Diabetic Nephropathy
- A Serious Kidney Complication

→ SYMPTOMS – DIAGNOSIS – MANAGEMENT – PREVENTION

Chronic kidney disease and end-stage renal disease are becoming increasingly important health concerns for individuals with diabetes worldwide. Back in 2017, there were approximately 697.5 million cases of chronic kidney disease globally, with India being the second most affected country, with 115.1 million cases. The current number is much higher. However, there is a lack of comprehensive reporting on the total magnitude and pattern of chronic kidney disease in India.

Diabetic nephropathy refers to specific pathological, functional, and structural changes in the kidneys of patients with diabetes. Continuous albuminuria and a decline in kidney function are the key indicators of diabetic nephropathy. This disease has a significant economic impact and can negatively affect the quality of life of patients, with treatment costs increasing as the disease progresses.

It is essential to recognize that individuals with type 2 diabetes are at higher risk of disease progression. Therefore, early detection and management of diabetic nephropathy are crucial to prevent its progression as chronic kidney disease and end-stage renal disease. By taking proactive measures and making lifestyle changes, such as maintaining a healthy weight, following a balanced diet, and engaging in regular physical activity, individuals with diabetes can reduce their risk of developing kidney problems.

Let’s understand diabetic nephropathy a bit more.

“Approximately 30% to 40% of patients with type 1 or type 2 diabetes mellitus develop Diabetic Kidney Disease.”

The burden of diabetic nephropathy in India: Need for prevention

– Vijay Viswanathan and Reshma Mirshad | Published by De Gruyter July 22, 2023

What is Diabetic Nephropathy?

Diabetic nephropathy is a type of kidney disease that can affect individuals with diabetes over a long period. It occurs when high levels of glucose in the blood damage the kidneys’ ability to function properly. If diabetes is not well managed, it can harm the blood vessels in the kidneys that are responsible for filtering waste from the blood. This can lead to kidney damage and high blood pressure.

High blood pressure can cause additional harm to the kidneys by increasing the pressure in the kidney’s filtering system.

Diabetic nephropathy is a type of chronic kidney disease (CKD) and can lead to end-stage renal disease (ESRD).

The Five Stages of Diabetic Nephropathy

Stage 1: Hyperfiltration (GFR: 90+)

In this early stage, the kidneys work harder to filter blood due to increased blood flow, but there are no apparent signs of kidney damage.

Stage 2: Microalbuminuria (GFR: 80 – 60)

This stage is characterized by the presence of small amounts of protein (albumin) in the urine, which indicates early kidney damage. Blood pressure may also begin to rise at this stage.

Stage 3: Overt Proteinuria (GFR: 50 – 30)

Also known as macroalbuminuria, this stage involves the excretion of larger amounts of protein in the urine. Blood pressure may continue to rise, and kidney function may decline further.

Stage 4: Severe Kidney Damage (GFR: 29 – 15)

Kidney function continues to deteriorate, leading to a significant decrease in glomerular filtration rate (GFR), which measures how well the kidneys are filtering waste from the blood.

Stage 5: End-Stage Renal Disease – ESRD (GFR: <15)

This is the most advanced stage of diabetic nephropathy, where kidney function is severely impaired, and the kidneys can no longer adequately remove waste and excess fluids from the body. Dialysis or kidney transplantation is typically required at this stage to sustain life.

What is the GFR?

Glomerular filtration rate, abbrev. GFR, is a measure of how effectively the kidneys filter waste and excess fluid from the blood. Specifically, it indicates the volume of fluid filtered by the glomeruli (the tiny blood vessels in the kidneys) per unit of time. GFR is considered one of the most important indicators of kidney function. A lower GFR typically indicates decreased kidney function, while a higher GFR suggests better kidney function.

Symptoms of Diabetic Nephropathy

During the initial stages of diabetic nephropathy, there may not be any apparent symptoms. However, as the condition progresses, a person may experience the following symptoms:

High blood pressure becomes increasingly difficult to manage
Swelling in the feet, ankles, hands, or eyes
Foamy urine
Confusion or difficulty with concentration
Shortness of breath
Loss of appetite
Nausea and vomiting
Itching
Feelings of tiredness and weakness

It is essential to seek medical attention promptly if you experience any of these symptoms, as they could be indicative of a more severe underlying condition.

