Diabetes renalis

this article describes the illness diabetes renalis. For information to diabetes insipidus renalis, see diabetes insipidus

as diabetes renalis a malfunction of the kidney one designates, which is characterized with normal glucose tolerance and not increased blood sugar mirror by a durable elimination of glucose in the urine (Glukosurie). Synonymous names are diabetes innocens, diabetes innocuus, kidney diabetes, kidney urine Ruhr, Normoglykämi Glukosurie or primary one renale Glukosurie. The symptom picture diabetes renalis 1895 was described for the first time. Swiss child physician Guido Fanconi coined/shaped 1931 the designation family one renale Glukosurie. Apart from innate diabetes renalis there are beyond that and temporary forms also acquired. Since this disturbance remains free and as a rule almost symptom-freely and thus for the patients and admits no late sequences are, a therapy is as a rule not necessary.

a cause

blood glucose arrives with the formation of the urine in the kidney first over the Glomeruli into the primary urine. From this it is under normal conditions back-absorbed completely actively and supplied to the bloodstream again. The Reabsorption happens thereby in the proximal sections of the Nierentubuli. A disturbance of these Reabsorption of glucose in the kidneys can be left either autosomal incompletely rezessiv and thus innately been (family form diabetes renalis), or it been based on acquired changes of the kidney function. As physiological basis there are two possibilities:

1. a reduced function of the glucose transporters in the kidney with a reduced Reabsorbtion for glucose (decreased maximum glucose transportation capacity, TmG)
2. a decrease of the kidney threshold for glucose with an increased delivery of glucose into the urine (normal maximum glucose transportation capacity, TmG)

according to Reubi can be differentiated between a type A, simultaneous being present of both disturbances, and a type B, exclusive being present of a reduced kidney threshold with normal Reabsorbtionsrate. This distinction is questioned however by some authors. When type 0 became so far only once a described form designation, which is characterized by a complete absence of the Reabsorbtion. For the autosomal incompletely rezessiv left form diabetes renalis was identified a mutation of the gene for the sodium glucose Cotransporter SGLT2 in the kidney. Further investigations resulted in that the extent of the Glukosurie probably depends on the kind and situation of the mutation as well as on being present the mutation in homozygoter or heterozygoter form.

With the acquired form a sinking of the kidney threshold is usually present . A possible cause is an acute or chronic inflammation of the kidney. This form diabetes renalis can appear beyond that also temporarily as accompaniment of a pregnancy and also as Schwangerschaftsglukosurie is then designated. As a cause here a pregnancy-conditioned rise of the suprarenal body hormones is considered. A temporary renale Glukosurie was described beyond that as possible accompaniment of an illness at Tetanus as well as with kidney transplant ions. Also being present of a transient Glukosurie with newborn children is far common.

diagnosis

primary diagnostic characteristic is the proof of a durable glucose elimination in the urine. Characteristic for the diabetes renalis thereby the Konstanz of the Glukosurie, of food intake, is as far as possible independent gift of insulin or oral Antidiabetika or physical load. For the differential diagnosis (demarcation) in relation to diabetes mellitus, with which a Glukosurie can likewise appear as symptom, serves a glucose tolerance test, which precipitates when being present diabetes renalis normally. Also a family anamnesis can be helpful with the diagnosis. For demarcation in relation to other disturbances of the kidney function the determination of the elimination rate of other substances, which are reabsorbiert at the proximal Tubuli, is possible.

Further illnesses or conditions, with which a Glukosurie can occur passing or durably than symptom, are for example Akromegalie, disease Cushing, Hyperthyreose, Phäochromozytom, tumors of the alpha cells of the Langerhans islands, cardiac infarct, Pankreatitis, pneumonia, blood high pressure, living ore erring trousers, disease Wilson, illnesses and/or injuries of the central nervous system, Fanconi syndrome, various Nephropathien, poisonings, longer continuing chamfering conditions as well as acute or chronic oxygen deficiency. An appropriate differential diagnosis is necessary also here for the specific proof possible diabetes renalis.

