Diabetic Nephropathy - Causes, Symptoms, Diagnosis and Prevention

Diabetic Nephropathy

Dr.Deodatta Shripad Chafekar profile Authored by Dr.Deodatta Shripad Chafekar on 3 Jan 2014 - 22:11.

Diabetic Nephropathy

Diabetic nephropathy is a disease that causes damage to the kidney as a consequence of diabetes. Diabetic nephropathy is a clinical syndrome characterized by albuminuria, hypertension, and progressive renal insufficiency. The earliest manifestation of nephropathy is the presence of small but abnormal levels of albumin in the urine during clinical examination (microalbuminuria).

The persistent high blood sugar along with uncontrolled blood pressure (BP) is believed to be responsible for the eventual damage of the kidney. Research indicates that almost 50 percent of Type 1 Diabetes Mellitus (DM) patients and about 40 percent of Type 2 DM patients are likely to develop nephropathy as diabetes progresses. However, according to experts, not every diabetic patient develops nephropathy. Chronic form of nephropathy may result in excess excretion of protein which may cause hypertension and other cardiovascular diseases.

With the progression of diabetes, patient may develop scars on the nephrons (a unit of kidney), which are responsible for filtration of blood. The scars damage the nephrons which eventually affect blood filtration and may result in excretion of useful protein (albumin). This ultimately results in damage to the nephrons causing fall in efficiency of nephrons.

Often, patients reveal symptoms of diabetic nephropathy much after the onset of disease, around ten years after the actual damage. The symptoms include:

  • There may not be any symptoms, the patient may just present with abnormal urine report.
     
  • Headache
     
  • Fatigue
     
  • Oliguria (low output of urine)
     
  • Symptoms of renal damage (kidney failure)
     
  • Feeling sick
     
  • Nausea and vomiting
     
  • Loss of appetite
     
  • Swelling of legs and feet
     
  • Breathlessness

Diagnosis includes the following:

 

  • It is recommended to have urine test done at least once in a year for early diagnosis of damage to the nephrons in the kidney. This is done by way of micral test (microalbuminuria).
     
  • To detect large quantities of proteinuria, a test called urine ACR is also done.  Blood urea nitrogen, serum, creatitine and other renal function tests are also done.
     
  • Sonography (USG) of kidney is done to detect various abnormalities. Kidney biopsy is done when kidney disease other than diabetic nephropathy is suspected.
     
  • Every patient should undergo BP check up every three months.
     
  • Every patient suffering from diabetic kidney disease should undergo an eye checkup to diagnose diabetic retinopathy.

 

Following factors increases the risk of developing diabetic nephropathy.

  • Obesity 
  • Systemic hypertension 
  • Uncontrolled hypertension and poor glycemic control
  • Hyperlipidemia 
  • Other factors: family history of nephropathy and smoking may increase the risk of progression to end-stage renal failure in patients with type 2 diabetes.

 

Prevention is better than cure, so a regular kidney check up can help detect any such kidney disorders in the early stage which can be successfully addressed.

Diabetic nephropathy can be treated effectively, if it is diagnosed in its early stages. It is difficult and complicated to manage it in its chronic condition when the amount of protein excretion is very high. However, suggested treatment that slows down the damage to the kidney include:

  • Medications to manage blood pressure (below130/80) – Ex. ACE inhibitors and angiotensin receptor blockers (ARBs)
     
  • Medications to manage blood sugar
     
  • Medicines to manage high blood cholesterol
     
  • Consumption of low fat and healthy diet
     
  • Exercising

In advanced stages, patient may require renal replacement therapy in the form of dialysis or kidney transplant.

Recommended preventive steps for diabetic nephropathy include:

  • Smoking should be completely stopped 
     
  • Blood sugar should be managed well
     
  • BP should be controlled
     
  • Healthy diet with low sodium should be consumed, while avoiding high protein food.
     
  • Daily exercise is recommended
     
  • Yearly check up of urine tests is mandatory.

 

Prevention is better than cure, so a regular kidney check up can help detect any such kidney disorders in the early stage which can be successfully addressed.

*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.