Employees with diabetes and nephropathy need special medical surveillance that involves occupational medicine specialists. However, diabetes is not a unique phenotype and each patient need to be carefully assessed. Age, gender, body mass index, renal function impairment (eGFR, creatinine, urea, uric acid), indicators of diabetes control (fasting glycaemia and HbA1C), the presence of co-morbidities, dyslipidaemia, level of serum albumin and total protein, cytokines and other inflammatory markers should be considered in a comprehensive evaluation of the severity of the chronic kidney disease and of the treatment plan. Chronic kidney disease in type 2 diabetes has many facets and various degrees of severity; therefore, permanent communication between the occupational medicine specialist and the treating physician should be maintained. For this purpose, this article reviews the current pathological mechanisms proposed for the explanation of the chronic kidney disease, the diagnostic and the general therapeutic recommendations and also the possible occupational interventions in patients with type 2 diabetic nephropathy.
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1. Mota M Popa SG Mota E Mitrea A Catrinoiu D Cheta DM Guja C Hancu N Ionescu-Tirgoviste C Lichiardopol R Mihai BM Popa AR Zetu C Bala CG Roman G Serafinceanu C Serban V Timar R Veresiu IA Vlad AR. Prevalence of diabetes mellitus and prediabetes in the adult Romanian population: PREDATORR study. J Diabetes. 2016;8:336-44.
2. Sorrentino FS Matteini S Bonifazzi C Sebastiani A Parmeggiani F. Diabetic retinopathy and endothelin system: microangiopathy versus endothelial dysfunction. Eye. 2018; 32:1157–63.
3.Vinod PB. Pathophysiology of diabetic nephropathy. Clinical Queries: Nephrology. 2012;1:121-6.
4. Martínez-Castelao A Navarro-González JF Górriz JL de Alvaro F. The Concept and the Epidemiology of Diabetic Nephropathy Have Changed in Recent Years. J Clin Med. 2015;4:1207–16.
5. Piccoli GB Grassi G Cabiddu G Nazha M Roggero S Capizzi I De Pascale A Priola AM Di Vico C Maxia S Loi V Asunis AM Pani A Veltri A. Diabetic Kidney Disease: A Syndrome Rather Than a Single Disease. Rev Diabet Stud. 2015;12:87–109.
6. Pizzorno J. Is the Diabetes Epidemic Primarily Due to Toxins?. Integr Med (Encinitas). 2016;15:8–17.
7. Edwards J Ackerman C. A Review of Diabetes Mellitus and Exposure to the Environmental Toxicant Cadmium with an Emphasis on Likely Mechanisms of Action. Curr Diabetes Rev. 2016;12:252–8.
8. Orr SE Bridges CC. Chronic Kidney Disease and Exposure to Nephrotoxic Metals. Int J Mol Sci. 2017;18:1039.
9. Ahamed M Siddiqui MK.Low level lead exposure and oxidative stress: current opinions. Clin Chim Acta. 2007;383:57-64.
10. Burckhardt BC Drinkuth B Menzel C Konig A Steffgen J Wright SH Burckhardt G. The renal Na(+)-dependent dicarboxylate transporter NaDC-3 translocates dimethyl- and disulfhydryl-compounds and contributes to renal heavy metal detoxification. J. Am. Soc. Nephrol. 2002;13:2628–38.
11. Barbier O Jacquillet G Tauc M Cougnon M Poujeol P. Effect of heavy metals on and handling by the Kidney. Nephron Physiol 2005;99:105-10.
12. Jacob S Héry M Protois JC Rossert J Stengel B. New insight into solvent-related end-stage renal disease: occupations products and types of solvents at risk. Occup Environ Med. 2007;64:843–8.
13. Prozialeck WC Edwards JR. Early biomarkers of cadmium exposure and nephrotoxicity. Biometals. 2010;23:793-809.
14. Chen J Li M Lv Q Chen G Li Y Li S Mo Y Ou S Yuan Z Huang M Jiang Y. Blood lead level and its relationship to essential elements in preschool children from Nanning China. J. Trace Elem. Med. Biol. 2015;30:137–141.
15. Jan AT Azam M Siddiqui K Ali A Choi I Haq QM. Heavy Metals and Human Health: Mechanistic Insight into Toxicity and Counter Defense System of Antioxidants. Int J Mol Sci. 2015;16:29592–29630.
