Cukrzyca u chorego po przeszczepieniu nerki — spojrzenie nefrodiabetologiczne

Abstract

A transplant physician often has under his care a kid­ney recipient with end-stage kidney disease due to diabetes mellitus (DM) or DM developed after trans­plantation (posttransplantation diabetes mellitus — PTDM). The presence of DM is associated with a de­terioration in quality of life and worse prognosis both for the transplanted kidney and the patient survival. Such patients should be provided with combined and coordinated nephrology/diabetes care. The diagnostic procedures for PTDM do not differ from those gen­erally accepted, the basic one being an oral glucose load test. An important role in the control of treatment is played by glycated haemoglobin, sometimes used as a diagnostic support tool. Until now, no unambigu­ous standards of therapeutic treatment in PTDM have been established and both in the diagnosis and the therapeutic regimens apply the guidelines established for diabetic patients without a transplanted organ. The basis of treatment should be a diet combined with ap­propriate physical exercise. There are many hypogly­cemic medications available, including new ones with wide spectrum pharmacokinetic and pharmacody­namic properties that vary in efficacy and safety pro­file. Graft function and also possible interactions with other medications, especially immunosuppressants, should be taken into account before implementing hy­poglycemic treatment in transplanted patients.