Dissecting the pathogenesis of diabetic kidney disease
|
|
- Osborne Ryan
- 7 years ago
- Views:
Transcription
1 Dissecting the pathogenesis of diabetic kidney disease Bryan Conway Scottish Senior Clinical Fellow/Honorary Consultant Nephrologist University of Edinburgh/Royal Infirmary Edinburgh
2 Overview Epidemiology of diabetic nephropathy (DN) Dissecting the pathogenesis of DN: o o Animal models Human disease Integrating animal and human data
3 Diabetic nephropathy (DN) is the most common cause of ESRD in UK Source: UK Renal Registry
4 Median survival on dialysis by diagnosis and age-group Scottish life expectancy data Source: Scottish Renal Registry
5 Prevalence of CKD in Lothian diabetic population CKD stage Number of patients %age of patients 1 2, , , Total 24, Source: Scottish Care Information: Diabetes Collaboration
6 CKD as a risk factor for cardiovascular disease Stage 3 Stage 4 Increasing cardiovascular risk Stage 5 Dialysis Death
7 CKD is a risk factor for cardiovascular disease Go et al. NEJM 2004;351:
8 CKD as a risk factor for cardiovascular disease Stage 3 Stage 4 Risk factors Diabetes Hypertension Smoking Dyslipidaemia Family history Increasing cardiovascular risk Stage 5 Dialysis Death
9 CKD as a risk factor for cardiovascular disease Stage 3 Stage 4 Risk factors Diabetes Hypertension Smoking Dyslipidaemia Family history Causality Renovascular disease Hypoperfusion Atheroemboli Increasing cardiovascular risk Stage 5 Dialysis Death
10 CKD as a risk factor for cardiovascular disease Stage 3 Stage 4 Risk factors Diabetes Hypertension Smoking Dyslipidaemia Family history Causality Renovascular disease Hypoperfusion Atheroemboli Increasing cardiovascular risk Stage 5 Dialysis Causality Classical Renal specific Anaemia Arterial calcification Death
11 Dissecting the pathogenesis of DN Animal models
12 Advantages of animal models Can determine causality v association with disease Useful for testing novel therapeutic agents
13 Natural history of diabetic nephropathy Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Pre-nephropathy Normoalbuminuria Incipient nephropathy Overt nephropathy Chronic renal failure Adapted from Mogensen et al, Diabetologia 1979; 17: 71-76
14 Normal glomerulus Early DN Late DN
15 Ideal animal model of DN (AMDCC guidelines) Progressive albuminuria (>100 fold normal) Decline in GFR >50% normal Pathology: Mesangial sclerosis Arterial hyalinosis GBM thickening >150% baseline Tubulo-interstitial fibrosis
16 Natural history of diabetic nephropathy Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Pre-nephropathy Normoalbuminuria Incipient nephropathy Overt nephropathy Chronic renal failure Adapted from Mogensen et al, Diabetologia 1979; 17: 71-76
17 Key role for hypertension in diabetic nephropathy Parental risk of hypertension confers increased risk of nephropathy in patients with diabetes Treatment of hypertension is at least as important as good glycaemic control High blood pressure is a requirement for DN
18 Diabetes with unilateral renal artery stenosis Diabetic glomerulosclerosis Normal kidney Berkman J, Rifken H. Metabolism 1973;22: Berionade VC, et al. Am J Nephrol 1987;7:55
19 Conditional mren2 rat model (Cyp1a1mRen2 rat) Indole-3-carbinol Cyp1a1 promoter mren2 cdna mren2 expression Titrable and reversible hypertension Kantachuvesiri et al. J.Biol.Chem 2001;276:
20 Conditional mren2 rat Citrate buffer 2wks Streptozotocin 2wks No HTN (n=6) HTN (n=8) No HTN (n=6) HTN (n=8) 28wks 28wks Readouts: Clinical: albuminuria, creatinine and inulin clearance Histological: glomerulosclerosis, tubulointerstitial fibrosis, M recruitment Microarray: determine molecular signature of interaction between hyperglycaemia and hypertension
21 Blood sugar (mm) Glycaemic control Blood sugar Cont Diabetic alone HTN alone Diabetic and HTN Time (wks)