16. Szablewski L. Distribution of glucose transporters in renal diseases. J Biomed Sci. 2017;24:64.
17. Kataria A Trasande L Trachtman H. The effects of environmental chemicals on renal function. Nat Rev Nephrol. 2015;11:610–25.
18. Gheith O Farouk N Nampoory N Halim MA Al-Otaibi T. Diabetic kidney disease: world wide difference of prevalence and risk factors. J Nephropharmacol. 2015;5:49–56.
19. J. Jameson and L. Loscalzo Harrison’s Nephrology and Acid-Base Disorders New York: McGraw-Hill Medical 2017.
20. Persson F Rossing P. Diagnosis of diabetic kidney disease: state of the art and future perspective. Kidney Int Suppl 2011;8:2-7.
21. Viberti GC Hill RD Jarrett RJ Argyropoulos A Mahmud U Keen H. Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet. 1982;1:1430–2.
22. Bosman DR Winkler AS Marsden JT Macdougall IC Watkins PJ. Anemia with erythropoietin deficiency occurs early in diabetic nephropathy. Diabetes Care 2001;24:495-9.
23. Chokhandre MK Mahmoud MI Hakami T Jafer M Inamdar AS. Vitamin D & its analogues in type 2 diabetic nephropathy: a systematic review. J Diabetes Metab Disord. 2015;14:58.
24. Lee SY Choi ME. Urinary biomarkers for early diabetic nephropathy: beyond albuminuria.Pediatr Nephrol.2015;30:1063–75.
25. American Diabetes Association. Diabetes and Employment. Diabetes Care. 2010;33 (Suppl1): S82-S86.
26. American Diabetes Association. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes—2019. Diabetes Care 2019 42(Suppl 1): S34-S45. https://care.diabetesjournals.org/content/42/Supplement_1/S4
27. He F Xia X Wu XF Yu XQ Huang FX. Diabetic retinopathy in predicting diabetic nephropathy in patients with type 2 diabetes and renal disease: a meta-analysis. Diabetologia 2013;56:457–66.
28. Uwaezuoke SN.The role of novel biomarkers in predicting diabetic nephropathy: a review. Int J Nephrol Renovasc Dis 2017:10: 221-31.
29. Li Y Xia W Zhao F Wen Z Zhang A Huang S Jia Z Zhang Y. Prostaglandins in the pathogenesis of kidney diseases. Oncotarget. 2018;9:26586–26602.
30. Al-Rubeaan K Siddiqui K Al-Ghonaim MA Youssef AM Al-Sharqawi AH AlNaqeb D. Assessment of the diagnostic value of different biomarkers in relation to various stages of diabetic nephropathy in type 2 diabetic patients. Sci Rep. 2017;7:2684.
31. Kazumi T Hozumi T Ishida Y Ikeda Y Kishi K Hayakawa M Yoshino G.Increased urinary transferrin excretion predicts microalbuminuria in patients with type 2 diabetes. Diabetes Care. 1999;22:1176-80.
32. Montero RM Herath A Qureshi A Esfandiari E Pusey CD Frankel AH Tam FWK. Defining Phenotypes in Diabetic Nephropathy: a novel approach using a cross-sectional analysis of a single centre cohort. Sci Rep. 2018;8:53.
33. Qaseem A Wilt TJ Kansagara D Horwitch C Barry MJ Forciea MA Clinical Guidelines Committee of the American College of Physicians. Hemoglobin A1c targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: a guidance statement update from the American College of Physicians. Ann Intern Med 2018; 168: 569-76.
34. Weijman I Ros WJ Rutten GE Schaufeli WB Schabracq MJ Winnubst JA. Fatigue in employees with diabetes: its relation with work characteristics and diabetes related burden. Occup Environ Med. 2003;60 Suppl 1:i93–i98.
35. Umanath K Lewis JB. Update on Diabetic Nephropathy: Core Curriculum. Am J Kidney Dis. 2018; 71: 884-95.
36. Detaille SI Haafkens JA Hoekstra JB van Dijk FJH. What employees with diabetes mellitus need to cope at work: Views of employees and health professionals. Patient Education and