Q: I am taking up nursing and I am in the junior year. We were told to study the patient records in our hospital. I was given a type II diabetic patient diagnosed with UTI and diabetic nephropathy. I am not sure if it is nephropathy, or neuropathy, the doctors handwriting was a mess. She showed ++ protein and sugar in her urine, and she was also given albumin through IV. Her face was a bit puffy and she had oedema around her feet and ankles. What I want to know is if she was diagnosed with nephropathy, is this one reason for the cause of her UTI and how exactly does a diabetic patient get UTI?

A:The patient you described most likely has diabetic nephropathy. The hallmark of diabetic nephropathy is protein in the urine. It takes usually 10-15 years of uncontrolled diabetes to affect the kidneys and usually 30-40 % of diabetics develop diabetic nephropathy. Diabetics with uncontrolled diabetes, uncontrolled high blood pressure and those diabetics with family history of diabetic nephropathy are at high risk of developing nephropathy. Monitoring for urine albumin (microalbumin 20-22 mg/24 hrs) identifies these high risk diabetics. Diabetics have same incidence of urinary tract infections as non diabetics but they have higher incidence of complications of urinary tract infections. Diabetics may develop UTI without any relation to development of diabetic nephropathy. Diabetics can develop autonomic neuropathy and cystopathy and also have papillary necrosis because of small vessel disease and these lead to complicated UTI.