22 Systolic BP (mmhg) Blood pressure 2wklyBP Cont Diabetic alone HTN alone Diabetic and HTN Time (wks)
23 ACR (mg/mmol) Albumin:creatinine ratio ACR ### $$ ### ### *** *** *** $ ### *** ### *** 1000 ### ### *** ***## # *** ### # ## *** *** *** 0 *** *** *** *** Time(wks) Cont Diabetic alone HTN alone Diabetic and HTN
24 GFR (ml/min) Trend towards reduced renal function in hypertensive animals 4 Terminal GFR Cont DM HTN DM+HTN
25 Cont DM HTN DM+HTN
26 Glomerulosclerosis index Synergistic increase in glomerulosclerosis in DM+HTN ** ## $ Cont DM HTN DM+HTN **<0.01 v Cont or DM; ## P<0.01 v DM; $ p<0.05 v HTN
27 Cont DM HTN DM+HTN
28 Percentage area Picosirus Red positive Increase in interstitial fibrosis in HTN and DM+HTN PicRed Quantification CON DM HTN DM+HTN * *** # *p<0.05 and ***p<0.001 v Cont #p<0.05 v DM
29 No.of ED-1 positive cells/ x200-power field No.of CD3+ve cells/ x200-power field Interstitial macrophage and T-cell infiltration CD *** ### *** ### $ *p< v control #p< v STZ ##p<0.001 v STZ 10 5 # *** ### $$ 0 Cont DM HTN DM+HTN 0 CON DM HTN DM+HTN ***p<0.001 v Cont; #p<0.05 and ###p<0.001 v DM; $p<0.05 v HTN
30 Up-regulated genes Down-regulated genes DM HTN DM HTN DM+HTN DM+HTN
31 The gene expression in diabetic rats mimics that in the tubulointerstium in human DN Human DN DM+HTN rats 50%
32 Summary Cyp1a1mRen2 rat model of DN mimics human disease: Progressive, severe albuminuria Trend to decline in renal function Histological features: glomerulosclerosis tubulointerstitial fibrosis Transcriptome
Diabetes and the Kidneys
Diabetes and the Kidneys Aim(s) and objective(s) This guideline focuses on the detection, prevention, and management of kidney disease in people with diabetes. The management of end-stage renal disease
More informationDefinition, Prevalence, Pathophysiology and Complications of CKD. JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013
Definition, Prevalence, Pathophysiology and Complications of CKD JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013 KI supplements January 2013 Objectives of the course on CKD:
More informationDiabetic Nephropathy
Diabetic Nephropathy Kidney disease is common in people affected by diabetes mellitus Definition Urinary albumin excretion of more than 300mg in a 24 hour collection or macroalbuminuria Abnormal renal
More informationAlbuminuria versus GFR as markers of diabetic CKD progression
Albuminuria versus GFR as markers of diabetic CKD progression KDIGO Controversies Conference: Diabetic Kidney Disease New Delhi, March 2012 Richard J MacIsaac PhD FRACP Director of Endocrinology & Diabetes,
More informationDiabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria.
Kidney Complications Diabetic Nephropathy Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. The peak incidence of nephropathy is usually 15-25 years
More informationPrevalence and risk factor of chronic kidney disease in elderly diabetic patients in Korea 성애병원 내과 김정한
Prevalence and risk factor of chronic kidney disease in elderly diabetic patients in Korea 성애병원 내과 김정한 Introduction CKD의 정의와 egfr의 측정 CKD의 risk factor와 mechanism 한국의 CKD prevalence 와 prognosis CKD의 치료와
More informationCurrent Renal Replacement Therapy in Korea - Insan Memorial Dialysis Registry, 2011 - ESRD Registry Committee, Korean Society of Nephrology*
Current Renal Replacement Therapy in Korea - Insan Memorial Dialysis Registry, 2011 - ESRD Registry Committee, Korean Society of Nephrology* =Abstracts= Registry committee of Korean Society of Nephrology
More informationUnderstanding diabetes Do the recent trials help?
Understanding diabetes Do the recent trials help? Dr Geoffrey Robb Consultant Physician and Diabetologist CMO RGA UK Services and Partnership Assurance AMUS 25 th March 2010 The security of experience.
