Diabetic nephropathy: what is it, symptoms, treatment, prognosis

What is Diabetic Nephropathy?

Diabetic nephropathy (Diabetic Kidney Disease) is a chronic kidney disease that can affect people with diabetes. It happens when high blood glucose disrupts the functioning of the human kidneys. High blood glucose levels due to diabetes can damage the part of the kidneys that filters the blood. The damaged filter "leaks" and allows the protein to pass into the urine.

Diabetic nephropathy is a type of chronic kidney disease (CKD). The kidneys help regulate the level of fluids and salts in the body, which is vital for controlling blood pressure and protecting the cardiovascular system.

When a person has diabetes, be it type 1, type 2, or gestational diabetes, his body cannot use or produce insulin, well.

Diabetes leads to high blood sugar levels. Over time, these high glucose levels can damage various areas of the body, including the cardiovascular system and kidneys. As a result, kidney damage is called diabetic nephropathy.

Diabetic kidney disease is a leading cause of long-term kidney disease and end-stage renal disease.

How common is diabetic nephropathy?

Diabetic nephropathy is a fairly common disease in diabetics. Every fourth woman and every fifth man with type 2 diabetes diabetic kidney disease develops. However, it is even more common with type 1 diabetes.

Diabetic kidney disease is the leading cause of kidney failure.

Symptoms and Signs

Diabetic nephropathy usually has no early symptoms. The patient cannot see that there is protein in the urine - this is what is detected with the help urinalysis.

It can take many years for kidney damage to progress. Symptoms and signs usually only appear when kidney damage has worsened significantly. Even then, the symptoms are usually vague.

If the kidney damage becomes severe, the person may notice:

• weight loss;
• poor appetite or feeling unwell;
• swollen ankles and feet (due to fluid retention);
• puffiness around the eyes;
• dry, itchy skin;
• muscle cramps;
• frequent urination;
• feeling tired;
• difficulty concentrating.

What happens to the kidneys in diabetes?

The main function of the kidneys is to filter waste and excess water from the bloodstream so that they can be excreted in the urine. This is carried out by a system of tubes and blood vessels known as nephrons. Inside the nephrons are tiny blood vessels called capillaries and tiny tubes for collecting urine. One of the main structures in the nephron is a group of blood vessels known as the glomerulus, which acts as a filter.

High blood glucose levels can interfere with glomerular function. The kidney's filtration function does not work properly and proteins start leaking from the blood into the urine.

High blood glucose levels can also cause scarring of the glomerulus (called glomerulosclerosis). As the scars get worse, the kidneys stop filtering waste from the blood.

When enough glomeruli are damaged, renal failure.

People with diabetic nephropathy also often have high blood pressure. High blood pressure (arterial hypertension) can also contribute to kidney damage.

Risk factors for diabetic nephropathy

There are many factors that can increase your risk of developing the disease. They include:

• the duration of diabetes (the longer, the more likely the occurrence of this complication);
• high blood glucose (due to poorly managed diabetes);
• high blood pressure;
• overweight or obesity;
• smoking, alcohol abuse.

The risk is also increased if there are other problems associated with diabetes mellitus. These include diabetic retinopathy or diabetic neuropathy.

The disease develops slowly. According to one study, a third of people tested showed high levels of protein (albumin) in their urine 15 years after diabetes was diagnosed. However, less than half of these people will develop complete nephropathy.

Statistics show that kidney disease is rare in people who have had diabetes for less than 10 years. In addition, if a person has no clinical signs of nephropathy 20–25 years after the onset of diabetes, it is unlikely that diabetes will develop after so many years.

Diabetic nephropathy is less likely if the person with diabetes effectively manages blood glucose levels.

Complications

The main complication of diabetic kidney disease is the development of chronic kidney disease and end stage renal failure. Chronic kidney disease can progress to kidney failure. People with kidney failure need treatment with dialysis or a kidney transplant (transplant).

All people with diabetes are at risk of high blood pressure and cardiovascular disease (for example, myocardial infarction, stroke). Having kidney disease also increases your risk of these problems. Thus, having diabetes and kidney disease means the risk is even higher.

Having diabetic kidney disease can also worsen other complications of diabetes (such as diabetic retinopathy and diabetic neuropathy).

