What is Diabetic Nephropathy?
By Dr Ananya Mandal, MD
 |
| Diabetes Mellitus: What is Diabetic Nephropathy? |
Diabetic nephropathy is the damage caused to the kidneys by diabetesmellitus. Around 50% of individuals with type 1 diabetes will develop
nephropathy within 10 years of having the disease and around 20% of those with
type 2 disease will develop it within 20 years.
The persistently high blood sugar that occurs in diabetes can eventually
cause damage to various organs including the kidneys, eyes and heart.
Diabetic nephropathy usually has a silent onset, meaning it may not be
detected until much of the kidney is damaged.
Diabetic Nephropathy Symptoms
Diabetic nephropathy is not typically
characterized by symptom onset, meaning that most individuals who develop it
are unaware of the condition until it has already caused considerable damage.
Screening diabetic patients for kidney damage is therefore important in
reducing the risk of long-term kidney damage and its associated problems.
Some of the features of diabetic kidney disease that may eventually
manifest include:
·
Edema or swelling of
the ankles, feet, lower legs or hands due to water retention.
·
Urine that is foamy
or frothy in appearance due to excessive protein being excreted in the urine.
This is most commonly seen in the first urine of the day.
·
Weight gain due to
fluid retention and edema
·
Nausea and vomiting
·
Loss of appetite
·
Feeling unwell and tired
·
Generalized itching
·
Headaches
·
Hiccups
·
High blood pressure
Stages of development of diabetic nephropathy
Stage 1
During stage 1, the rate of kidney filtration is increased. The glomerular filtration rate (GFR) in the kidney is increased and the organ may increase in size. However, urine albumin levels and blood pressure may be only mildly raised or normal. At this early stage of nephropathy, there is no pathological damage and the condition is usually reversible.
During stage 1, the rate of kidney filtration is increased. The glomerular filtration rate (GFR) in the kidney is increased and the organ may increase in size. However, urine albumin levels and blood pressure may be only mildly raised or normal. At this early stage of nephropathy, there is no pathological damage and the condition is usually reversible.
Stage 2
During stage 2, there is structural damage of the glomeruli and microalbuminuria starts to occur. The GFR is higher than normal.
During stage 2, there is structural damage of the glomeruli and microalbuminuria starts to occur. The GFR is higher than normal.
Stage 3
Stage 3 disease is termed early stage renal disease. The albumin excretion rate is continuously raised and may exceed 200 μg/min. Blood levels of creatinine are raised and blood pressure may also be high.
Stage 3 disease is termed early stage renal disease. The albumin excretion rate is continuously raised and may exceed 200 μg/min. Blood levels of creatinine are raised and blood pressure may also be high.
Stage 4
This stage of disease is termed clinical diabetic nephropathy, an irreversible stage of disease. There is a decline in GFR of 1 ml/min every month, large amounts of protein pass into the urine and blood pressure is almost always raised.
This stage of disease is termed clinical diabetic nephropathy, an irreversible stage of disease. There is a decline in GFR of 1 ml/min every month, large amounts of protein pass into the urine and blood pressure is almost always raised.
Stage 5
Stage 5 kidney disease is kidney failure or end stage renal disease. The GFR is less than 10 ml/min. Increases in serum creatinine and blood urea nitrogen are accompanied by severe edema, hypertension and hypoproteinemia. This stage of disease necessitates dialysis and even kidney transplant.
Stage 5 kidney disease is kidney failure or end stage renal disease. The GFR is less than 10 ml/min. Increases in serum creatinine and blood urea nitrogen are accompanied by severe edema, hypertension and hypoproteinemia. This stage of disease necessitates dialysis and even kidney transplant.
Outcome
Without treatment, diabetic nephropathy may eventually leads to end
stage renal disease.
In the initial stages of disease, diabetic nephropathy does not cause
pathological damage to the kidneys and is reversible. If the condition
progresses, the kidneys will start to become damaged and the gromerular
filtration rate will decrease.
The extent of kidney damage can range from mild and symptomless, as in
stage 2 disease, through to end stage renal disease which is characterized by a
significantly lowered filtration rate causing a build up of waste products in
the blood.
