diabetic nephropathy in a clinical context [Seite 41]
6.3.2 - Challenges in genetic research on diabetic nephropathy [Seite 43]
6.3.2.1 - What is diabetic nephropathy? [Seite 43]
6.3.2.2 - What is the optimal study design? [Seite 44]
6.3.3 - Methods for genetic analyses [Seite 45]
6.3.4 - Results of genetic analyses [Seite 47]
6.3.4.1 - Family-based linkage analyses [Seite 47]
6.3.4.2 - Genome-wide association studies [Seite 48]
6.3.4.3 - The future of genetic analyses [Seite 49]
6.3.5 - Translation into animal models [Seite 50]
6.3.6 - Translation into clinical use [Seite 50]
6.3.7 - Glossary [Seite 50]
6.3.8 - References [Seite 51]
6.4 - Chapter 4: Pathophysiology of diabetic nephropathy [Seite 57]
6.4.1 - Structural hallmarks of diabetic nephropathy [Seite 57]
6.4.2 - Hemodynamic changes and the role of different renal cell types in DN [Seite 58]
6.4.3 - Important mediators in DN [Seite 62]
6.4.3.1 - Advanced glycation end products [Seite 62]
6.4.3.2 - Transforming growth factor-?1 [Seite 62]
6.4.3.3 - Connective tissue growth factor [Seite 64]
6.4.3.4 - Angiotensin II [Seite 64]
6.4.3.5 - Platelet-derived growth factor [Seite 64]
6.4.3.6 - Hepatocyte growth factor and bone morphogenic protein-7 [Seite 64]
6.4.3.7 - Insulin-like growth factor-I [Seite 65]
6.4.3.8 - Vascular endothelial growth factor [Seite 65]
6.4.3.9 - Nitric oxide [Seite 65]
6.4.4 - Tubulointerstitial fibrosis, EMT, and EndMT in diabetic nephropathy [Seite 66]
6.4.5 - Hypoxia, oxidative stress and inflammation and DN [Seite 66]
6.4.5.1 - Hypoxia [Seite 66]
6.4.5.2 - Oxidative stress [Seite 68]
6.4.5.3 - Inflammation [Seite 68]
6.4.6 - Mouse models of DN [Seite 68]
6.4.6.1 - Streptozotocin model [Seite 68]
6.4.6.2 - db/db mouse model [Seite 69]
6.4.6.3 - Endothelial nitric oxide synthase-deficient mice [Seite 69]
6.4.6.4 - BTBR ob/ob mice [Seite 69]
6.4.7 - References [Seite 69]
6.5 - Chapter 5: Histology of human diabetic nephropathy [Seite 74]
6.5.1 - Clinical and epidemiologic aspects of diabetic nephropathy [Seite 74]
6.5.1.1 - Morphology and pathogenesis of characteristic histologic alterations of the kidney in diabetic nephropathy [Seite 76]
6.5.2 - Differential diagnoses of diabetic nephropathy [Seite 78]
6.5.3 - Concurrent renal findings in diabetes mellitus [Seite 79]
6.5.4 - Clinical perspective [Seite 79]
6.5.5 - References [Seite 79]
6.6 - Chapter 6: Natural history and diagnosis of diabetic kidney disease [Seite 82]
6.6.1 - Introduction [Seite 82]
6.6.2 - Course of disease [Seite 83]
6.6.3 - Type 1 diabetes and kidney disease [Seite 83]
6.6.4 - Type 2 diabetes and kidney disease [Seite 84]
6.6.5 - Remission/reversal of proteinuria [Seite 84]
6.6.6 - Tubuloglomerular feedback and early renal pathology [Seite 85]
6.6.7 - Current criteria for diagnosis [Seite 85]
6.6.7.1 - Risk factors [Seite 85]
6.6.7.2 - Guidelines for diagnosis [Seite 85]
6.6.8 - Future insights [Seite 88]
6.6.9 - References [Seite 89]
7 - Part II: Special Situations, Risk Factors and Complications [Seite 95]
7.1 - Chapter 7: Cardiovascular disease in diabetic nephropathy: pathophysiology and treatment [Seite 97]
7.1.1 - Introduction [Seite 97]
7.1.2 - Pathophysiology of atherothrombotic vascular disease [Seite 99]