More informationMechanism for Dehydration Associated Kidney Disease
Mechanism for Dehydration Associated Kidney Disease Richard J Johnson, University of Colorado A sugarcane worker dying from kidney failure Dr Johnson has received funding from Danone Research Chronic Kidney
More informationChronic Kidney Disease and the Electronic Health Record. Duaine Murphree, MD Sarah M. Thelen, MD
Chronic Kidney Disease and the Electronic Health Record Duaine Murphree, MD Sarah M. Thelen, MD Definition of Chronic Kidney Disease (CKD) Defined by the National Kidney Foundation Either a decline in
More informationRenovascular Hypertension
Renovascular Hypertension Philip Stockwell, MD Assistant Professor of Medicine (Clinical) Warren Alpert School of Medicine Cardiology for the Primary Care Provider September 28, 201 Renovascular Hypertension
More informationPrediction of Kidney Disease Progression in Patients with Diabetes
Prediction of Kidney Disease Progression in Patients with Diabetes John Arthur, MD, PhD Medical University of South Carolina SEKDC Meeting September 8, 2012 Objectives Understand the importance of predicting
More informationChronic Kidney Disease (CKD) Algorithm. Chronic Kidney Disease (CKD) Algorithm Page 1
Chronic Kidney Disease (CKD) Algorithm Chronic Kidney Disease (CKD) Algorithm Page 1 Chronic Kidney Disease (CKD) Algorithm (See NICE Clinical Guideline CG73 1 and Quality Standards 2 ) Who should have
More informationSystolic Blood Pressure Intervention Trial (SPRINT) Principal Results
Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Paul K. Whelton, MB, MD, MSc Chair, SPRINT Steering Committee Tulane University School of Public Health and Tropical Medicine, and
More informationRenal Disease in Type 2 Diabetes Mellitus
Renal Disease in Type 2 Diabetes Mellitus 6th Collaborative DiGP/HSE/UCC Conference 25 th September 2013 Dr. Eoin O Sullivan Consultant Endocrinologist Bon Secours Hospital Cork Case 69 year old woman
More informationDiabetic nephropathy is a major cause of morbidity and
PEER REVIEWED FEATURE 2 CPD POINTS The shifting paradigm of albuminuria in diabetic kidney disease ANNA K. WATTS MB BS, BMedSci, DRANZCOG; KAREN M. DWYER MB BS, PhD, FRACP; ELIF I. EKINCI MB BS, FRACP,
More informationCardiovascular Risk in Diabetes
Cardiovascular Risk in Diabetes Lipids Hypercholesterolaemia is an important reversible risk factor for cardiovascular disease and should be tackled aggressively in all diabetic patients. In Type 1 patients,
More informationCalculating the stage of Renal Disease
Calculating the stage of Renal Disease When the Refresh Template/Check Labs button is depressed, the box next to MDRD, will be automatically checked. In order to use this in the calculation of the stage
More informationNew Kidney Allocation and What it Means to Your Transplant Center and Your Patients
New Kidney Allocation and What it Means to Your Transplant Center and Your Patients Alexander Wiseman, M.D. Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney and Pancreas
More informationNierfunctiemeting en follow-up van chronisch nierlijden
Nierfunctiemeting en follow-up van chronisch nierlijden 12 Jan 2016 Patrick Peeters, M.D. Dept Nephrology Ghent University Hospital Plan of presentation 1/ Renal function determination: Measured GFR Estimated
More informationGuidelines for the management of hypertension in patients with diabetes mellitus
Guidelines for the management of hypertension in patients with diabetes mellitus Quick reference guide In the Eastern Mediterranean Region, there has been a rapid increase in the incidence of diabetes
More informationCardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg
Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg 2 nd Annual Duke Renal Transplant Symposium March 1, 2014 Durham, NC Joseph G. Rogers, M.D. Associate
More informationPHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES.
PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES. Hossam Bahy, MD (1992 2012), 19 tools have been identified 11 stroke scores 1
More informationKidney Disease: Key Facts and Figures. September 2010
Kidney Disease: Key Facts and Figures September 2010 ii Kidney Disease Key Facts and Figures Contents Introduction... 1 1 Kidney disease common definitions... 2 1.1 Chronic kidney disease... 2 1.2 Acute
More informationGuideline for Microalbuminuria Screening
East Lancashire Diabetes Network Guideline for Microalbuminuria Screening Produced by: Task and Finish Group, Clinical Standards Group Produced: August 2006 Approved by: East Lancashire Diabetes Network
More informationMetabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007
Metabolic Syndrome Overview: Easy Living, Bitter Harvest Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Evolution of Metabolic Syndrome 1923: Kylin describes clustering
More informationGFR (Glomerular Filtration Rate) A Key to Understanding How Well Your Kidneys Are Working
GFR (Glomerular Filtration Rate) A Key to Understanding How Well Your Kidneys Are Working www.kidney.org National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Did you know that the National
More informationModels of Chronic Kidney Disease Care and Initiation of Dialysis. Dr Paul Stevens Kent Kidney Care Centre East Kent Hospitals, UK
Models of Chronic Kidney Disease Care and Initiation of Dialysis Dr Paul Stevens Kent Kidney Care Centre East Kent Hospitals, UK Early Crash Landings Talk Outline Pathways & Definitions Guideline recommendations
More informationMicroalbuminuria: We are in the midst of an epidemic: the epidemic. So What s a Little Protein? Malcolm s diabetes. How much is too much?
