SBI241 Case Study: Understanding Diabetes and Chronic Kidney Disease

This case study examines the relationship between diabetes and chronic kidney disease, focusing on a 58-year-old female patient with stage 3B CKD. It discusses the pathophysiological mechanisms by which poorly controlled diabetes leads to kidney damage, including hyperglycemia, glomerular hyperfiltration, and increased intra-glomerular pressure. The case highlights the importance of managing blood pressure, diet, and lifestyle to slow the progression of kidney disease. The management goals at stage 3B are aimed at preventing further loss of kidney function through lifestyle modifications, dietary changes, and stress reduction. Desklib offers a platform for students to access similar solved assignments and past papers for enhanced learning.

Pathophysiology

Table of Contents
QUESTION 1...................................................................................................................................3
QUESTION 2...................................................................................................................................3
REFERENCES................................................................................................................................1

QUESTION 1
Diabetes is one of the main cause which cause chronic kidney disease as well as end
stage of kidney disease also known as ESKD (Ammirati, 2020). Diabetic kidney disease is one
of the complex as well as heterogeneous disease which have various extend over of etiologic
pathways. If the patients diabetes is poorly controlled there are various symptoms which affect
the health. These symptoms are high blood glucose, getting infected frequently, increase in
urination, increase in thirst, diabetic ketoacidosis, appetite is increased which does not lead to
weight gain and various others (Kakitapalli, and et.al., (2020)). This can lead to various other
disease one of them is a chronic kidney diesease which takes place due to the side effects of
diabetes. The effect of chronic kidney disease is damaged kidney and the blood is not being
filtered properly.
In the early diabetes critical metabolic changes promote inflammation as well as alter the
Kidney hemodynamics and fibrosis. These include hyperglycemia, hyperaminoacidemia as well
as act as a promoter of hyper perfusion and glomerular hyperfiltration. Glomerular hyper
filtration is increased with the help mechanisms where the contribution is of obesity and
systematic hypertension in level 2 of diabetes mellitus. The effect of this is high blood pressure
and glomerular enlargement. The well recognized effect of early diabetes is Glomerular Hyper
filtration. This effect is observed in around 40% of patients with level 2 of diabetes mellitus and
around 10 to 40 % or 75% patients of level 1 of diabetes mellitus. Mechanisms are not
completely understood under glomerular hyper filtration that is present in diabetes. There is a
mechanism which makes increase in proximal tubular reabsorption of glucose plausible. This is
done with the help of sodium glucose cotransporter. This helps the body to decrease particularly
sodium chloride, distal delivery of solutes, till the macula densa. Increase in glomerular
perfusion with the help of afferent arteriole is the result of decrease in the level of
tubuloglomerular feedback. At the same time angiotensin local production is high during the
process of produce of vasoconstriction of arteriole. This results into high level of glomerular
hyper filtration and intra glomerular pressure (Jankowski, and et.al., 2021).
QUESTION 2
There are various stages of chronic disease. Jennifer who is a 58 years old female is
suffering from stage 3B because the GFR is at 32ML/min/1.73m2 (Rady, & Anwar, 2019). The

goal of management at stage 3B is to reduce the further loss in function of kidney. The
symptoms of this stage is fatigue, weakness, back pain, increased blood pressure and various
others. At this stage it is difficult to cure the disease as the stage 3b is middle stage of chronic
kidney disease. But the management will try to prevent it from moving to stage 4 of chronic
kidney disease. They prevent the kidney from getting damaged by changing the lifestyle of the
person as well as changes in the treatment. The doctor will suggest doing some changes in the
diet and routine. Here the patients will have to exercise as well as manage their blood pressure
and reduce the stress (Lalau, and et.al., 2018).

REFERENCES
Books and journals
Ammirati, A. L. (2020). Chronic kidney disease. Revista da Associação Médica Brasileira. 66.
s03-s09.
Kakitapalli, Y. and et.al., (2020). Detailed review of chronic kidney disease. Kidney Diseases.
6(2). 85-91.
Jankowski, J. and et.al., (2021). Cardiovascular disease in chronic kidney disease:
pathophysiological insights and therapeutic options. Circulation. 143(11). 1157-1172.
Rady, E. H. A., & Anwar, A. S. (2019). Prediction of kidney disease stages using data mining
algorithms. Informatics in Medicine Unlocked, 15, 100178.
Lalau, J. D. and et.al., (2018). Metformin treatment in patients with type 2 diabetes and chronic
kidney disease stages 3A, 3B, or 4. Diabetes Care. 41(3). 547-553.
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