7.1.3 - Pathophysiological conditions of vascular disease in diabetic nephropathy [Seite 100]
7.1.3.1 - Endothelial dysfunction [Seite 100]
7.1.3.2 - Insulin resistance [Seite 100]
7.1.3.3 - Hyperglycemia/hypoglycemia [Seite 100]
7.1.3.4 - Dyslipidemia [Seite 101]
7.1.3.5 - Platelet function [Seite 101]
7.1.3.6 - Advanced glycation end products [Seite 101]
7.1.3.7 - Asymmetric dimethylarginine [Seite 102]
7.1.3.8 - C-reactive protein [Seite 102]
7.1.3.9 - Homocysteine [Seite 103]
7.1.3.10 - Renin-angiotensin system/hypertension [Seite 103]
7.1.3.11 - Vascular calcification [Seite 103]
7.1.4 - Clinical evidence, prevention, and treatment strategies [Seite 104]
7.1.4.1 - Aspirin use [Seite 104]
7.1.4.2 - Lipid lowering [Seite 105]
7.1.4.3 - Antihypertensive treatment [Seite 105]
7.1.4.4 - Management of diabetes in the face of vascular disease [Seite 105]
7.1.4.5 - The challenge of nephropathy [Seite 107]
7.1.5 - Different clinical situations [Seite 107]
7.1.5.1 - Coronary artery disease [Seite 107]
7.1.5.2 - Cerebrovascular disease [Seite 108]
7.1.5.3 - Peripheral arterial disease [Seite 108]
7.1.5.4 - Microvascular complications [Seite 109]
7.1.6 - References [Seite 109]
7.2 - Chapter 8: Statin therapy in patients with diabetic nephropathy [Seite 113]
7.2.1 - Introduction [Seite 113]
7.2.2 - Macrovascular risk and atherogenic dyslipidemia [Seite 114]
7.2.3 - Diabetic microvascular risk [Seite 114]
7.2.4 - Intervention studies reducing microvascular outcomes in diabetic nephropathy [Seite 115]
7.2.4.1 - Multifactorial interventions [Seite 115]
7.2.5 - Other therapeutic approaches to reducing vascular risk in diabetic patients [Seite 116]
7.2.6 - Statins in later stages of diabetes and CKD and in patients on renal replacement therapy [Seite 117]
7.2.6.1 - Die Deutsche Diabetes Dialyse Studie [Seite 118]
7.2.6.2 - AURORA [Seite 118]
7.2.6.3 - SHARP [Seite 120]
7.2.6.4 - ALERT [Seite 120]
7.2.7 - What do the guidelines say? [Seite 121]
7.2.7.1 - Possible rationale of guideline statements [Seite 121]
7.2.7.2 - Special considerations [Seite 122]
7.2.8 - Perspectives [Seite 122]
7.2.9 - References [Seite 122]
7.3 - Chapter 9: Diabetes mellitus, bone and kidney [Seite 128]
7.3.1 - Diabetes and osteoporosis [Seite 128]
7.3.1.1 - Introduction [Seite 128]
7.3.1.2 - Osteoporosis in type 1 and type 2 diabetes [Seite 129]
7.3.1.3 - Falls and fracture risk [Seite 130]
7.3.1.4 - Proposed mechanisms underlying the increased fracture risk in diabetes [Seite 130]
7.3.1.5 - Specific influence of diabetes drugs on fracture risk [Seite 131]
7.3.1.6 - Cross-talk between bone remodeling and energy metabolism [Seite 132]
7.3.2 - Kidney and bone: renal osteodystrophy [Seite 132]
7.3.2.1 - Epidemiology [Seite 132]
7.3.2.2 - Pathophysiology [Seite 133]
7.3.2.3 - Diagnostic procedures: bone turnover markers, bone mineral density, bone biopsy [Seite 133]
7.3.2.4 - Classification of renal osteodystrophy by bone biopsy [Seite 135]
7.3.2.5 - Therapeutic options [Seite 135]
7.3.3 - References [Seite 136]
7.4 - Chapter 10: Diabetes, pregnancy and the kidney [Seite 141]
7.4.1 - Introduction [Seite 141]
7.4.1.1 - Historical perspective [Seite 142]
7.4.1.2 - Health aims [Seite 142]