Individuals with disease that is this advanced eventually require
dialysis or a kidney transplant to stay alive. These individuals may also have
complications of kidney disease such as high blood pressure, heart disease,
bone disease and anemia.
Diabetic Nephropathy Treatment
Diabetic nephropathy describes
the damage caused to kidneys due to diabetes mellitus. If left untreated, the
condition may eventually result in severe renal disease and renal failure. In
the early stages of diabetic nephropathy when the urine levels of albumin are
raised, the use of blood pressure medications such as ACE inhibitors can reduce
the leakage of protein into urine. In more advanced stages, treatment
approaches include blood sugar and blood pressure control along with the
correction of other factors that raise the risk of heart disease such as high
blood cholesterol.
An outline of treatment for
diabetic nephropathy is given below:
Screening for diabetic
nephropathy
In the early stages of diabetic nephropathy, individuals may be free of symptom as these tend to only manifest in the later stages of disease when the kidneys are already damaged. Since diabetic nephropathy is fairly common among long-standing diabetic patients, regular screening of these patients for diabetic nephropathy is important. Routine kidney function tests such as urine albumin and blood creatinine assessment are performed to check for the condition while it is still in the early stages. Beginning treatment early prevents or slows down the progression of kidney disease in most diabetics.
In the early stages of diabetic nephropathy, individuals may be free of symptom as these tend to only manifest in the later stages of disease when the kidneys are already damaged. Since diabetic nephropathy is fairly common among long-standing diabetic patients, regular screening of these patients for diabetic nephropathy is important. Routine kidney function tests such as urine albumin and blood creatinine assessment are performed to check for the condition while it is still in the early stages. Beginning treatment early prevents or slows down the progression of kidney disease in most diabetics.
Blood sugar control
The basic cause of kidney damage in diabetics is the uncontrolled high blood sugar. Tight blood sugar control using insulin or other antidiabetic medications along with a restricted diet can help prevent or slow the progression of diabetic renal disease.
The basic cause of kidney damage in diabetics is the uncontrolled high blood sugar. Tight blood sugar control using insulin or other antidiabetic medications along with a restricted diet can help prevent or slow the progression of diabetic renal disease.
Blood pressure control
Strict blood pressure control can help protect diabetic individuals against kidney disease, heart disease and other complications of diabetes. Evidence suggests that each 10 mm Hg reduction in systolic blood pressure is associated with a 12% decrease in the risk of developing complications of diabetes such as nephropathy. Ideally, the systolic blood pressure should be maintained below 120 mmHg and diastolic blood pressure below 80 mmHg.
Strict blood pressure control can help protect diabetic individuals against kidney disease, heart disease and other complications of diabetes. Evidence suggests that each 10 mm Hg reduction in systolic blood pressure is associated with a 12% decrease in the risk of developing complications of diabetes such as nephropathy. Ideally, the systolic blood pressure should be maintained below 120 mmHg and diastolic blood pressure below 80 mmHg.
The
renin-angiotensin-aldosterone system
A regulatory hormone system called the renin-angiotensin-aldosterone system controls blood pressure and balances the body's fluid content. When blood volume is low, the kidneys secrete renin which converts angiotensinogen into angiotensin I. Angiotensin I is then converted to angiotensin II, a potent vaso-active peptide that stimulates vessel constriction to raise blood pressure.
A regulatory hormone system called the renin-angiotensin-aldosterone system controls blood pressure and balances the body's fluid content. When blood volume is low, the kidneys secrete renin which converts angiotensinogen into angiotensin I. Angiotensin I is then converted to angiotensin II, a potent vaso-active peptide that stimulates vessel constriction to raise blood pressure.
Angiotensin 2 also triggers
the release of aldosterone which causes the kidneys to reabsorb sodium and
water in the blood, therefore increasing the volume of bodily fluid and raising
blood pressure. The conversion of angiotensin I to angiotensin II is mediated
by the angiotensin converting enzyme (ACE). ACE inhibitors such as nalapril and
captopril inhibit this conversion and help to maintain a lower blood pressure.
The agents can also decrease the risk of kidney damage in individuals with
diabetes.
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