Question

A patient is being seen due to vision changes, a burning sensation in his feet, and decreasing amounts of urine when he uses the bathroom. He has a long-standing history of hypertension and hyperlipidemia. Your physical assessment reveals retinal hemorrhages in both eyes, and decreased sensation to moderate touch in the soles of his feet. A spot urinalysis shows microalbuminuria and a stat Basic Metabolic Profile (BMP) shows decreased Glomerular Filtration Rate (GFR).

My initial diagnosis is diabetes mellitus type 2 with diabetic complications such as diabetic retinopathy, nephropathy and neuropathy.

1. Describe the pathophysiologic processes related to your diagnosis that explain the signs/symptoms, and lab results obtained.

2. State the effect of his symptoms on his life expectancy and the rationale for your answer.

Answer 1

Diabetic nephropathy is a kidney disease caused by damage to the capillaries in the kidneys due to long-standing diabetes mellitus. High levels of glucose in the blood lead to damage of blood vessels and nerves, resulting in symptoms and lab results observed in the patient. These complications can have a significant impact on life expectancy.

Step-by-step explanation:

Diabetic nephropathy is a progressive kidney disease caused by damage to the capillaries in the glomeruli of the kidneys due to long-standing diabetes mellitus. High levels of glucose in the blood in diabetes can lead to damage of glomerular capillaries. The patient's vision changes and retinal hemorrhages are consistent with diabetic retinopathy, which is caused by damage to the blood vessels in the retina. The burning sensation in the feet and decreased sensation are signs of diabetic neuropathy, which is caused by damage to the nerves in diabetes. Decreased Glomerular Filtration Rate (GFR) and microalbuminuria in the urine are indicative of diabetic nephropathy.

The symptoms and lab results observed are a result of the long-term impact of uncontrolled diabetes on various body systems. Persistently high levels of glucose in the blood lead to inflammation and injury of blood vessels, which can cause atherosclerosis, kidney damage, and impaired circulation to the limbs. Nerve damage results in a loss of sensation and contributes to the risk of injury and infection. The decreased GFR and microalbuminuria indicate impaired kidney function. These complications can significantly impact overall health and life expectancy.