7.4.2 - Physiological adaptations in normal pregnancy [Seite 142]
7.4.3 - Prevalence and diagnosis of diabetic nephropathy in pregnant women [Seite 142]
7.4.4 - Effect of pregnancy on diabetic nephropathy [Seite 143]
7.4.5 - Effect of diabetic nephropathy on the course of pregnancy [Seite 144]
7.4.6 - Counseling women with nephropathy while planning a pregnancy [Seite 145]
7.4.7 - Management of women with diabetic nephropathy during pregnancy [Seite 146]
7.4.7.1 - Medical nutritional therapy [Seite 146]
7.4.7.2 - Insulin [Seite 147]
7.4.7.3 - Arterial hypertension [Seite 147]
7.4.7.4 - Dyslipidemia, smoking [Seite 147]
7.4.7.5 - Exercise [Seite 148]
7.4.7.6 - Acute diabetes-specific complications [Seite 148]
7.4.7.7 - Pre-eclampsia [Seite 148]
7.4.7.8 - Diagnostic criteria of pre-eclampsia [Seite 149]
7.4.8 - Future perspectives [Seite 150]
7.4.9 - References [Seite 150]
7.5 - Chapter 11: Diabetic nephropathy in children [Seite 155]
7.5.1 - Introduction [Seite 155]
7.5.2 - Prevalence of diabetic nephropathy in children and adolescents [Seite 156]
7.5.3 - Risk factors [Seite 157]
7.5.4 - Nephrological differential diagnoses [Seite 157]
7.5.5 - Practical approach in patient care [Seite 158]
7.5.5.1 - Diagnostics [Seite 158]
7.5.5.2 - Therapy [Seite 160]
7.5.6 - References [Seite 162]
7.6 - Chapter 12: Diabetes, the kidney and retinopathy [Seite 165]
7.6.1 - Introduction [Seite 165]
7.6.2 - Retinal pathology [Seite 166]
7.6.3 - Epidemiology of diabetic retinopathy [Seite 167]
7.6.4 - Role of diabetic retinopathy in prediction of cardiovascular morbidity and mortality [Seite 169]
7.6.5 - Pathogenesis of diabetic retinopathy [Seite 170]
7.6.6 - Secondary effects [Seite 173]
7.6.7 - Links to diabetic nephropathy [Seite 173]
7.6.8 - Clinical treatment [Seite 174]
7.6.9 - References [Seite 176]
8 - Part III: Prevention and Therapy [Seite 181]
8.1 - Chapter 13: Reducing progression of diabetic nephropathy by antihyperglycemic treatment [Seite 183]
8.1.1 - Introduction [Seite 183]
8.1.2 - Diabetes control and development of nephropathy (primary prevention) [Seite 184]
8.1.3 - Practical consequences [Seite 186]
8.1.4 - Diabetes control and progression of diabetic nephropathy (secondary prevention) [Seite 187]
8.1.5 - Practical consequences [Seite 189]
8.1.6 - Diabetes control and survival prognosis with terminal renal insufficiency [Seite 189]
8.1.7 - Practical consequences [Seite 191]
8.1.8 - Monitoring of metabolic control [Seite 191]
8.1.9 - Blood glucose self-monitoring [Seite 191]
8.1.9.1 - Interfering substances [Seite 191]
8.1.9.2 - Changes in hematocrit [Seite 191]
8.1.10 - Continuous glucose monitoring [Seite 192]
8.1.11 - Long-term control [Seite 192]
8.1.11.1 - HbA1c [Seite 192]
8.1.11.2 - Fructosamine [Seite 193]
8.1.11.3 - Glycosylated albumin [Seite 193]
8.1.12 - References [Seite 194]
8.2 - Chapter 14: Dosage of antihyperglycemic drugs in patients with renal insufficiency [Seite 198]
8.2.1 - Introduction [Seite 198]
8.2.2 - Metformin [Seite 199]
8.2.2.1 - History [Seite 199]
8.2.2.2 - Mechanism of action [Seite 199]
8.2.2.3 - Indications and contraindications [Seite 199]
8.2.2.4 - Chronic kidney disease [Seite 200]
8.2.2.5 - Side effects [Seite 200]
