Diabetic Nephropathy:Causes,Symptoms & Treatment

Diabetic Nephropathy: Diabetic nephropathy is a type of progressive kidney disease that may occur people with type 1 and type 2 diabetes. It manifests as slowly progressive albuminuria with worsening hypertension and renal insufficiency. Diagnosis is based on history, physical examination, urinalysis, and urine albumin/creatinine ratio.Diabetic-Nephropathy-TreatmentDiabetic nephropathy is a notable cause of long-term kidney disease and end-stage renal disease (ESRD), which is when the kidneys no longer work well adequately to meet the needs of daily life.

Over 40 percent of cases of kidney failure is induced by diabetes, and it’s figured that nearly 180,000 people are living with kidney failure precipitated by complications of diabetes.

Causes of Diabetic Nephropathy

Diabetic nephropathy is the usual common etiology(cause) of nephrotic syndrome in adults. The predominance of renal failure is apparently about 40% among patients with type 1 diabetes mellitus. The prevalence of renal failure in patients with type 2 diabetes mellitus is normally stated as 20 to 30%. The kidneys have numerous tiny blood vessels that purify waste from your blood. High blood sugar from diabetes can destroy these blood vessels.  Other risk factors include :

  • High blood pressure (hypertension) that's difficult to control
  • Cigarette smoking and having diabetes
  • Family history of diabetic nephropathy
  • Being a smoker High blood cholesterol and having diabetes
  • A family history of diabetes and kidney disease

Symptoms of Diabetic Nephropathy

In the early stages of diabetic nephropathy, you may not notice any signs or symptoms. So it's important to have regular urine tests to find kidney damage early. Sometimes early kidney damage can be reversed. In later stages, the signs and symptoms include:

  • Swelling of the ankles, feet, lower legs or hands
  • Worsening blood pressure control
  • Darker urine, caused by blood in the urine
  • Persistent itching
  • Becoming short of breath, when climbing the stairs for instance
  • Fatigue as a result of a lack of oxygen in the blood
  • Nausea or vomiting
  • Increased need to urinate

Diagnosis & Stages of Diabetic Nephropathy

  • Urinalysis for symbols of another renal disorder (hematuria, RBC casts)
  • Annually screening of patients with diabetes with random urine albumin/creatinine ratio

Albumin measurements are represented as follows-

  • Normal albuminuria: urinary albumin excretion less than <30 mg/24h;
  • Microalbuminuria: urinary albumin excretion within 30–299 mg/24h;
  • Macroalbuminuria: urinary albumin excretion  ≥300 mg/24h.

The diagnosis is suspected in patients who have proteinuria, especially if they have diabetic retinopathy.

The stages of diabetic nephropathy are determined by the glomerular filtration rate or GFR. The GFR can tell how well the kidneys are working.

Stage 1: Kidney impairment present but have normal kidney function; GFR above 90.

Stage 2: Kidney illness with some impairment of kidney function; GFR within 60 and 89.

Stage 3: Mild to drastic impairment of kidney function; GFR within 30 and 59.

Stage 4: Severe damage to kidney function; GFR within 15 and 29.

Stage 5: Kidney failure; GFR smaller than 15.

Prevention of Diabetic Nephropathy

To reduce your risk of developing diabetic kidney disease:

  • Treat your diabetes-you may prevent or delay diabetic kidney disease.
  • Manage high blood pressure-If you have high blood pressure, work with your doctor to control them.
  • Over-the-counter medications- When using aspirin, ibuprofen and acetaminophen follow the instructions on the package, taking these types of pain relievers can lead to kidney damage.
  • Don't smoke- If you're a smoker, talk to your doctor about strategies for quitting smoking.
  • Maintain a healthy weight

Treatment of Diabetic Nephropathy

Early treatment can only delay the onset of diabetic nephropathy. One keystone in the prevention and management of diabetic nephropathy is tight glycemic control. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) have been proved to help lowering blood pressure, as well as preserve kidney function and limit further damage.

If diabetic nephropathy has advanced to the final stage and ESRD later there are only two types of treatment available-

Kidney dialysis

There are three types of dialysis:

  • Haemodialysis
  • Continuous ambulatory peritoneal dialysis
  • Automated peritoneal dialysis

Kidney transplant

A physician may suggest a kidney transplant if diabetic nephropathy has reached the final stages.