Focus on CME at the University of Saskatchewan Microalbuminuria: So What s a Little Protein? By Judith T. Klassen, BSc, MD, FRCPC University of Saskatchewan Practical Management of Common Medical Problems
More informationGUIDELINES FOR THE TREATMENT OF DIABETIC NEPHROPATHY*
71 GUIDELINES FOR THE TREATMENT OF DIABETIC NEPHROPATHY* Ryuichi KIKKAWA** Asian Med. J. 44(2): 71 75, 2001 Abstract: Diabetic nephropathy is the most devastating complication of diabetes and is now the
More informationRenal Blood Flow GFR. Glomerulus Fluid Flow and Forces. Renal Blood Flow (cont d)
GFR Glomerular filtration rate: about 120 ml /minute (180 L a day) Decreases with age (about 10 ml/min for each decade over 40) GFR = Sum of the filtration of two million glomeruli Each glomerulus probably
More informationScottish Diabetes Survey 2014. Scottish Diabetes Survey Monitoring Group
Scottish Diabetes Survey 2014 Scottish Diabetes Survey Monitoring Group Contents Table of Contents Contents... 2 Foreword... 4 Executive Summary... 6 Prevalence... 8 Undiagnosed diabetes... 21 Duration
More informationControl of hypertension in Nigerians with Diabetes Mellitus: A report of the Ibadan Diabetic / Kidney Disease Study Group.
Int J Diabetes & Metabolism (2007) 15: 82-86 Control of hypertension in Nigerians with Diabetes Mellitus: A report of the Ibadan Diabetic / Kidney Disease Study Group. Ayodeji Arije, 1 Modupe Kuti, 2 Adesoji
More informationHYPERTENSION ASSOCIATED WITH RENAL DISEASES
RENAL DISEASE v Patients with renal insufficiency should be encouraged to reduce dietary salt and protein intake. v Target blood pressure is less than 135-130/85 mmhg. If patients have urinary protein
More informationThe sensitive marker for glomerular filtration rate (GFR) Estimation of GFR from Serum Cystatin C:
The sensitive marker for glomerular filtration rate (GFR) Estimation of GFR from Serum Cystatin C: The good correlation allows close estimation of GFR Cystatin C GFR GFR in serum estimated* measured* n
More informationSUMMARY OF CHANGES TO QOF 2015/16 - ENGLAND CLINICAL
SUMMARY OF CHANGES TO QOF 2015/1 - ENGLAND KEY No change Retired/replaced Wording and/or change Point or threshold change Indicator ID change 14/15 QOF ID 15/1 QOF ID NICE ID Indicator wording Changes
More informationManaging diabetes in the post-guideline world. Dr Helen Snell Nurse Practitioner PhD, FCNA(NZ)
Managing diabetes in the post-guideline world Dr Helen Snell Nurse Practitioner PhD, FCNA(NZ) Overview Pathogenesis of T2DM Aims of treatment The place of glycaemic control Strategies to improve glycaemic
More informationPrevention and management of chronic kidney disease in type 2 diabetes
162..194 NEPHROLOGY 2010; 15, S162 S194 doi:10.1111/j.1440-1797.2010.01240.x Prevention and management of chronic kidney disease in type 2 diabetes Date written: April 2009nep_1240 Final submission: April
More informationUsing multiple biomarkers to predict renal and cardiovascular drug efficacy: Implications for drug development and registration
Using multiple biomarkers to predict renal and cardiovascular drug efficacy: Implications for drug development and registration Hiddo Lambers Heerspink Department of Clinical Pharmacology University Medical
More informationInDependent Diabetes Trust
InDependent Diabetes Trust Kidneys and Diabetes Updated July 2015 Registered Company Number 3148360 Registered Charity No 1058284 Contents Introduction Healthy Kidneys Kidney disease and diabetes The use
More informationInterpretation Of Renal Function Tests and The Renal Effects of Lithium. John Collins (April 2014)
Interpretation Of Renal Function Tests and The Renal Effects of Lithium John Collins (April 2014) Causes of Kidney disease Diabetes Glomerulonephritis Genetic disorders- Polycystic kidney disease Causes
More informationESIM 2014 WHEN CHRONIC BECOMES ACUTE
ESIM 2014 WHEN CHRONIC BECOMES ACUTE Anna Salina, MD Pauls Stradins Clinical University Hospital Riga, Latvia 37 years old female, 50 kg, 150 cm Complaints Severe edema +8 kg Tiredness, dry cough Chills
More informationCorrespondence to: Rima B Shah (rima_1223@yahoo.co.in) DOI: 10.5455/ijmsph.2013.2.167-172 Received Date: 29.11.2012 Accepted Date: 03.12.
