Diabetic Neuropathy, Vascular Disease, and the Foot in Diabetic Nephropathy

  • A. Grenfell
  • M. E. Edmonds
  • P. J. Watkins
Part of the Topics in Renal Medicine book series (TIRM, volume 6)


Diabetic foot problems occur either as a result of neuropathy, from peripheral vascular disease, or from both factors combined [1, 2]. Vascular disease is closely associated with diabetic nephropathy and neuropathy is common in these long-term patients. Foot problems therefore occur frequently in nephropathy patients both before and after renal support treatment. They represent an additional and often neglected problem in the complex management of these patients. Although foot disorders in nephropathy patients are broadly the same as in those without nephropathy, there are some significant differences that are described in this chapter. The pathogenesis, clinical features, and management are discussed especially in terms of neuropathy and vascular disease. Finally, there is a short discussion on foot care and the prevention of problems in patients with diabetic nephropathy.


Diabetic Nephropathy Renal Transplantation Continuous Ambulatory Peritoneal Dialysis Arteriovenous Shunting Peripheral Blood Flow 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Grenfell A, Watkins PJ: Clinical diabetic nephropathy: natural history and complications. Clin Endocrinol Metab 15: 783–805, 1986.PubMedCrossRefGoogle Scholar
  2. 2.
    Edmonds ME: The diabetic foot: pathophysiology and treatment. Clin Endocrinol Metab 15: 889–916, 1986.PubMedCrossRefGoogle Scholar
  3. 3.
    Jervell J, Dahl BO, Flatmark A, et al.: Renal transplantation in insulin dependent diabetics: joint Scandinavian report. Lancet 2: 915–917, 1978.Google Scholar
  4. 4.
    Gonzalez-Carrillo M, Moloney A, Bewick M, et al.: Renal transplantation in diabetic nephropathy. Br Med J 285: 1713–1716, 1982.CrossRefGoogle Scholar
  5. 5.
    Khauli RB, Novick AC, Braun WE, et al.: Improved results of cadaver renal transplantation in the diabetic patient. J Urol 130: 867–870, 1983.PubMedGoogle Scholar
  6. 6.
    Guy RJC, Clark CA, Malcolm PN, Watkins PJ: Evaluation of thermal and vibration sensation in diabetic neuropathy. Diabetologia 28: 131–137, 1985.PubMedGoogle Scholar
  7. 7.
    Ctercteko GC, Chanendran M, Hutton WC, LeQuesne LP: Vertical forces acting on the feet of diabetic patients with neuropathie ulceration. Br J Surg 68: 608–614, 1981.PubMedCrossRefGoogle Scholar
  8. 8.
    Watkins PJ, Edmonds ME: Sympathetic nerve failure in diabetes. Diabetologia 25: 73–77, 1983.PubMedCrossRefGoogle Scholar
  9. 9.
    Scarpello JH, Martin TR, Ward JD: Ultrasound measurements of pulse wave velocity in the peripheral arteries of diabetic subjects. Clin Sci 58: 53–57, 1980.PubMedGoogle Scholar
  10. 10.
    Edmonds ME, Roberts VC, Watkins PJ: Blood flow in the diabetic neuropathie foot. Diabetologia 22: 9–15, 1982.PubMedCrossRefGoogle Scholar
  11. 11.
    Archer AG, Roberts VC, Watkins PJ: Blood flow patterns in painful diabetic neuropathy. Diabetologia 27: 563–567, 1984.PubMedCrossRefGoogle Scholar
  12. 12.
    Gilbey SG, Grenfell A, Edmonds ME, Archer A, Watkins,PJ: Peripheral blood flow in diabetic patients with end stage renal failure. Transplant Proc 18: 1611, 1986.Google Scholar
  13. 13.
    Ward JD, Simms JM, Knight G, Boulton AJM, Sandier DA: Venous distension in the diabetic neuropathie foot (physical sign of arteriovenous shunting). J R Soc Med 76: 1011–1014, 1983.PubMedGoogle Scholar
  14. 14.
    Boulton AJM, Scarpello JHB, Ward JD: Venous oxygenation in the diabetic neuropathie foot: evidence of arteriovenous shunting? Diabetologia 22: 6–8, 1982.PubMedCrossRefGoogle Scholar
  15. 15.
    Brand PW: The diabetic foot. In: Ellenberg M, Rifkin H (eds) Diabetes mellitus New York: Medical Examination, 1983, pp 829–849.Google Scholar
  16. 16.
    Ewing DJ, Winney R: Autonomic function in patients with chronic renal failure on intermittent haemodialysis. Nephron 15: 424–429, 1975.PubMedCrossRefGoogle Scholar
  17. 17.
    Moloney A, Tunbridge WMG, Ireland JT, Watkins PJ: Mortality from diabetic nephropathy in the United Kingdom. Diabetologia 25: 26–30, 1983.PubMedCrossRefGoogle Scholar
  18. 18.
    Edmonds ME, Blundell MP, Morris HE, et al.: Improved survival of the diabetic foot: the role of a special foot clinic. Q J Med 232: 763–771, 1986.Google Scholar
  19. 19.
    Edmonds ME: The diabetic foot. Med Int 13: 551–553, 1985.Google Scholar
