Скачать или смотреть Diabetes Mellitus | How Diabetes Destroys Your Kidneys

Diabetes Mellitus is a Disease which is Ubiquitous. Almost Everybody, has a Family Member, who is suffering from Diabetes Mellitus and its Complications. Diabetes is a Silent Disease. It is a Non-communicable disease, but, the Most Dangerous Disease. Diabetes itself affects Every Organ of the Body. It causes Paralysis in the Brain. It causes Myocardial Infarction Heart Attacks. It causes Vasculopathy Neuropathy and Amputations of the feet. And, of course, Diabetes affects Kidney. Previously, it was called as Diabetic Nephropathy. But now, it has been called as Diabetic Kidney Disease. This Simplifies the Term and, makes it Lucid, to Understand, for the General Public, and, the Patient and Relatives.

00:00 Diabetes Mellitus. Multiple Organ Involvement. Diabetic Kidney Disease DKD
00:44 Diabetes. And other causes for need for Chronic Dialysis
01:10 Metabolic Syndrome in Indians
01:34 Diabetes effect on Kidney Function and Structure. Afferent Arteriole. Efferent Artereriole. Glomerular Basement Membrane (GBM). Filtration Slit. Mesangial Cells. Tubulo Glomerular Feedback (TGF). Macula Densa
03:51 Mechanism of Proteinuria. Overt Proteinuria
04:13 Usual Minor leak of proteins. Physiological.
04:39 Osmotic diuresis. Temporary effect.
04:56 Permanent effect.
05:06 Renin Angiotensin Aldosterone System (RAAS), Radical Oxygen Species (ROS). TGF beta. Nitric Oxide
05:48 Slow Fall, Decline in Function and Structure.
06:12 Staging. Hyper-Filtration. Hypo-Filtration. Albuminuria. Curve shaped, Paradoxical up then down. Both GFR and Albuminuria.
08:02 CKD stage one to five. 1, 2, 3a, 3b, 4, 5.
09:13 Albuminuria. A1 A2 A3.
09:38 Microscopy Light Microscopy Immuno-fluorescence Electron Microscopy. KW Lesions Kimmelstiel Wilson Nodules.
10:27 Usual GFR decline as per age
10:43 GFR decline in Diabetic
11:06 Management. Lifestyle. Diet. ACE inhibitor RAAS Dapagliflozin
12:51 Calcium Phosphorus Uric acid
13:06 Team work. Focus is Patient
13:38 Renal replacement therapy RRT Vascular Access AV fistula. Counselling
14:19 Acute Kidney Injury
14:30 Dialysis
14:43 Diabetologist to check Kidney, Once a Year

If you enter any Dialysis Department, then around 60% of the Patients on Dialysis, that is End Stage Kidney Disease, would be having Diabetes Mellitus, as the Primary Cause. While Hypertension would be around 30%, Painkiller Abuse Medicine Abuse and Stone, would be around 10%. And, 10% would be Unknown, in which there are Small Shrunken Kidneys, and whatever test you do, you may never ever come to find the Cause, for End Stage Kidney Disease.

In India, there is something called as the Metabolic Syndrome. That is a Triad of Diabetes Mellitus, Hypertension, Dyslipidemia, associated with Obesity. And all these factors, together cause more Morbidity and even Mortality in Indian Patients. So, Diabetic Kidney Disease, as a part of the Metabolic Syndrome is a requirement for Research by Nephrologist in India.

Diabetes Mellitus leads to very high Sugar. Now that very high Sugar finally reaches the Filters of the Kidney, the Glomeruli. And the Glomerular Corpuscle, is the place, where the primary effects of high Sugar occur.

Now the Glomerulus Corpuscle consists of various Cells. There is the Afferent Arteriole. There is the Efferent Arteriole. There are the Glomerular Capillaries, in between. And those are having the Endothelial cells inside, and, outside are the Podocytes, which are covering the Glomular Tuft.

Now the area between the Endothelial cells and the Podocytes, forms a fusion, that is called as the Glomular Basement Membrane. Now the Glomerular Basement Membrane opens into the Filtration Slit, which is in between the inter-digitated Pedicels of the Podocytes. Which means that, the adjoining ones, are from Different cells. Now whenever the Glomerular Basement Membrane is seen, it is around 300 nanometers in thickness, while the Perforations are approximately 80 nanometers in size. There is also a Charge-selectivity and a Size-selectivity of the Glomerular Basement Membrane. That is why, the negatively-charged Albumin is repelled back into the Blood Circulation. The Solutes and the Solvents, they all come out, as the Ultra-filtrate, in between the filtration slits.

Diabetes mellitus High sugars also affect the Mesangial Cells. The Mesangial Cells, are the ones, which are the Frame-work of the Glomerular Tuft. And they are, there for clearing out the various Proteins which are Deposited there. In Diabetes Mellitus, there would be a Decrease in the Clearance of the Proteins from the Space. So there will be Mesangial Expansion, next to the Mesangial Cells. And also there would be Apoptosis, that is Death of the Mesangial Cells. So, the Structure of the Glomerulus gets Damaged. Now this is going to be a Diseased Glomerulus. Also there will be a Problem with the Tubular Glomular Feedback (TGF), which is for the Proper Functioning of the Glomerulus per se.