RESEARCH ARTICLE STUDY OF UTILIZATION PATTERN OF ANTI-HYPERTENSIVE DRUGS IN HYPERTENSIVE DIABETIC PATIENTS WITH OR WITHOUT REDUCED RENAL FUNCTION AT TERTIARY CARE TEACHING HOSPITAL Jay Shah 1, Tejas Khakhkhar
More informationRisk factors associated with the development of overt nephropathy in type 2 diabetes patients: A 12 years observational study
Indian J Med Res 136, July 2012, pp 46-53 Risk factors associated with the development of overt nephropathy in type 2 diabetes patients: A 12 years observational study Vijay Viswanathan, Priyanka Tilak
More informationPREPARAZIONE DI UN KIT DIAGNOSTICO COMMERCIALE PER IL DOSAGGIO SIERICO DEL mir-148b NELLA MALATTIA RENALE: IMMUNOGLOBULINA A NEFROPATIA (IgAN)
PREPARAZIONE DI UN KIT DIAGNOSTICO COMMERCIALE PER IL DOSAGGIO SIERICO DEL mir-148b NELLA MALATTIA RENALE: IMMUNOGLOBULINA A NEFROPATIA (IgAN) F.P. Schena Università degli Studi di Bari; Consorzio C.A.R.S.O.
More informationHIGH BLOOD PRESSURE AND YOUR KIDNEYS
HIGH BLOOD PRESSURE AND YOUR KIDNEYS www.kidney.org About the Information in this Booklet Did you know that the National Kidney (NKF) Foundation offers guidelines and commentaries that help your healthcare
More informationAggressive Lowering of Blood Pressure in type 2 Diabetes Mellitus: The Diastolic Cost
Aggressive Lowering of Blood Pressure in type 2 Diabetes Mellitus: The Diastolic Cost Naftali Stern Institute of Endocrinology, Metabolism and Hypertension Tel Aviv -Sourasky Medical Center and Sackler
More informationJohn Sharp, MSSA, PMP Manager, Research Informatics Quantitative Health Sciences Cleveland Clinic, Cleveland, Ohio
John Sharp, MSSA, PMP Manager, Research Informatics Quantitative Health Sciences Cleveland Clinic, Cleveland, Ohio Co-Director BiomedicalResearch Informatics Clinical and Translational Science Consortium
More informationEpidemiology of Diabetic Kidney Disease
Epidemiology of Diabetic Kidney Disease Anne T. Reutens, MBBS, PhD, FRACP a,b, * KEYWORDS Diabetes Prevalence Incidence Microalbuminuria Macroalbuminuria End-stage renal disease KEY POINTS Diabetic kidney
More informationPrimary prevention of chronic kidney disease: managing diabetes mellitus to reduce the risk of progression to CKD
Primary prevention of chronic kidney disease: managing diabetes mellitus to reduce the risk of progression to CKD Date written: July 2012 Author: Kate Wiggins, Graeme Turner, David Johnson GUIDELINES We
More informationADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes
ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes Effects of a fixed combination of the ACE inhibitor, perindopril,
More informationHow To Determine The Prevalence Of Microalbuminuria
Research Journal of Pharmaceutical, Biological and Chemical Sciences Prevalence of Microalbuminuria in relation to HbA1c among known Type2 Diabetic Patients in Puducherry population Muraliswaran P 1 *,
More informationDRUG UTILIZATION EVALUATION OF ANTIHYPERTENSIVE DRUGS IN DIABETIC PATIENTS WITH CKD
WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Elhami et al. SJIF Impact Factor 5.210 Volume 4, Issue 11, 1159-1166 Research Article ISSN 2278 4357 DRUG UTILIZATION EVALUATION OF ANTIHYPERTENSIVE
More informationAn Interprofessional Approach to Diabetes Management
Disclosures An Interprofessional Approach to Diabetes Management Principal in DiabetesReframed, LLC. Inventor of U.S. Provisional Patent Application No. 61/585,483 METHODS OF USING A DIABETES CROSS- DISCIPLINARY
More informationProgression and remission of nephropathy in type 2 diabetes: new strategies of treatment and monitoring