  20. 20.
    Boulton AJM, Franks CI, Betts RP, Duckworth T, Ward JD: Reduction of abnormal foot pressures in diabetic neuropathy using a new polymer insole material. Diabetes Care 7: 42–46, 1984.PubMedCrossRefGoogle Scholar
  21. 21.
    Edmonds ME, Archer AG, Watkins PJ: Ephedrine: a new treatment for diabetic neuropathie oedema. Lancet 1: 548–551, 1983.PubMedCrossRefGoogle Scholar
  22. 22.
    Peters C, Sutherland DER, Simmons RL, Fryd DS, Najarian JS: Patient and graft survival in amputated versus non-amputated diabetic primary renal allograft recipients. Transplantation 32: 498–503, 1981.PubMedCrossRefGoogle Scholar
  23. 23.
    Shapiro FL: Haemodialysis in diabetic patients. In: Keen H, Legrain M (eds) Prevention and treatment of diabetic nephropathy. Lancaster UK: MTP Press, 1983, pp 247–259.Google Scholar
  24. 24.
    Strandness DE Jr, Priest RE, Gibbons GE: Combined clinical and pathological study of diabetic and non-diabetic peripheral arterial disease. Diabetes 13: 366–372, 1984.Google Scholar
  25. 25.
    Conrad MC: Large and small artery occlusion in diabetics and non-diabetics with severe vascular disease. Circulation 36: 83–91, 1967.PubMedCrossRefGoogle Scholar
  26. 26.
    Barner HB, Kaiser GGC, William VL: Blood flow in the diabetic leg. Circulation 43: 391–394, 1971.PubMedCrossRefGoogle Scholar
  27. 27.
    Parving H-H, Andersen AR, Smidt UM, et al.: Diabetic nephropathy and arterial hypertension. Diabetologia 24: 10–12, 1983.PubMedCrossRefGoogle Scholar
  28. 28.
    Cramp DB, Moorhead JF, Wills MR: Disorders of blood lipids in renal disease. Lancet 1: 672–673, 1975.PubMedCrossRefGoogle Scholar
  29. 29.
    Ibels LS, Simons LA, King JO, Williams PF, Neale FC, Stewart JH: Studies on the nature and causes of hyperlipidaemia in uraemia, maintenance dialysis and renal transplantation. Q J Med 44: 601–614, 1975.PubMedGoogle Scholar
  30. 30.
    Gilbey SG, Grenfell A, Edmonds ME, Archer A, Watkins PJ: Peripheral blood flow in diabetic patients with end stage renal failure. Transplant Proc 18: 1611, 1986.Google Scholar
  31. 31.
    LeGerfo FW, Coffman JD: Vascular and microvascular disease in the foot in diabetes. N Engl J Med 311: 1615–1619, 1984.CrossRefGoogle Scholar
  32. 32.
    Najarian JS, Sutherland DER, Simmons RL, et al.: Ten year experience with renal transplantation in juvenile onset diabetics. Ann Surg 190: 487–500, 1979.PubMedCrossRefGoogle Scholar
  33. 33.
    Hauser CJ, Klein SR, Mehringer CM, Appel P, Shoemaker WC: Superiority of transcutaneous oximetry in noninvasive vascular diagnosis in patients with diabetes. Arch Surg 119: 690–694, 1984.Google Scholar
  34. 34.
    Edmonds ME, Roberts VC, Watkins PJ: Blood flow in the diabetic neuropathie foot. Diabetologia 22: 9–15, 1982.PubMedCrossRefGoogle Scholar
  35. 35.
    Auer Al, Hurley JJ, Binnington HB, Nunnelett JD, Hershey FB: Distal tibial vein grafts for limb salvage. Arch Surg 118: 597–602, 1983.CrossRefGoogle Scholar
  36. 36.
    Andros G, Harris RW, Dulawa LB, Oblath RW, Salles-Cunha SX: The need for arteriography in diabetic patients with gangrene and palpable foot pulses. Arch Surg 119: 1260–1263, 1984.PubMedCrossRefGoogle Scholar
  37. 37.
    Nieman HL, Brabdt TD, Greenberg M: Percutaneous transluminal angioplasty an angiographer’s viewpoint. Arch Surg 116: 821–828, 1981.CrossRefGoogle Scholar
  38. 38.
    Sprayregen S, Sniderman KW, Sos TA, et al.: Popliteal artery branches: percutaneous trans-luminal angioplasty. Am J Roent 135: 945–950, 1980.Google Scholar
  39. 39.
    Sagalowsky Al, Gailiunas P, Helderman JH, et al.: Renal transplantation in diabetic patients: the end result does justify the means. J Urol 129: 253–255, 1983.Google Scholar
  40. 40.
    Sutherland DER, Bentley FR, Mauer SM, et al.: A report of 26 diabetic renal allograft recipients alive with functioning grafts at 10 or more years after primary transplantation. Diabetic Nephropathy 3: 39–43, 1984.Google Scholar
  41. 41.
    Khanna R, Wu G, Prowant B, et al.: Continuous ambulatory peritoneal dialysis in diabetics with ESRD: a combined experience of two North American Centers. In: Friedman EA, L’Experance FA (eds) Diabetic renal—retinal syndrome. Orlando FL: Grune and Stratton, 1985, pp 363–381.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1988

Authors and Affiliations

  • A. Grenfell
  • M. E. Edmonds
  • P. J. Watkins

There are no affiliations available

Personalised recommendations