Description

Diabetic nephropathy is a serious complication of diabetes type 1 and type 2 diabetes. It is also called diabetic kidney disease. In the united States, approximately 1 out of every 3 people living with diabetes have diabetic nephropathy.

Diabetic nephropathy affects the kidneys usual work of removing waste products and excess fluid from the body. The best way to prevent or delay diabetic nephropathy is a healthy lifestyle and maintain diabetes and high blood pressure managed.

Over the years, diabetic nephropathy slowly damages the kidneys, the filtration system. Early treatment can prevent this condition or decrease, and decrease the possibility of complications.

Diabetic kidney disease can lead to kidney failure. This is also called end-stage renal disease. Renal failure is a life-threatening condition. Treatment options for kidney failure are dialysis or a kidney transplant.

Symptoms

In the early stages of diabetic nephropathy, there may be no symptoms. In later stages, symptoms may include:

  • The high blood pressure makes it more difficult to control.
  • Swelling of feet, ankles, hands or eyes.
  • Foamy urine.
  • Confusion or difficulty thinking.
  • Shortness of breath.
  • Loss of appetite.
  • Nausea and vomiting.
  • The itching.
  • The feeling of tiredness and weakness.

When to see a doctor

Make an appointment with your health care professional if you have symptoms of kidney disease. If you have diabetes, talk to your health professional each year, or as often as you say of tests that measure how well your kidneys are working.

Causes

Diabetic nephropathy occurs when diabetes damages the blood vessels and other cells in the kidneys.

How the kidneys work

The kidneys have millions of tiny blood vessel clusters called glomeruli. The glomeruli filter waste from the blood. Damage to these blood vessels can lead to diabetic nephropathy. The damage can keep the kidneys working as it should and lead to kidney failure.

Diabetic nephropathy cause

Diabetic nephropathy is a common complication of type 1 and type 2 diabetes.

Over time, diabetes is not well controlled can damage the blood vessels in the kidneys that filter waste from the blood. This can lead to kidney damage and cause high blood pressure.

High blood pressure can cause more damage to the kidneys by the elevation of the pressure in the filtering system of the kidneys.

Risk factors

If you have diabetes, the following factors may increase the risk of diabetic nephropathy:

  • Uncontrolled high blood sugar, also called hyperglycemia.
  • Uncontrolled high blood pressure, also called hypertension.
  • The habit of smoking.
  • High cholesterol in the blood.
  • Obesity.
  • A family history of diabetes and kidney disease.

Complications

The complications of diabetic nephropathy can occur slowly over months or years. They may include:

  • Body of the fluid accumulation. This could lead to swelling in the arms and legs, high blood pressure, or fluid in the lungs, called pulmonary edema.
  • An increase in the levels of the minerals of potassium in the blood, which is called hyperkalemia.
  • Heart and blood vessel disease, also called cardiovascular disease. This could lead to a stroke.
  • Lowest number of red blood cells to carry oxygen. This condition is also known as anemia.
  • Complications in pregnancy that involve risks to the pregnant person and the fetus in growth.
  • Damage to the kidneys that can't be fixed. This is called end-stage renal disease. The treatment is dialysis or a kidney transplant.

Prevention

To reduce your risk of developing diabetic nephropathy:

  • Check with your health care team regularly to control diabetes. Appointments to check how well the management of your diabetes and the verification of diabetic nephropathy and other complications. Appointments can be annual or more frequently.
  • The treatment of diabetes. With a good treatment of the diabetes, you can keep your blood sugar levels in the target range as much as possible. This can prevent or delay diabetic nephropathy.
  • Manage high blood pressure or other medical conditions. If you have high blood pressure or other conditions that increase the risk of kidney disease, work with your health care professional for the control of them.
  • Take the medicines you get without a prescription only as directed. Read the labels of the pain relievers that you take. This could include aspirin and nonsteroidal anti-inflammatory drugs, such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others). For people with diabetic nephropathy, these types of pain relievers can lead to kidney damage.
  • Stay at a healthy weight. If you are at a healthy weight, work to stay that way by being physically active most days of the week. If you need to lose weight, talk with a member of your health care team about the best way for you to lose weight.
  • Do not smoke. Cigarette smoking can damage the kidneys or cause damage to the kidneys worse. If you are a smoker, talk to a member of your health care team about ways to stop smoking. Support groups, counseling, and some medications might help.

Diagnosis

Diabetic nephropathy is usually diagnosed during the regular tests that are part of the management of diabetes. Take the test every year if you have type 2 diabetes or have had type 1 diabetes for more than five years.

