Diabetic nephropathy Mechanisms

One of the most seriouschronic compliions of diabetes mellitus is a condition known as diabetic nephropathy. Which, if you break down the term into nephro and pathy literally means kidney disease that occurssecondary to diabetes. And it's actually pretty common as it eventually affects about20% to 40% of all individuals

with diabetes, includingboth type I and type II. In this tutorial, let'stalk about the mechanism underlying the causeof diabetic nephropathy and how individuals withdiabetes develop the condition. So diabetic nephropathyis a chronic compliion of diabetes mellitus. Meaning, it usually has aslow progression over decades after the initial diagnosis of diabetes.

And to give you anoverview of what happens, an insulin deficiency due to the diabetes resultshyperglycemia, which then causes hypertensionand kidney dysfunction. This kidney function isactually then further worsened by the hypertension. And ultimately, all of thisresultskidney failure, which can have very severeand potentially even

life threateningcompliions, such as anemia, electrolyte imbalances,such as metabolic acidosis, and heart arrhythmias. Now, before we dive into the mechanism of diabetic nephropathy, let'sbriefly the structure of the glomerulusthe kidney, by bringinga diagram here. So, the glomerulus isthe portion of the kidney

where blood is initially filtered. So blood enters the glomerulus over here, through this afferent arterial, and then leaves the glomerulus throughthe efferent arterial. And you can remember this, that it leaves throughthe efferent arterial for E for exit, or efferent. And while the blood iswithin the glomerulus,

there's this advanced filtration system, which we'll talk about morea minute. And the filtered fluidthat exits the blood is known as a filtrate and it collectsBowman's space before it enters into thetubules of the nephron where further reabsorptionand secretion occurs before it exits the kidneyinto the ureters as urine.

Fluoroquinolones and Peripheral Neuropathy

Peripheral neuropathy, this is an often devastatingconditionwhich people develop pain and numbnesstheir hands and feet. Basicallythey're told on the evening news that they should be taking this or that mediion sothat they can get through life. That's treating the smoke and ignoring thefire. Those medicines that you're seeing advertised don't treat the neuropathy, they only treatthe symptoms. But what's causing peripheral neuropathy? Well we know thatAmerica,one of the biggest causes of peripheral neuropathy is being diabetic, which is clearly relatedto the foods that you eat by and large. Becoming a type 2 diabetic amatically increases yourrisk for having peripheral neuropathy and

fact being devastated by it. This is adisease that effects 115 Americans. Let's take a look. So again this is 115 Americans—thisis 20 million Americans afflicted by this disease, that aside from diabetes, we're toldthe cause is unknown. Well maybe that's not exactly true. Last month,the journal Neurology,an incredible study was published describing a relationship between what are called fluoroquinolones,and the risk of developing a peripheral neuropathy. You may not know what fluoroquinolones are,but chances are you may have actually been exposed to fluoroquinolone. These are antibioticsused for treating things like upper respiratory

infections and even urinary tract infections.Things like Levaquin and Cipro are commonly usedwalks. If you have a urinarytract infection, you may have received these mediations. Well, here's what the study showedus: So this is a study publishedSeptember2014 that looked at men between age 45 to 80 years of age followed for a 10 year periodandthis group there were over 6,000 cases of peripheral neuropathy. And they comparedthese individuals to about 25,000 aged match controls, and what they found was that riskfor developing this devastating condition called peripheral neuropathy was doubled inthose individuals exposed to this class of

antibiotics called fluoroquinolones. And whatthe researchers also told us is that, and I quote, quot;Fluoroquinolones have been shownto neurotoxic. Oral fluoroquinolones have also been associated with reported cases ofpsychosis and seizures, which similar to peripheral neuropathy have been shown to be acute eventsoccurring within days of fluoroquinolone use. In light of strong evidence of unnecessaryprescribing of oral fluoroquinolonesthe United States, ians must weigh the riskof PN against the benefits of prescribing FQ when prescribing these ugs to their patients.quot; We've got to practice medicine under the dictumof quot;above all do no harm.quot; One of our most

well respected peer journals is nowtelling us that the use of these mediions—these fluoroquinolone antibiotics is associatedwith doubling of the risk of peripheral neuropathy. A disease which often is not treatable. Sokeep thatmind the next time you think you need an antibiotic for this or that problem,discuss this study with your treating physician. I'm David Perlmutter.