8.2.2.6 - Evaluation [Seite 200]
8.2.2.7 - The metformin controversy in moderate to severe chronic kidney disease [Seite 201]
8.2.3 - Sulfonylureas [Seite 201]
8.2.3.1 - History [Seite 201]
8.2.3.2 - Mechanism of action [Seite 201]
8.2.3.3 - Indications and contraindications [Seite 202]
8.2.3.4 - Chronic kidney disease [Seite 202]
8.2.3.5 - Side effects [Seite 202]
8.2.3.6 - Evaluation [Seite 202]
8.2.3.7 - The controversy about myocardial infarction [Seite 202]
8.2.4 - Meglitinides [Seite 202]
8.2.4.1 - History [Seite 202]
8.2.4.2 - Mechanism of action [Seite 203]
8.2.4.3 - Indications and contraindications [Seite 203]
8.2.4.4 - Chronic kidney disease [Seite 203]
8.2.4.5 - Side effects [Seite 203]
8.2.4.6 - Evaluation [Seite 203]
8.2.5 - Thiazolidinediones [Seite 203]
8.2.5.1 - History [Seite 203]
8.2.5.2 - Mechanism of action [Seite 203]
8.2.5.3 - Indications and contraindications [Seite 203]
8.2.5.4 - Chronic kidney disease [Seite 204]
8.2.5.5 - Side effects [Seite 204]
8.2.5.6 - Evaluation [Seite 204]
8.2.6 - Glucosidase inhibitors [Seite 204]
8.2.6.1 - History [Seite 204]
8.2.6.2 - Mechanism of action [Seite 204]
8.2.6.3 - Indications and contraindications [Seite 204]
8.2.6.4 - Chronic kidney disease [Seite 204]
8.2.6.5 - Side effects [Seite 204]
8.2.6.6 - Evaluation [Seite 205]
8.2.7 - Incretin-based therapy [Seite 205]
8.2.7.1 - History [Seite 205]
8.2.7.2 - Mechanism of action [Seite 205]
8.2.7.3 - Indications and contraindications [Seite 205]
8.2.7.4 - Side effects [Seite 205]
8.2.7.5 - Renal insufficiency [Seite 206]
8.2.7.6 - Evaluation [Seite 206]
8.2.8 - Insulin [Seite 206]
8.2.8.1 - History [Seite 206]
8.2.8.2 - Mechanism of action [Seite 206]
8.2.8.3 - Indications and contraindications [Seite 206]
8.2.8.4 - Side effects [Seite 206]
8.2.8.5 - Renal insufficiency [Seite 206]
8.2.8.6 - Evaluation [Seite 209]
8.2.9 - References [Seite 209]
8.3 - Chapter 15: Reducing progression of diabetic nephropathy by antihypertensive treatment [Seite 214]
8.3.1 - Introduction [Seite 214]
8.3.2 - Prevention of diabetic nephropathy by blood pressure control [Seite 215]
8.3.2.1 - BENEDICT and ROADMAP [Seite 215]
8.3.2.2 - ABCD trial [Seite 216]
8.3.2.3 - DIRECT [Seite 217]
8.3.3 - Slowing progression of established diabetic nephropathy by antihypertensives [Seite 218]
8.3.3.1 - Type 1 diabetics [Seite 218]
8.3.3.2 - Type 2 diabetics with advanced diabetic nephropathy [Seite 218]
8.3.3.3 - Albuminuria and antihypertensive treatment [Seite 219]
8.3.3.4 - IRMA-2, MARVAL and DETAIL [Seite 219]
8.3.3.5 - ADVANCE [Seite 220]
8.3.4 - Renin-inhibition and RAS blocker combinations [Seite 220]
8.3.4.1 - ONTARGET [Seite 220]
8.3.4.2 - AVOID and ALTITUDE [Seite 221]
8.3.5 - Target blood pressure levels in patients with diabetic nephropathy [Seite 222]
8.3.6 - References [Seite 224]
8.4 - Chapter 16: Treatment of the patient with end-stage diabetic nephropathy [Seite 227]
8.4.1 - Anemia in the patient with end-stage diabetic nephropathy [Seite 227]
8.4.2 - Pathogenesis of anemia in diabetic CKD patients [Seite 228]
8.4.2.1 - Erythropoietin deficiency and hyporesponsiveness [Seite 228]
8.4.2.2 - Iron deficiency [Seite 228]
8.4.2.3 - Anemia of chronic disease [Seite 228]