Routine screening tests may include:

  • Test for microalbuminuria. This test can detect a blood protein called albumin in the urine. Normally, the kidneys don't filter the albumin of the blood. Too much albumin in the urine may mean that the kidneys are not working well.
  • The albumin/creatinine ratio. Creatinine is a chemical waste product that the kidneys healthy filtered out of the blood. The albumin/creatinine ratio measures the amount of albumin in comparison with the creatinine in a urine sample. Shows how well the kidneys are working.
  • The Glomerular filtration rate (GFR). The measurement of creatinine in a blood sample can be used to see how quickly the kidneys filter the blood. This is called the glomerular filtration rate. The rate is low, it means that the kidneys are not working well.

Other diagnostic tests may include:

  • Imaging tests. The X-ray and ultrasound can show the composition and size of the kidneys. The CT and mri can show how well the blood is moved within the kidneys. You may need other imaging tests, as well.
  • The renal biopsy. This is a procedure to take a sample of kidney tissue to be studied in a laboratory. Involves a numbing medicine called a local anaesthetic. A thin needle is used to remove small pieces of kidney tissue.

Treatment

The first step in the treatment of diabetic nephropathy is for the treatment and control of diabetes and high blood pressure. The treatment includes diet, lifestyle changes, exercise, and medication prescription. The control of blood sugar and blood pressure may prevent or delay kidney problems and other complications.

Drugs

In the early stages of diabetic nephropathy, treatment may include medications to manage the following:

  • Blood pressure. Medicines called angiotensin-converting enzyme inhibitors (acei) and angiotensin 2 receptor blockers (Arbs) used to treat high blood pressure.
  • Of sugar in the blood.Medications can help control high blood sugar in people with diabetic nephropathy. They include older diabetes medications such as insulin. The newer medications include Metformin (Fortamet, Glumetza, others), glucagon-like peptide-1 (GLP-1) receptor agonists and SGLT2 inhibitors. Ask your health care professional if treatments, such as inhibitors of SGLT2 orGLP-1receptor agonists might work for you. These treatments can protect the heart and the kidneys from damage due to diabetes.
  • High cholesterol. Cholesterol-lowering medicines called statins used to treat high cholesterol or to lower the amount of protein in the urine.
  • Kidney scars. Finerenone (Kerendia) could help to reduce the scar tissue in diabetic nephropathy. Research has shown that the drug may decrease the risk of renal failure. You can also reduce the risk of dying from heart disease, have heart attacks and having to go to a hospital for treatment of heart failure in adults with chronic kidney disease linked to type 2 diabetes.

Of sugar in the blood. Medications can help control high blood sugar in people with diabetic nephropathy. They include older diabetes medications such as insulin. The newer medications include Metformin (Fortamet, Glumetza, others), glucagon-like peptide-1 (GLP-1) receptor agonists and SGLT2 inhibitors.

Ask your health care professional if treatments, such as SGLT2 inhibitors or GLP-1 receptor agonists might work for you. These treatments can protect the heart and the kidneys from damage due to diabetes.

If you take these medicines, you will need a regular follow up of the tests. The test is performed to see if your kidney disease is stable or it is worsening.

Advanced treatment of diabetic nephropathy

For kidney failure, also called end-stage renal disease, the treatment focuses on replacing the work of the kidneys and make you feel more comfortable. The options include:

  • The kidney dialysis.This treatment removes waste products and excess fluid from the blood. Hemodialysis filters the blood out of the body with a machine that does the work of the kidneys. For hemodialysis, you may need to visit a dialysis center three times a week. Or you could have dialysis done at home by a competent person. Each session lasts 3 to 5 hours. Peritoneal dialysis uses the lining of the abdomen, called the peritoneum, to filter out waste. A cleansing fluid flows through a pipe into the peritoneum. This treatment can be done at home or at work. But not everyone can use this method of dialysis.
  • Transplantation. Sometimes, a kidney transplant or kidney-pancreas transplantation is the best treatment option for kidney failure. If you and your health care team decide on a transplant, you will be evaluated to know if you can have the surgery.
  • The management of the symptoms. If you have kidney failure, and you do not want dialysis or a kidney transplant, you most likely live only a few months. The treatment can help to keep you comfortable.

The kidney dialysis. This treatment removes waste products and excess fluid from the blood. Hemodialysis filters the blood out of the body with a machine that does the work of the kidneys. For hemodialysis, you may need to visit a dialysis center three times a week. Or you could have dialysis done at home by a competent person. Each session lasts 3 to 5 hours.