The ICD10-Code for the diabetes renalis reads E74.8, together with essential Pentosurie,Oxalose and Oxalurie as “other one disturbances of the coal hydrate metabolism” specified in more detail. The code for a Glukosurie of an unclear cause is R81.

frequency

for the frequency of the family form diabetes renalis does not give it reliable data. Refuge Bibergeil indicates an estimation of 0,3 per cent in an older study. The age group of 18 to 49 years is with priority concerned. This however possibly is to attribute due to the usually symptom-free process, also to a late diagnosis in the context of a routine investigation. Men are more frequently concerned than women.

symptoms and therapy

when exclusive being present diabetes renalis exist under normal conditions no clinically relevant symptoms, so that a specific therapy is usually not necessary. The occurrence of a increased urine elimination (Polyurie) and an increased thirst and hunger feeling (Polydipsie and Polyphagie) is possible. Diabetes renalis can, usually during physical load, due to which increased glucose elimination occasionally also and release thus temporarily symptoms of a mild Unterzuckerung (Hypoglykämie) cause a reduced blood sugar mirror. About ten to twelve per cent of the concerning suffer occasionally from difficulty in breathing (dyspnea), weakness, nervousness, tiredness or a tightness feeling in the thorax (Stenokardie).

prognosis

for the diabetes renalis no long-term sequences are well-known, so that generally from a benignen process without Progredienz one proceeds. The height of the Glukosurie can even decrease in the course of the life, since it can come to one also with healthy humans arising rise of the kidney threshold. When being present mild diabetes renalis without the occurrence of further symptoms such as Polyurie, Polydypsie, Polyphagie and Hypoglykämie for these reasons a relevance than illness is partly questioned. A transition diabetes renalis in diabetes mellitus in the literature in the form of drop descriptions documented several times. Whether however being present diabetes renalis is generally connected with a increased risk to get sick later with diabetes mellitus is not secured. Relevant long-term Followup studies did not furnish appropriate references.

literature

• various authors: Ten year follow UP report on Birmingham diabetes Survey OF 1961. Report by the Birmingham diabetes Survey Working party. In: British Medical journal. July 3/1976. BMJ Publishing Group Ltd., S. 35-37, ISSN 0959-8146
• W.W. Chen, L. Sese, P. Tantakasen, V. Tricomi: Pregnancy associated with renal glucosuria. In: Obstetrics & Gynecology. 47/1976. Lippincott, Williams & Wilkins, S. 37-40, ISSN 0029-7844
• O. Gotz: Renal glucosuria and aminoaciduria. In: Acta Medica Scandinavica. 202 (1-2) /1977. Almqvist & Wiksell, S. 65-7, ISSN 0001-6101
• A. Secchi, A. Hadj Aissa, N. Pozet, J.L. Touraine, G. Pozza, J.M. Dubernard, J. Carrier: Renal glucose transport after kidney transplantation. In: European journal OF Clinical Investigation. 14 (2) /1984. Blackwell Publishing, S. 142-145, ISSN 0014-2972
• J. Brodehl, B.S. Oemar, P.F. Hoyer: Renal glucosuria. In: Pediatric Nephrology. 1 (3) /1987. Springer publishing house GmbH, S. 502-508, ISSN 0931-041X
• M. Serrano Rios: Renal diabetes (primary renal glycosuria): A short overview. In: Negotiations of the German society for internal medicine. 93/1987. Miner Munich, S. 512-517, ISSN 0070-4067
• Dietrich Michaelis: Differential diagnosis diabetes mellitus. Section 7.3.1: Diabetes renalis (family Glukosurie). (S. 193-194) and section 7.3.2: Begleitglukosurien with endokrinen and organic illnesses. (S. 194-195). In: Refuge Bibergeil (Hrsg.): Diabetes mellitus. A reference book for diabetologische practice. VEB Gustav Fischer publishing house, Jena 1989, ISBN 3-33-400087-7
• G. - R. Rezaiana, P. Khajehdehia, S. Beheshtib: Transiently Renal Glucosuria in Patients with Tetanus. In: Nephron. 80/1998. S. Meager AG, S. 292-295, ISSN 0028-2766
• L.P. van the Heuvel, K. ASS ASS, M. Willemsen, L. Monnens: Autosomal recessive renal glucosuria attributable ton of A mutation into the sodium glucose more cotransporter (SGLT2). In: Human Genetics. 111 (6) /2002. Springer publishing house GmbH, S. 544-547, ISSN 0340-6717
• S. Scholl Bürgi, R. Santer, J.H.H. Ehrich: Long term outcome OF renal glucosuria type 0: the original patient and his natural history. In: Nephrology Dialysis Transplantation. 19 (9) /2004. Oxford journal Oxford University press, S. 2394-2396, ISSN 0931-0509

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