Diabetic Nephropathy

Diabetes- blood sugar
Nephropathy: kidney disease

Sravanthi Allareddy
(Research Associate)
Department of Prevention of Diabetic Kidney Disease



Diabetic Nephropathy, a complication of diabetes, is a kidney disease caused by too much sugar in the blood. High levels of sugar in the blood can damage tiny blood vessels in the kidneys, making them fail to function normally. Their functions include filtering waste products from the body, regulating the balance of electrolyte and secreting essential hormones. Therefore, patients with Diabetic Nephropathy will have problems, regarding renal function.






Untreated or poorly treated, Diabetic Nephropathy will progress to renal failure rapidly.

People who have diabetes as well as high blood pressure are at greater risk of kidney problems because uncontrolled blood pressure hastens the progress of kidney damage as shown in the figure below.


Diabetic nephropathy can occur in both:
* Type 1 diabetes
* Type 2 diabetes

Causes, incidence, and risk factors

* Each kidney is made up of hundreds of thousands of small units called nephrons. These structures filter your blood and help remove wastes from your body.
* In people with diabetes, the nephrons thicken and slowly become scarred over time. The kidneys begin to leak and protein (albumin) passes into the urine.
* Poor control of blood sugar is thought to lead to kidney damage. If you also have high blood pressure, kidney damage is even more likely.
* In some cases, your family history may also play a role.
* People with diabetes who smoke and those with type 1 diabetes that started before the age of 20 have a higher risk for kidney problems.
* People of African-American, Hispanic, and American Indian origin are also more likely to have kidney damage.

Symptoms

* Often, there are no symptoms as the kidney damage starts and slowly gets worse. Kidney damage can begin 5 to 10 years before symptoms start.
* People who have more severe kidney disease may have a poor appetite, feel tired most of the time, and have a general ill feeling
* Headache, vomiting, swelling, and many other symptoms may also occur.

Signs and tests


* Once a year, people with diabetes should test their urine . The urine test looks for a protein called albumin. Because the test looks for small amounts of albumin, it is sometimes called a test for microalbuminuria. Too much protein is often a sign of kidney damage.
* High blood pressure often goes along with diabetic nephropathy. You may have high blood pressure that begins quickly or is hard to control.




Check your kidneys with the following blood tests every year:
* BUN
* Serum creatinine

Other lab tests that may be done include:

* 24-hour urine protein
* Blood levels of phosphorus, calcium, bicarbonate, PTH, and potassium
* Hemoglobin
* Hematocrit
* Protein electrophoresis - urine

A kidney biopsy confirms the diagnosis. However, biopsy is not needed all the time, but for correct diagnosis to conform.


Treatment

* Keeping blood pressure under control (under 130/80) is one of the best ways to slow kidney damage.
* To protect kidney damage, often the best types of medicine to use are ACE inhibitors and angiotensin receptor blockers (ARBs) such as ramipril, almisarton etc
* Eating a low-fat diet, taking drugs to control lipids, and getting regular exercise can also help prevent or slow kidney damage.

Urinary tract and other infections are common, and can be treated with antibiotics.