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Author Topic: What causes proteinuria in diabetes?  (Read 2419 times)

Offline raju_ayer

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What causes proteinuria in diabetes?
« on: 12/04/2013 16:26:31 »
Hello..can you please tell me this:

A chronic diabetic with a history of more than 30 years of Type 2 diabetes shows symptoms of anemia, fatigue, and has a serum creatinine value of
3.4 mg/dl and excretes about 300 mg of protein per day. His insulin requirements have been reduced. What macrovascular complication is he having?

Liver damage or Neuropathy or Nephropathy or Muscle wasting due to muscular dystrophy??

Thanks
« Last Edit: 14/04/2013 11:03:02 by chris »


 

Offline RD

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Re: What kind of disease is this?
« Reply #1 on: 12/04/2013 17:51:44 »
... What macrovascular complication is he having?

I vote for so-called* diabetic-nephropathy,
( and a typo in the question which should be microvascular not "macrovascular").


* IMO the so-called "sequelae of diabetes" , (which includes nephropathy, neuropathy, retinopathy),  are caused by microvascular disease which is not caused by diabetes , but that this microvascular disease has caused the diabetes: vasculopathic endocrinopathy, i.e. so-called "sequelae of diabetes" are not sequelae, but are (strongly) associated with diabetes because they have a common origin in systemic microvasular disease.

 ( However you will be burned at the stake for heresy if you repeat this ).
« Last Edit: 12/04/2013 18:10:54 by RD »
 

Offline raju_ayer

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Re: What kind of disease is this?
« Reply #2 on: 12/04/2013 18:20:34 »
hey thanks..even I answered it as nephropathy..it was asked in an exam of mine..and the question paper said "macrovascular"..don't worry I'm not gonna repeat it..
cheers
 

Offline cheryl j

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Re: What kind of disease is this?
« Reply #3 on: 12/04/2013 20:32:57 »
Uncontrolled diabetes damages tiny blood vessels (the capillaries.) It does the most damage in delicate structures like the eye and the kidneys. If the kidneys become damaged, protein in the liquid portion of blood will leak through the capillaries and show up in the urine. Creatinine is a normal product of muscle metabolism. It is made by the muscles and excreted by the kidneys at a constant rate. Creatinine clearance is used to measure kidney function. I'm not sure how to interpret serum creatinine alone. Usually the test measures serum creatinine and urine creatinine and compares the two to see how the kidney is functioning. The normal values depend on whether the person is male or female and their estimated muscle mass (based on height and weight I believe.)

Long term uncontrolled diabetes will also damage the blood vessels that supply blood to nerves. Without an adequate blood supply, the nerves themselves can be damaged and not function properly, affecting sensation and the function of whatever those nerves control.  This called neuropathy. It may result in numbness or insensitivity to pain. I know a diabetic who was sitting too close to a wood stove and burned the bottom of his foot because he could not feel the pain.

These things are sequelae or results of diabetes. The diabetes itself is caused by the pancreas not producing the hormone insulin. Insulin makes cells of the body take up glucose. Without insulin, the sugar just stays in the blood system. Type two diabetes may also be caused by cells becoming more resistant to insulin, even though the pancreas is making normal amounts of it.
« Last Edit: 12/04/2013 20:42:08 by cheryl j »
 

Offline RD

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Re: What kind of disease is this?
« Reply #4 on: 12/04/2013 20:59:23 »
Uncontrolled diabetes damages tiny blood vessels (the capillaries.) ...

Q. If "uncontrolled diabetes" (hyperglycemia) was the cause of the vasculopathy, then why do type-1 diabetics with tight glycemic control still go blind with undue frequency ?

A. A disease process other than diabetes is responsible for the systemic microvascular disease, ( causing vasculopathy, which amongst other things has caused the diabetes ) . So treating the diabetes, (tight glycemic control), does not stop the progression of the microvascular disease which caused the diabetes, (vascular endocrinopathy), and which also causes neuropathy nephropathy retinopathy and gangrene via vasculopathy.
« Last Edit: 12/04/2013 21:37:04 by RD »
 

Offline cheryl j

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Re: What kind of disease is this?
« Reply #5 on: 13/04/2013 16:45:22 »
That's interesting. If you can provide any sources, I'd appreciate it. But when I looked around briefly - the Mayo Clinic Website, NCBI and JAMA articles, Nathional Eye Institute, American Academy of Opthamology website, they all say that diabetic retinopathy and macular degeneration are caused by sugar damaging the inside of capillaries. High blood pressure also increases the risk of retinopathy.

Type one diabetes is an autoimmune disease where the immune system destroys the cells in the pancreas that produce insulin. Perhaps there could also be an autoimmune attack on other tissues, but I could no find information suggesting this was the cause of the vasculaopathy or damage to eyes.
 

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Re: What kind of disease is this?
« Reply #5 on: 13/04/2013 16:45:22 »

 

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