8.4.2.4 - Decreased survival of red blood cells [Seite 228]
8.4.2.5 - Miscellaneous factors contributing to anemia [Seite 228]
8.4.3 - Consequences of anemia [Seite 228]
8.4.4 - Recommendations for anemia treatment [Seite 229]
8.4.4.1 - Target Hb level [Seite 229]
8.4.4.2 - Iron therapy [Seite 229]
8.4.4.3 - Adverse effects of anemia therapy [Seite 229]
8.4.5 - Bone and mineral metabolism disorders in diabetic patients with ESRD [Seite 231]
8.4.5.1 - Pathogenesis of BMD in diabetes and CKD [Seite 231]
8.4.5.2 - Treatment of BMD in diabetic patients with CKD [Seite 231]
8.4.6 - Glycemic control in diabetic patients with ESRD [Seite 232]
8.4.6.1 - Glycemia in the diabetic end-stage renal disease patient [Seite 232]
8.4.6.2 - Diagnostic tools of glycemic control in ESRD [Seite 232]
8.4.6.3 - Hypoglycemic agents in ESRD [Seite 233]
8.4.6.4 - Impact of glycemic control on outcomes [Seite 233]
8.4.7 - Hypertension in diabetic patients with end-stage renal disease [Seite 234]
8.4.7.1 - Assessment of hypertension in ESRD patients [Seite 234]
8.4.7.2 - Mechanisms of hypertension in ESRD patients [Seite 234]
8.4.7.3 - Management of hypertension in ESRD patients [Seite 235]
8.4.8 - Dyslipidemia in diabetic patients with ESRD [Seite 235]
8.4.8.1 - Therapy of dyslipidemia in diabetic ESRD patients [Seite 235]
8.4.9 - Cardiovascular disease in diabetic patients with ESRD [Seite 236]
8.4.9.1 - Cardiovascular risk factors [Seite 236]
8.4.9.2 - Evaluation of cardiovascular disease in ESRD [Seite 236]
8.4.9.3 - Aspirin use in ESRD [Seite 236]
8.4.9.4 - Management of acute coronary syndromes (ACS) in ESRD [Seite 237]
8.4.9.5 - Coronary artery bypass graft (CABG) surgery in ESRD [Seite 237]
8.4.10 - Comparing renal replacement therapies in diabetic patients with ESRD [Seite 237]
8.4.10.1 - Hemodialysis versus peritoneal dialysis [Seite 238]
8.4.10.2 - Potential benefits of PD in diabetes [Seite 239]
8.4.10.3 - Potential disadvantages of PD in diabetes [Seite 239]
8.4.10.4 - Where does the use of PD stand in diabetic patients? [Seite 239]
8.4.11 - References [Seite 239]
8.5 - Chapter 17: Combined pancreas and kidney transplantation or kidney alone transplantation for patients with diabetic nephropathy [Seite 244]
8.5.1 - Rationale of pancreas kidney transplantation for patients with diabetic nephropathy [Seite 244]
8.5.2 - Indications and contraindications to pancreas kidney transplantation [Seite 245]
8.5.3 - Evaluation of candidates for pancreas kidney transplantation [Seite 245]
8.5.3.1 - Cardiovascular, cerebrovascular, and peripheral vascular evaluation [Seite 246]
8.5.3.2 - Immunologic evaluation [Seite 248]
8.5.4 - Transplantation surgery [Seite 248]
8.5.4.1 - Evaluation of pancreas kidney donor [Seite 248]
8.5.4.2 - Kidney alone transplant surgery [Seite 254]
8.5.4.3 - Pancreas transplant surgery [Seite 255]
8.5.5 - Perioperative management [Seite 256]
8.5.5.1 - Pre- and postoperative management of pancreas kidney transplantation [Seite 256]
8.5.5.2 - Complications after pancreas kidney transplantation [Seite 257]
8.5.5.3 - Results of pancreas kidney transplantation [Seite 260]
8.5.6 - References [Seite 261]
9 - Index [Seite 265]
10 - Supplemental Images [Seite 283]
