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Diabetic Nephropathy

Diabetic nephropathy is a kidney disease or damage to the kidneys caused by uncontrolled diabetes. In these patients, the kidneys cannot efficiently filter the waste materials from the body nor maintain the balance of chemicals in the body. Diabetic nephropathy is a progressive disease which can result in kidney failure if it is not properly managed.

Symptoms

In the initial stages, diabetic nephropathy does not produce any symptoms. However, the below mentioned symptoms develop when diabetic nephropathy progresses:

  • Edema or swelling develops initially in the legs and feet and later throughout the body
  • Worsening of blood pressure
  • Weight loss
  • Loss of appetite
  • Tiredness and weakness
  • Difficulty to concentrate
  • Sleeping difficulty
  • Persistent itching
  • Nausea and vomiting

Causes

Diabetic nephropathy occurs due to damage to the blood vessels and cells of the kidneys in diabetic patients. It occurs as a complication of type I and type II diabetes. When diabetes is not controlled properly, it can lead to high blood pressure. This pressure can cause damage to the delicate filtering units of the kidneys called the glomeruli leading to diabetic nephropathy.

Risk factors

Not all the patients with diabetes develop diabetic nephropathy. Some of the modifiable and non-modifiable risk factors which make a person more prone to develop diabetic nephropathy are:

  • Uncontrolled blood sugar levels
  • Having type 1 diabetes before the age of 20 years
  • Uncontrolled high blood pressure
  • Dyslipidemia (abnormal lipid levels)
  • Smoking
  • Family history of kidney disease
  • Advancing age

If any of the above mentioned signs or symptoms of kidney disease are experienced, then visit the doctor immediately. Diabetic patients should undergo urine tests once in a year to check for efficient kidney functioning.

Diagnosis

Diabetic nephropathy is usually identified during regular follow up visits to a doctor. Presence of protein albumin in the urine is the main indication of kidney damage. Additionally, there is a decline in the glomerular filtration rate (GFR). The other tests include:

  • Urine albumin to creatinine ratio which is higher than the normal value.
  • Serum creatinine blood test shows an increase in the levels of creatinine in the blood.
  • Blood urea nitrogen (BUN) test helps in detecting the presence of urea nitrogen in the blood.
  • Imaging tests such as CT scan and MRI can detect structural changes in the filtering units of the kidneys, i.e. the glomeruli.
  • A kidney biopsy is performed in which a small tissue sample is collected from the kidneys and examined under the microscope to check for diabetic nephropathy.  

Treatment

Treatment aims at delaying the progression of diabetic nephropathy but it cannot completely cure the condition.

Medications along with lifestyle changes are helpful to control high blood pressure and diabetes. The doctor may prescribe medications such as ACE inhibitors or angiotensin receptor blockers to control blood pressure. More intensive treatment such as dialysis or kidney transplant is necessary if the condition progresses and leads to kidney failure.

The doctor may also suggest the patient to follow a strict diet which is as follows:

  • Restricting the intake of sodium to 1500 to 2000mg per day or even less
  • Limiting the intake of proteins
  • Reducing the intake of potassium and phosphorous
  • Taking healthy fats while avoiding saturated fats

Lifestyle changes

In addition to the dietary restrictions, some of the lifestyle changes which can prevent the progression of diabetic nephropathy are:

  • Taking medications exactly as prescribed
  • Quitting the habit of smoking
  • Maintaining a healthy weight
  • Exercising everyday as suggested by the doctor

Complications

The following complications can occur if diabetic nephropathy is not properly managed:

  • Kidney failure, a condition in which the kidneys completely stop functioning
  • A sudden increase in the serum potassium levels (hyperkalemia)
  • Fluid retention which can result in high blood pressure, swelling of legs and arms, or fluid in lungs (pulmonary edema)
  • Foot sores
  • Erectile dysfunction
  • Damage of the blood vessels supplying the retina (diabetic retinopathy)
  • Heart and blood vessel related diseases which can lead to stroke
  • Complications during pregnancy which can be dangerous to both mother and fetus
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