DOCTOR OF MEDICAL SCIENCE Progression and remission of nephropathy in type 2 diabetes: new strategies of treatment and monitoring Kasper Rossing This review has been accepted as a thesis together with
More informationBeneficial effects of CCR1 blockade on the progression of chronic allograft nephropathy
Beneficial effects of CCR1 blockade on the progression of chronic allograft nephropathy J. Bedke 1,2, E. Kiss 2, L. Schaefer 3, M. Bonrouhi 2, N. Gretz 4, H.-J. Gröne 2 1 Klinik für Urologie, Universität
More informationsurvival, morality, & causes of death Chapter Nine introduction 152 mortality in high- & low-risk patients 154 predictors of mortality 156
introduction 152 < mortality in high- & low-risk patients 154 < predictors of mortality 156 < impact of anemia & dialysis therapy on mortality 158 < mortality in esrd patients with rare s 16 < expected
More information2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY
Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented National Quality Strategy Domain: Community / Population Health 2016 PQRS OPTIONS F INDIVIDUAL MEASURES:
More informationKnow your Numbers The D5 Goals for Diabetes Care. Shelly Hanson RN, CNS, CDE Cuyuna Regional Medical Center November 6, 2014
Know your Numbers The D5 Goals for Diabetes Care Shelly Hanson RN, CNS, CDE Cuyuna Regional Medical Center November 6, 2014 The D5 What is it 5 different treatment goals identified for optimal diabetes
More informationDiagnosis, classification and staging of chronic kidney disease
Diagnosis, classification and staging of chronic kidney disease Date written: July 2012 Author: David Johnson DIAGNOSIS GUIDELINES a. We recommend that chronic kidney disease (CKD) be diagnosed in all
More informationOUTPATIENT MANAGEMENT OF CHRONIC KIDNEY DISEASE. Jeanie Park, MD MS Assistant Professor Renal Division Emory University School of Medicine
OUTPATIENT MANAGEMENT OF CHRONIC KIDNEY DISEASE Jeanie Park, MD MS Assistant Professor Renal Division Emory University School of Medicine Disclosures None Goals Background and staging Strategies to slow
More informationQUALITY OF LIFE WITH DIABETES AND CHRONIC KIDNEY DISEASE
QUALITY OF LIFE WITH DIABETES AND CHRONIC KIDNEY DISEASE www.kidney.org National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Did you know that the National Kidney Foundation's Kidney
More informationDiabetes now accounts for ~35% of all new
hapter 16 Kidney Diseases in Diabetes Robert G. Nelson, MD, MPH; William. Knowler, MD, DrPH; David J. Pettitt, MD; and Peter H. Bennett, MB, FRP, FFM SUMMARY Diabetes now accounts for ~35% of all new cases
More information2/20/2015. Cardiac Evaluation of Potential Solid Organ Transplant Recipients. Issues Specific to Transplantation. Kidney Transplantation.
DISCLOSURES I have no relevant financial relationships to disclose. Cardiac Evaluation of Potential Solid Organ Transplant Recipients Michele Hamilton, MD Director, Heart Failure Program Cedars Sinai Heart
More informationScottish Diabetes Survey 2013. Scottish Diabetes Survey Monitoring Group
Scottish Diabetes Survey 2013 Scottish Diabetes Survey Monitoring Group Contents Contents... 2 Foreword... 4 Executive Summary... 6 Prevalence... 8 Undiagnosed diabetes... 18 Duration of Diabetes... 18
More informationScottish Diabetes Survey
Scottish Diabetes Survey 2011 Scottish Diabetes Survey Monitoring Group Foreword The Scottish Diabetes Survey 2011 data reflects many aspects of the quality of diabetes care across the whole of Scotland.