Diagnostics

If you have diabetes, your doctor will recommend regularly checking your blood glucose levels and checking for complications of diabetes. Your doctor will ask you about any symptoms and do a physical exam to determine possible complications of diabetes.

Basic tests done to look for signs of diabetic nephropathy and how well your kidneys are functioning include urinalysis and blood tests.

Urine tests

Urine samples are tested for a protein called albumin. The amount of albumin found in urine indicates the amount of kidney damage.

• Microalbuminuria (a small amount of albumin in the urine) indicates that there is a risk of developing diabetic nephropathy or there may be an early stage of diabetic kidney disease.
• Proteinuria or macroalbuminuria (more albumin in the urine) indicates that the patient has more advanced diabetic nephropathy, which may affect the kidneys' ability to filter waste.

Blood tests

A blood test is also recommended to check kidney function. Level creatinine, a waste product in the blood, can be measured to calculate the estimated glomerular filtration rate (GFR). GFR measures how well the kidneys work to filter waste products from the blood.

As a general rule, people with diabetes are advised to have blood and urine tests at least once a year to check kidney function.

Diabetic Nephropathy Treatment

Early detection and treatment of diabetic nephropathy can not only stop the progression of kidney disease in people with diabetes, but can actually reverse it in the early stages. Treatment includes monitoring blood glucose and blood pressure.

Blood glucose levels should be as high as possible in the normal range to prevent or slow the progression of the disease. Lifestyle measures (including diet and exercise) in combination with oral medications for diabetes (oral hypoglycemic agents) or insulin can be used to control glucose levels in blood.

People with type 2 diabetes who have microalbuminuria or proteinuria (evidence of some degree of diabetic kidney disease) usually also treated with drugs called angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (BRA).

These medicines are also used to control blood pressure, but even if the blood pressure is normal pressureThe doctor may prescribe an ACE inhibitor or ARB because they decrease the amount of protein in the urine and may prevent or slow the progression of diabetic kidney disease.

Other medicines may also be prescribed to help control high blood pressure.

Treatment of progressive disease

If the disease progresses to renal failure (end-stage kidney disease), the doctor may switch to treatment that either replaces kidney function or improves comfort. Options include:

• Kidney dialysis. This procedure is a way of removing waste and excess fluid from the blood. There are two main types of dialysis - hemodialysis and peritoneal dialysis. In the first, more common method, you may need to visit a dialysis center and be connected to an artificial kidney machine about 3 times a week, or you can have dialysis at home with a qualified specialist. Each session takes 3 to 5 hours. The second method can be done at home.
• Transplantation. In some situations, a kidney transplant or a kidney-pancreas transplant is the best option. If the doctor and patient decide to have a transplant, specialists will conduct an assessment to determine if such an operation is possible.
• Pain and symptom management during the last days of life. If the patient decides not to undergo dialysis or organ transplantation, life expectancy is usually only a few months.

Healthy lifestyle

Eating a healthy diet and exercising regularly is important for controlling blood glucose and blood pressure. Doctors can give advice on proper nutrition and exercise advice.

The patient may be advised to avoid high protein diets if they have diabetic nephropathy, as excessive protein in the diet can lead to further damage kidneys. A low protein diet may be recommended for people with advanced diabetic kidney disease to help delay the onset of kidney failure. Patients should never restrict major food groups from their diet without first consulting a doctor or dietitian.

If a person smokes, quitting is the right choice for their health.

Prophylaxis

You can help protect your kidneys from diabetes-related damage by working with your doctor to:

• know that blood glucose levels are well controlled;
• know that your blood pressure is within the normal range;
• quit smoking if you smoke;
• maintain a healthy weight;
• control cholesterol levels.

These measures can help reduce your risk of developing diabetic kidney disease or delay its onset.

You also need to have a kidney test (urinalysis, blood pressure, and blood pressure) at least once a year to check how well your organs are functioning.

Prognosis for diabetic nephropathy

The outlook for people with diabetic nephropathy will depend on how well they manage their blood sugar and blood pressure levels, and at what stage they get diagnosis. The earlier treatment starts, the better the prognosis.

Treatment can delay or prevent the progression of diabetic kidney disease. People with diabetes should get tested as recommended by their doctor and take early steps to prevent the progression of kidney disease.