Peritoneal dialysis uses the lining of the abdomen, called the peritoneum, to filter out waste. A cleansing fluid flows through a pipe into the peritoneum. This treatment can be done at home or at work. But not everyone can use this method of dialysis.

Potential future treatments

In the future, people with diabetic kidney disease may benefit from treatments that are being developed using techniques that help the body repair itself, called regenerative medicine. These techniques can help to reverse or delay kidney damage.

For example, some researchers think that if a person with diabetes can be cured with a treatment in the future, such as islet cells of the pancreas transplant or stem cell therapy, the kidneys may work better. These therapies, as well as the new drugs, are still under study.

Lifestyle and home remedies

Diet, exercise and self-care are necessary to control the blood sugar and high blood pressure. Your care team of the diabetes may help with the following objectives:

  • Monitor your blood sugar. Your health care team will tell you how often to check your blood sugar level to make sure you stay in your target range. You can, for example, the need to check once a day, and before or after exercise. If you take insulin, you may need to check your blood sugar level several times a day.
  • Be active on most days of the week. Try to do at least 30 minutes or more of moderate to vigorous aerobic exercise on most days. Go for a total of at least 150 minutes a week. Activities may include brisk walking, swimming, cycling or running.
  • Eat a healthy diet. Eating a high-fiber diet with plenty of fruits, non-starchy vegetables, whole grains and legumes. Limit saturated fats, processed meats, sweets, and salt.
  • Stop smoking. If you smoke, talk with your healthcare provider about ways to quit smoking.
  • Stay at a healthy weight. If you need to lose weight, talk with your healthcare provider about ways to do it. For some people, weight loss surgery is an option.
  • Taking a daily aspirin. Talk with your healthcare provider about whether you should take a daily low-dose aspirin to reduce the risk of heart disease.
  • Talk with your health care team. Make sure that all the professionals of the care to know you have diabetic nephropathy. They can take steps to protect the kidneys from more damage by not doing the medical examinations that the use of contrast medium. These include angiography and computed tomography (CT).

Coping and support

If you have diabetic nephropathy, these steps may help you cope:

  • Connect with other people who have diabetes, and kidney disease. Ask a member of your health care team about support groups in your area. Or contact with such groups as the American Association of Kidney Patients or the National Kidney Foundation of groups in your area.
  • Adhere to usual routine, when possible. Try to maintain your usual routine, doing activities that you enjoy and working, if their condition allows it. This can help you to deal with feelings of sadness or loss that you may have after their diagnosis.
  • Talk with someone you trust. Living with diabetic nephropathy can be stressful, and it can help to talk to about your feelings. You can have a friend or family member who is a good listener. Or you may find it helpful to speak to a religious leader or someone else you trust. Ask a member of your health care team for the name of a social worker or a counselor.

Preparing for your appointment

Diabetic nephropathy is most often found in the schedule of appointments for diabetes care. If you have been diagnosed with diabetic nephropathy recently, you may want to ask your healthcare provider the following questions:

  • How good are my kidneys to work now?
  • How can I keep my condition from getting worse?
  • What treatment do you suggest?
  • How to do these treatments change or adjustment in my diabetes treatment plan?
  • How will we know if these treatments are not working?

Questions for the academic appointments

Before any appointment with a member of your treatment team of diabetes, ask if you need to take any type of restrictions, such as fasting before taking a test. Questions to periodically check with your doctor or other members of the team include:

  • How often should I check my blood sugar? What is my target range?
  • What changes in my diet to help me better manage my blood sugar, cholesterol or blood pressure?
  • When should I take my medications? I take it with food?
  • How do I manage my diabetes affect the treatment for other conditions that I have? How can I manage my treatments better?
  • When I have to do a follow-up appointment?
  • What should I ask him to call me or seek emergency care?
  • There are brochures or online sources, you can suggest?
  • There is help for the payment of supplies for diabetes?

What to expect from your doctor

Your healthcare provider is likely to ask questions during your appointment, including:

  • Do you understand your treatment plan and to know that you can follow?
  • How are you coping with diabetes?
  • Have you had any low blood sugar?
  • Do you know what to do if your blood sugar is too high or too low?
  • What do you normally eat in a day?
  • Are you exercising? If so, what type of exercise? What's the frequency?
  • Do you feel too much?
  • What are you finding hard on managing your diabetes?
Symptoms and treatment of Diabetic nephropathy (kidney disease)