Diabetic Nephropathy: Causes and Consequences Essay

Our study shows that frequency of nephropathy in patients undergoing diabetic foot amputation is 36.99% displaying that a worsening of kidney function would affect the treatment effect and prognosis of foot ulcers in patients with diabetic foot ulcers, implicating that it is very important to improve the kidney function in the treatment of patients with diabetic foot ulcers. Xiao and coworkers studied the relationship between kidney function and the therapeutic effect and prognosis of foot ulcers in the patients with DM and observe the time of growth of granulation tissue, the time of healing, the amputation rate, and mortality. Granulation tissue and healing time of ulcer prolonged with worsening of diabetic nephropathy regardless of the disease phase of foot ulcers. Granulation tissue and healing time in all the patients with the foot ulcers in the similar condition exhibited significantly positive linear correlation with the severity of diabetic nephropathy.[116]
Nather and colleagues found that nephropathy was a significant predictive factor for limb loss.[117] Some other studies have also found nephropathy to be a significant prognostic factor.[118-120] However, some investigators have disputed the predictive role of nephropathy.[121,122]
Although a correlation between Diabetic Foot and nephropathy is not proof of a causal relationship, some suggestions about underlying pathophysiological mechanisms can be made. Advanced glycation end-products have been implicated in diabetic complications, and their concentrations are increased in diabetic nephropathy. Podocytes express specific receptors for Advanced glycation end-products , and binding to these receptors induce podocyte pathology including induction of proteinuria [123]. Impairment of wound healing is a major feature of Diabetic Foot , and Advanced glycation end-products have also been implicated in this process. The blocking of Advanced glycation end-products improves diabetic nephropathy as well as restoring effective wound healing in diabetic mice, indicating a common pathophysiological pathway between these two diabetic complications [124].
Current literature indicates poor survival and limb salvage rates in patients with DM and kidney failure who present with ulcerated or gangrenous lower extremities.[125] Three major pathogenesis, neuropathy, ischemia, and infection, are the main contributory factors. Nephropathy appears to be an important predictor of long-term outcome of the treatment of diabetic foot ulcer.[126] Increasing awareness of the condition and careful clinical examination are indispensable to avoid serious complication.
One major advantage of our study is that , As a single centre study it offers the advantage of measurement of laboratory parameters in a central laboratory, under standardized conditions that may be not achievable if data are used from multiple practitioners who send their specimens in from various laboratories.
Some limitations to our study can be noted. One may argue that patients seen at a tertiary university center are highly selected. However, our outpatient clinic has the function of primary care for many of the studied patients and they do not have other physicians. We believe that we do not only see very severe or selected cases. This fact is also documented in the wide range of basic data of our patients (e.g. age, sex, duration of diabetes, etc.).