More informationINSULIN REQUIREMENT IN DIABETIC PATIENTS WITH CHRONIC RENAL FAILURE DUE TO DIABETIC NEPHROPATHY (DN)
E:/Biomedica/New Journal 2004/Bio-11.doc (A) INSULIN REQUIREMENT IN DIABETIC PATIENTS WITH CHRONIC RENAL FAILURE DUE TO DIABETIC NEPHROPATHY (DN) KAMRAN RASHID, KHALIL UR REHMAN, M. SAEED ANWER AAEISHA
More informationChronic Kidney Disease and Diabetes
Anyone with diabetes can get kidney disease. Diabetes and high blood pressure are the most common causes of kidney disease, and people often have both. Chronic (long term) kidney disease (CKD) caused by
More informationKDIGO THE GEORGE INSTITUTE FOR GLOBAL HEALTH. Antiocoagulation in diabetes and CKD Vlado Perkovic
THE GEORGE INSTITUTE FOR GLOBAL HEALTH Antiocoagulation in diabetes and CKD Vlado Perkovic Executive Director, George Institute Australia Professor of Medicine, University of Sydney Affiliated with the
More informationMeasure #236 (NQF 0018): Controlling High Blood Pressure National Quality Strategy Domain: Effective Clinical Care
Measure #236 (NQF 0018): Controlling High Blood Pressure National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS F INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION: Percentage of patients
More informationHow To Test For Microalbuminuria
Original Article Iran J Ped Sep 2007; Vol 17 ( No 3), Pp: 252-256 Evaluation of Microalbuminuria 4 to 6 Years Following Type 1 Diabetes in Children Ali Derakhshan* 1, MD; Mohsen Akhavan 1, MD; Hamdollah
More informationCDS Starter Kit: Diabetes f ollow-up care
CDS Starter Kit: Diabetes f ollow-up care Introduction The delivery of high-quality diabetes care is a complex process that requires a provider to consider many pieces of patient information and treatment
More informationPopulation health management at Cleveland clinic
Population health management at Cleveland clinic Sankar D Navaneethan, MD, MS, MPH Using Health Information Technology to Identify and Manage CKD Populations Oct 22-23 2015 Objectives Development of an
More informationAbsolute cardiovascular disease risk assessment
Quick reference guide for health professionals Absolute cardiovascular disease risk assessment This quick reference guide is a summary of the key steps involved in assessing absolute cardiovascular risk
More informationKIDNEY FUNCTION RELATION TO SIZE OF THE TUMOR IN RENAL CELL CANCINOMA
KIDNEY FUNCTION RELATION TO SIZE OF THE TUMOR IN RENAL CELL CANCINOMA O.E. Stakhvoskyi, E.O. Stakhovsky, Y.V. Vitruk, O.A. Voylenko, P.S. Vukalovich, V.A. Kotov, O.M. Gavriluk National Canсer Institute,
More informationCoding to be more efficient and accurate
Why we need to code well! Coding to be more efficient and accurate Diabetes without Complication Diabetes with opthamologic or unspecified complication Diabetes with acute complication $1833 $2931 $3836
More informationChronic Kidney Disease: A New Classification and Staging System
Clinical Review Article Series Editor: Mark A. Perazella, MD, FACP Chronic Kidney Disease: A New Classification and Staging System Mark A. Perazella, MD, FACP Robert F. Reilly, MD Chronic kidney disease
More informationComplicanze del diabete nel bambino e nell adolescente
Clinica Pediatrica Università di Chieti Complicanze del diabete nel bambino e nell adolescente Franco Chiarelli XVII Congresso Nazionale SIPPS Parma, 25 Novembre 2005 Type 1 diabetes in childhood: Only
More informationPROCEEDINGS DIABETIC NEPHROPATHY: DETECTION AND TREATMENT OF RENAL DISEASE IN PATIENTS WITH DIABETES* Jiten Vora, MA, MD, FRCP ABSTRACT
DIABETIC NEPHROPATHY: DETECTION AND TREATMENT OF RENAL DISEASE IN PATIENTS WITH DIABETES* Jiten Vora, MA, MD, FRCP ABSTRACT Diabetic nephropathy affects people with either type 1 or type 2 diabetes mellitus.
More informationJournal of Nephropathology
www.nephropathol.com DOI:10.12860/JNP.2013.37 J Nephropathology. 2013; 2(4): 234-240 Journal of Nephropathology A story of microalbuminuria and diabetic nephropathy Bijan Roshan 1,*, Robert C. Stanton
More informationAtherosclerosis of the aorta. Artur Evangelista
Atherosclerosis of the aorta Artur Evangelista Atherosclerosis of the aorta Diagnosis Classification Prevalence Risk factors Marker of generalized atherosclerosis Risk of embolism Therapy Diagnosis Atherosclerosis
More informationGeneral and Abdominal Adiposity and Risk of Death in Europe
Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke General and Abdominal Adiposity and Risk of Death in Europe Tobias Pischon Department of Epidemiology German Institute of Human Nutrition Potsdam-Rehbruecke
More informationIdentifying and treating long-term kidney problems (chronic kidney disease)
Understanding NICE guidance Information for people who use NHS services Identifying and treating long-term kidney problems (chronic kidney disease) NICE clinical guidelines advise the NHS on caring for
