Diyabetik Nefropatide Tıbbi Beslenme Tedavisi

Diabetik nefropati, son dönem böbrek yetmezliğinin en önemli nedenlerinden biridir. Tip 1 ve tip 2 diabetes mellituslu hastaların %40ını etkiler. Diabetik nefropati, artmış glomerüler permeabilite nedeniyle belirli proteinlerin aşırı atımı ile karakterizedir ve bu glomerül hasarın derecesi ile koreledir. Nefropatinin gelişmesi veya hızlanmasında, diyabet kontrolünün kötü olması, hipertansiyon, dislipidemi, genetik etmenler, sigara, dengesiz beslenme gibi birçok etmenin etkisi olabilir. Diyabetik nefropati patogenezinde, hemodinamik etmenler, glukoza bağımlı yollar (glikasyon son ürünleri), poliol yolu, protein kinaz C aktivitesinde artış, sitokinler sorumlu tutulur. Diyabetik nefropati 5 evrede izlenir. İleri evresi son dönem böbrek yetmezliğidir ve renal replasman tedavisi (diyaliz, transplantasyon) uygulanır. Diyabetik nefropatinin önlenmesinde bozukluğa neden olabilecek bilinen risk etmenlerinin ortadan kaldırılması önemlidir.

Medical Nutrition Therapy in Diabetic Nephropathy

Diabetic nephropathy is the leading cause of end-stage renal diseases. It affects 40% of type 1 and type 2 diabetic patients. Diabetic nephropathy is characterized by excessive protein excretion caused by increased glomerular permeability and correlated with the glomerular damage grade. In development and acceleration of nephropathy, some factors such as, uncontrolled diabetes, hypertension, dyslipidemia, genetic factors, smoking, imbalanced nutrition play important roles. In pathogenesis of nephropathy, hemodynamic factors, glucose dependent pathways (advanced glycation endproducts), polyol pathway, increased of protein C kinase activity, and cytokines are responsible. In diabetic nephropathy there are 5 stages. The final phase is stage five kidney diseases, also known as kidney failure or end-stage renal disease. Patients in this phase require dialysis or transplantation to survive. Prevention from nephropathy, to control the risk factors is very important.

