Diabetic nephropathy

Diabetic nephropathy refers to damages on the kidney due to its affectation on the disease processes involved in diabetes mellitus (DM). ^[1] Among the features of the condition are albuminuria, increased blood pressure in the arteries and progressive decline in the glomerular filtration rate which can lead to end stage kidney disease that frequently necessitates dialysis or transplantation. ^[2]

Epidemiology

After a patient has been diagnosed with DM, approximately the occurrence of diabetic nephropathy is about 1 to 2 decades after. 20 to 30% of DM patients develop the syndrome. Diabetic nephropathy is actually the top cause of end stage kidney disease in the United States and is responsible for a significantly huge percentage of new cases reported. The syndrome is more common in certain races such as Mexican-Americans and African-Americans.  ^[2]

Causes

The exact cause is unknown. In diabetic renal disease, the kidney structures called nephrons, which function to filter blood in waste elimination processes, become thickened and scarred in due course until leakage ensues and proteins are spilled into the urine. Early on, this damage can occur silently thus the person does not manifest any observable symptom. Only on the late part of the syndrome does the person show off symptoms.  The good thing is that not all DM patients develop the condition.                                                   

The factors identified that increases the chance of a diabetic patient to develop renal ailment are obesity, uncontrolled hypertension, poor sugar control, hyperlipidemia, positive family history, smoking and having an African descent.  ^[1][2]

Signs and Symptoms

Symptoms are often nonspecific like fatigue, headache, nausea and vomiting and poor appetite. As the organ damage becomes more severe, the patient can have leg swelling. ^[1]

Diagnosis

Regular urine tests are important since the syndrome can be detected even before symptoms show off.  Blood pressure should also be monitored. Kidney biopsy is confirmatory.

Blood tests to check the kidney function are equally important. These include getting the levels of BUN and serum creatinine. ^[1][3]

Treatment

To slow down the damage, it is imperative to control the blood pressure. This is often done thru medicines like ACE inhibitors. Controlling the blood sugar and cholesterol thru medicines, exercise and diet are essential measures to thwart or slow down the injurious processes to the kidney^{.  [1] [2]}

References:

1.      http://www.nlm.nih.gov/medlineplus/ency/article/000494.htm

2.      https://www.clinicalkey.com/topics/nephrology/diabetic-nephropathy.html

3.      http://diabetes.webmd.com/tc/diabetic-nephropathy-topic-overview

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Pine Bark Extract [1, 2, 3, 4]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (There is insufficient evidence to support claims that Pine Bark extract helps to treat diabetes)

Grade of Evidence: very low quality of evidence

* www.gradeworkinggroup.org

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.clinicaltrials.gov/ct/show/NCT00214032

3. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/pine-bark-extract

4. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-pycnogenol.html