More informationDialyse patiënten & Transplant patiënten prevalentie december 31, 1993-2005
NBVN 2005 PRE_VIEW Dialyse patiënten & Transplant patiënten prevalentie december 31, 1993-2005 4000 3500 3000 2500 2000 1500 1000 500 0 Dialyse Populatie Transplant Populatie 1993 1994 1995 1996 1997 1998
More informationWilliam B. Schwartz Division of Nephrology Fellowship Training Program Curriculum
William B. Schwartz Division of Nephrology Fellowship Training Program Curriculum Consult/Transplant Servic Patient Care Take medical history Perform physical examination Urinalysis and sediment eval Interpret
More informationCompound extracted from plant Aristolochia. Nephrotoxin and carcinogen. Page 2
Mariana Babayeva MD, PhD Touro College of Pharmacy, New York, NY, USA Page 1 Compound extracted from plant Aristolochia Nephrotoxin and carcinogen Page 2 AA-I is an organic anion eliminated by the kidney
More informationDIABETES A chronic, debilitating and often deadly disease A global epidemic Diabetes in Africa
DIABETES A chronic, debilitating and often deadly disease Diabetes is a chronic condition that arises when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin
More informationPrevalence of microalbuminuria among sudanese type 2 diabetic patients at elmusbah center at ombadda - omdurman
IOSR Journal of Pharmacy ISSN: 2250-3013, www.iosrphr.org Volume 2 Issue 5 Sep-Oct. 2012 PP.51-55 Prevalence of microalbuminuria among sudanese type 2 diabetic patients at elmusbah center at ombadda -
More informationDrug Treatment in Type 2 Diabetes with Hypertension
Hypertension is 1.5 2 times more prevalent in Type 2 diabetes (prevalence up to 80 % in diabetic subjects). This exacerbates the risk of cardiovascular disease by ~ two-fold. Drug therapy reduces the risk
More informationAortic Valve Stenosis and CAD
EUROECHO 14, Copenhagen 2010 Aortic Valve Stenosis and CAD Aleksandar N. Neskovic Clinical Hospital Center Zemun Belgrade University School of Medicine Aortic Stenosis and CAD Important facts Links AS/CAD
More informationRheumatoid arthritis: an overview. Christine Pham MD
Rheumatoid arthritis: an overview Christine Pham MD RA prevalence Chronic inflammatory disease affecting approximately 0.5 1% of the general population Prevalence is higher in North America (approaching
More informationDISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD
STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with
More informationEnd Stage Renal Disease (ESRD)
End Stage Renal Disease (ESRD) AN OVERVIEW OF ESRD, TREATMENT COSTS & COVERAGE WSHIP Board Meeting January 14, 2015 Lisa Matthews and Sharon Becker 1 Kidney Disease Facts & Figures 1 in 10 people have
More informationAssociations of Chronic Kidney Disease with Infectious Disease Bertrand L. Jaber, M.D. Tufts University School of Medicine, Boston, MA
Associations of Chronic Kidney Disease with Infectious Disease Bertrand L. Jaber, M.D. Tufts University School of Medicine, Boston, MA KDIGO Controversies Conference, Amsterdam, The Netherlands October
More informationDepartment of Nephrology and Immunology (Medizinische Klinik II) RWTH University Clinic Aachen, Germany
Department of Nephrology and Immunology (Medizinische Klinik II) RWTH University Clinic Aachen, Germany Aachen, Germany RWTH Aachen University Hospital NAME OF THE UNIT: Department of Nephrology and Immunology
More informationUrine Protein/Creatinine Ratio as a Mortality Risk Predictor in Non-Diabetics with Normal Renal Function
JOURNAL OF INSURANCE MEDICINE Copyright E 2012 Journal of Insurance Medicine J Insur Med 2012;43:76 83 MORTALITY Urine Protein/Creatinine Ratio as a Mortality Risk Predictor in Non-Diabetics with Normal
More informationICD Codes: Utility for Classification of CKD by Severity, Treatment and Diagnosis
ICD Codes: Utility for Classification of CKD by Severity, Treatment and Diagnosis Lesley Stevens MD MS Tufts-New England Medical Center Boston, MA Robert Jakob MD Medical Officer, Classifications and Terminologies
More informationUpdate in Contrast Induced Nephropathy
Update in Contrast Induced Nephropathy Yves Pirson Service de Néphrologie, Clin. Univ. St-Luc - UCL A 76-year-old man with - type 2 diabetes - CKD (ser. creat.: 1.8 mg/dl; GFR: 32) presents with angina
More informationElectronic Health Record Strategies for Pay for Performance. James O Connor MD Director of Clinical Informatics
Electronic Health Record Strategies for Pay for Performance This Title is Copy where the title would go. James O Connor MD Director of Clinical Informatics Early Days of EMR... Access to Records E&M Coding
More informationIM 655 Nephrology Clerkship. Selective/Elective Clerkship Rotation Syllabus
IM 655 Nephrology Clerkship Selective/Elective Clerkship Rotation Syllabus Osteopathic Medical Specialties Mary Hughes DO Chairperson, Instructor of Record Mary Hughes DO hughesm@msu.edu (100% for CLIFMS
More information