Risk Factors

If you suffer from diabetes, certain factors may increase your chances of developing diabetic nephropathy. These factors include

Uncontrolled hyperglycemia (high blood sugar)
Uncontrolled hypertension (high blood pressure)
Smoking
High blood cholesterol
Obesity
A family history of diabetes and kidney disease.

It’s important to manage these risk factors to reduce your chances of developing diabetic nephropathy.

How can Diabetic Nephropathy be Diagnosed?

Diabetic nephropathy is typically diagnosed during routine testing for diabetes management. To stay on top of it, get tested regularly if you have type 2 diabetes or if you’ve had type 1 diabetes for more than five years.

Routine Screening Tests

Urinary albumin test: This detects a protein called albumin in your urine. Normally, the kidneys don’t filter out albumin, so if there’s too much in your urine, it may indicate kidney problems.
Albumin/creatinine ratio: This test measures the ratio of albumin to creatinine in your urine sample. It provides insights into kidney function.
Glomerular filtration rate (GFR): It is a measure of how efficiently the kidneys filter blood. A low GFR indicates decreased kidney function.

Other Diagnostic Tests

Imaging tests: X-rays, ultrasounds, CT scans, and MRI scans can help visualize the kidneys and assess blood flow.
Kidney biopsy: This procedure involves local anaesthesia and taking a small sample of kidney tissue to analyze in a lab. It provides more in-depth information about kidney health.

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Can Diabetic Nephropathy be Prevented?

The onset and progression of diabetic nephropathy can be slowed by intensive management of diabetes and its symptoms, including taking medications to lower blood pressure.

Preventive Healthcare Save Lives – Get Regular Health Check-ups

Tips for Healthy Kidneys – Managing Diabetic Nephropathy

If you have diabetes, it’s important to take steps to protect your kidneys and reduce your risk of diabetic nephropathy.

To do this, you should

Keep your blood sugar levels within their target range
Manage your blood pressure, and get treatment if you have high blood pressure.
It’s also important to quit smoking if you smoke and to work with your doctor to find a smoking cessation plan that works for you.
If you’re overweight or obese, losing weight can also help protect your kidneys.
Eating a healthy diet that’s low in sodium, focusing on fresh produce, lean meats, whole grains, and healthy fats
Limit your intake of processed foods that are high in salt and empty calories
Regular exercise can help you maintain a healthy weight and reduce your blood pressure, so be sure to work with your doctor to develop an exercise program that’s right for you.
Besides, regular health check-ups are kind of mandatory to keep track of your renal health

Medication and Procedures for Diabetic Nephropathy

In the early stages of diabetic nephropathy, management may include medicines for blood pressure, blood sugar, high cholesterol and medicines to reduce tissue scarring due to diabetic nephropathy.

The treatment for advanced stages includes Kidney Dialysis and Transplant. Symptom management is offered to patients who don’t want dialysis or transplants. However, in such cases, life expectancy does not extend beyond a few months.

What Does the Future Hold?

In the future, regenerative medicine—a field of study that aims to help the body heal itself—may provide diabetic nephropathy patients with useful treatments. These methods could aid in halting or reversing renal impairment.

For example, some experts believe that the kidneys may function better if a person’s diabetes can be treated by a future treatment like stem cell therapy or a pancreas islet cell transplant. Both these treatments and novel medications are still being researched.

At North City Diagnostic Center we offer personalized testing schedule that aligns with your medical history and risk factors. Consistent monitoring can be invaluable for early detection and effective management of arthritis. It’s not just about how often you test but making sure that the tests are aligned with your overall health profile for maximum benefit.

References

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North City Diagnostic

Diabetic Nephropathy
- A Serious Kidney Complication

→ SYMPTOMS – DIAGNOSIS – MANAGEMENT – PREVENTION

Table of Contents

What is Diabetic Nephropathy?