Abstract: PUB077
Diabetic Nephropathy Affected by Social Determinants of Health
Session Information
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
Authors
- Aziz, Zainab, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States
- Siddiqi, Muhammad Hammad, Virginia Commonwealth University Medical Center, Richmond, Virginia, United States
- Street, Sarah E., Virginia Commonwealth University Medical Center, Richmond, Virginia, United States
Introduction
Diabetes is a leading cause of chronic kidney disease, with 1 in 3 adults with diabetes having kidney disease. Recent advancements in pharmacotherapy can decelerate the progression of chronic kidney disease. However, medical management is intricately tied to social determinants of health which may negatively impact disease progression.
Case Description
A 64-year-old Caucasian male with a history of type 2 diabetes, hypertension, and alcohol use disorder was admitted after being found down at a home wellness check.
On presentation, he had a blood pressure of 191/115. Labs revealed an acute kidney injury (serum creatinine 2.91 mg/dL, eGFR 23 mL/min/1.73m2), nephrotic range proteinuria (proteinuria of 12.02 g/day), mildly elevated CK (468 U/L) and a urine sediment with muddy brown granular casts. HbA1C was 7.1%. Immunological markers (ANA, ANCA, PLA2-R Ab) and viral serologies (hepatitis B and C, HIV, and syphilis) were negative. C3, C4 and serum protein electrophoresis were normal. Renal ultrasound showed normal-sized kidneys with no obstruction. Renal biopsy revealed one non-sclerotic glomerulus with thickened capillary loops, acute tubular injury, and significant tubular atrophy with thickening of tubular basement membranes and severe interstitial fibrosis. Immunofluorescence was negative for immune deposits and electron microscopy was indeterminate due to absence of glomeruli.
A diagnosis of diabetic nephropathy with acute tubular necrosis was made and the patient was discharged with home health assistance.
Discussion
There were several social determinants of health that contributed to the patient’s chronic kidney disease. In terms of healthcare literacy, the patient displayed limited understanding of the chronic nature of the disease and a possible assumption that a lack of symptoms meant no progression of the disease. Secondly, the patient reported frequent medication nonadherence despite adequate access to appropriate pharmacotherapy (SGLT-2 inhibitor and ARB inhibitor). Though these barriers were partly addressed by home health assistance, there are further opportunities for intervention such as health education on chronic disease management and frequent outpatient follow-up with care coordination. Addressing these upstream factors with patient-centered interventions is critical for improving outcomes of chronic kidney disease in underserved populations.