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1.National Hemodialysis, Transplantation and Nephrology Registry Report of Turkey, Pasifik Reklam ve Tanıtım Hizmetleri / Metris Matbaacılık, 2009
2.Newman DJ, Mattock MB, Dawnay AB. Systematic review on urine albumin testing for early detection of diabetic complications. Health Technol Assess 2005; 9:iii.
3.Yıldız A, Sekonder Glomerüler Hastalıklar, Erol Ç, İç Hastalıkları, Ankara: Nobel Tıp Yayınları; 2008. s2861- 2868.
4.Parving HH, Osterby R, Anderson PW, Hsueh WA. Diabetic Nephropathy. In Brenner BM editor. In The Kidney. Philadelphia: W.B. Saunders; 1996. p1864-92.
5.Kurt M, Atmaca A, Gürlek A. Diyabetik nefropati. Hacettepe Tıp Dergisi, 2004;35:12-17
6.Tuğrul A. Diyabetik nefropati. Trakya Üniversitesi Tıp Fakültesi Dergisi. 2002;19(2):113-121.
7.ADA Position Statement. Nephropathy in diabetes. Diab Care 2004;27(Suppl 1):79-83.
8.EMD Diyabetus Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu, 2011.
9.National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis 2007;49(suppl 2):1-180.
10.The Diabetes Control and Complications (DCCT) Research Group. Effect of intensive therapy on the development and progression of diabetic nephropathy in the diabetes control and complications trial. Kidney Int 1995;47:1703-1720.
11.UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998;352:837-53.
12.National Kidney Foundation. KDOQI clinical practice guideline for diabetes and CKD: 2012 Update. Am J Kidney Dis 2012;60(5):850-886.
13.Standards of Medical Care in Diabetes. Diab Care 2007;30(suppl 1):4-41.
14.National Kidney Foundation. KDOQL Clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Dis 2004;43(suppl 1):1-290.
15.Gross Jl, Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropaty: diagnosis, preventation, and treatment. Diab Care 2005;28(1):164- 176.
16.Buse JB, Ginsberg HN, Bakris GL, et all. Primary preventation of cardiovascular disease in people with diabetes mellitus, ADA. Diab Care 2007;30(1):162- 172.
17.Grundy SM, Brewer HB, Cleeman JI, Smith SC, Lenfant C. Definition of metabolic syndrome: Report of the National Heart, Lung and Blood Institute/American Heart Association Conference on scientific issues related to definition, AHA. Circulation 2004;109:433- 438.
18.Standards of Medical Care in Diabetes, Position of Statament. Diab Care 2008:13-54.
19.NKF-KDOQI Adult Guidelines Appendices, Appendix VII. Methods for Performing Anthropometry and Calculating Body Measurements and Reference Tables, 2000.
20.Fouque D, Vennegoor M, Wee PT, Wanner C, Başcı A, Canaud B, et al. EBPG guideline on nutrition. Nephrol Dial Transplant 2007;22 (suppl 2):4587.
21.Tom K, Young VR, Chapman T, Masud T, Akpele L, Maroni BJ: Long-term adaptive responses to dietary protein restriction in chronic renal failure. Am J Physiol 1995;268:668-677.
22.NKF-KDOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure, Guidlines 25: Dietary Energy Intake For Nondialyzed Patients, 2000.
23.Ikizler TA, Wingard RL, Sun M, Harvell J, Parker RA, Hakim RM. Increased energy expenditure in hemodialysis patients. J Am Soc Nephrol 1996;7:2646- 2653.
24.Koya D, Haneda M, Inomata S, Suzuki Y, Suzuki D, Makino H, Shikata K, Murakami Y, Tomino Y, Yamada K, Araki SI, Kashiwagi A, Kikkawa R. Long-term effect of modification of dietary protein intake on the progression of diabetic nephropathy. Diabetologia 2009:52;20372045.
25.Pijls LTJ, Vries H, Eijk JM, Donker AJM. Protein restriction, glomerular filtration rate and albuminuria in patients with type 2 diabetes mellitus. EJCN 2002;56(12):1200-1207.
26.Hansen HP, Tauber-Lassen E, Jensen BR, Parving HH. Effect of dietary protein restriction on prognosis ın patients with diabetic nephropathy. Kidney Int 2002;62: 220228.
27.Fouque D, Laville M, Boissel JP. Low protein diets for chronic kidney disease in nondiabetic adults. Cochrane Database Syst Rev 2006;(2): doi: 10.1002/14651858. CD001892.pub2.
28.Levin A, Hemmelgarn B, Culleton B, Tobe S, McFarlene P, Ruzicka M, Burns K, Manns M et al. Guidelines for the management of chronic kidney disease. CMA 2008;179(11):1154-1162.
29.Azadbakht L, Atabaks S, Esmaillzadeh A. Soy protein intake, cardiorenal indices, and C-reactive protein in type 2 diabetes with nephropathy. Diab Care 2008;31:648654.
30.National Kidney Foundation: K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 2000;35(suppl 2):1-140
31.Knight EL, Stampfer MJ, Hankinson SE, Spiegelman D, Curhan GC. The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency. Ann Intern Med 2003;138:460- 467.
32.Wrone EM, Carnethon MR, Palaniappan L, Fortmann SP. Association of dietary protein intake and microalbuminuria in healthy adults: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003;41:580-587.
33.Wright JD, Wang CY, Kennedy-Stephenson J, Ervin RB: Dietary intake of ten key nutrients for public health, United States: 1999-2000. Centers for Disease Control and Prevention, National Center for Health Statistics, 2003:1-4.
34.Standards of Medical Care in Diabetes. Diab Care 2006;29(suppl 1):4-42.
35.Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001;344:3-10.
36.Azadbakht L, Shakerhosseini R, Atabak S, Jamshidian M, Mehrabi Y, Esmaill-Zadeh A. Beneficiary effect of dietary soy protein on lowering plasma levels of lipid and improving kidney function in type 2 diabetes with nephropathy. Eur J Clin Nutr 2003;57:1292-1294.
37.Gross JL, Zelmanovitz T, Moulin CC, et al. Effect of a chicken-based diet on renal function and lipid profilein patients with type 2 diabetes. Diab Care 2002;25:645- 651.
38.Food and Nutrition Board, Institute of Medicine of the National Academies: Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (macronutrients). Washington DC, National Academies Press, 2005
39.Dias VM, Pandini JA, Nunes RR, Sperandei SL, Portella ES, Cobas RA, Gomes Mde B.Influence of dietary glycemic index on anthropometric and biochemical parameters in patients with type 1 diabetes. Arq Bras Endocrinol Metabol 2010;54(9):801-806.
40.Standards of Medical Care in Diabetes. Diab Care 2005;28(suppl 1):4-36.
41.Snow V, Aronson MD, Hombake ER, Mottur-Pilson C, Weiss KB. Lipid control in the management of type 2 diabetes mellitus: A clinical practice guideline from The American College of Physicians. Ann Intern Med 2004;140:644-649.
42.Haffner SM. Dyslipidemia management in adults with diabetes. Diab Care 2004;27(Suppl 1):S68-S71.
43.Johnson RJ, Herrera-Acosta J, Schreiner GF, Rodriguez-Iturbe B. Subtle acquired renal injury as a mechanism of salt-sensitive hypertension. N Engl J Med 2002;346:913-923.
44.NKF-KDOQI Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease, Guideline 6: Dietary and Other Therapeutic Lifestyle Changes in Adults. http://www. kidney.org/professionals/kdoqi/guidelines_bp/guide_6. htm, 2002.
45.Akal Yıldız E. Böbrek Hastalıklarında Beslenme. Sağlık Bakanlığı Yayınları, 2008.
46.NKF-KDOQI updates clinical practice guidelines and recommendations hemodialysis adequacy, peritoneal dialysis adequacy. Vascular Access 2006:3-405.
47.EBPG guideline on nutrition. Nephrol Dial Transplant 2007;22(2):45-87.
48.Coburn JW, Elangovan L. Prevention of metabolic bone disease in the pre-end-stage renal disease setting. J Am Soc Nephrol 1998;9:71-77.
49.NKF-KDOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42(suppl 3):1-201.