Diabetic Nephropathy

Manoj Mandela

RESEARCH ASSOCIATE

Department of Kidney Research

Diabetes mellitus is a major health problem and has become a serious concern in the Indian population. It leads to various complications affecting the neuro-vascular systems.

One such complication is Diabetic Nephropathy.

Diabetic nephropathy, also known as Kimmelstiel-Wilson syndrome, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli..

Diabetic nephropathy is characterized by the following:

• Persistent albuminuria (>300 mg/d or >200 μg/min) that is confirmed on at least 2 occasions, 3-6 months  apart
• Progressive decline in the glomerular filtration rate (GFR)
• Elevated arterial blood pressure

Currently, Diabetic Nephropathy is one of the most significant long-term complications in terms of morbidity and mortality for individual patients with diabetes. It is generally considered after a routine urinalysis and screening for microalbuminuria in people with diabetes. Patients may have physical findings associated with long-standing diabetes mellitus. Early treatment delays or prevents the onset of diabetic nephropathy or diabetic kidney disease.

Regular outpatient follow-up is the key in managing diabetic nephropathy successfully.

Apart from the individual human suffering, the cost of dialysis in patients with Type 2 diabetes is very high.

The normal process - The process of digesting the protein in food creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) act as filters to remove these waste products. As blood flows through the capillaries, waste products squeeze outand become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and remain in the blood.

Diabetes can damage this system.

High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters and after many years, they start leaking  and useful protein is lost in the urine.

Having small amounts of protein in the urine is called microalbuminuria.When kidney disease is diagnosed early (during microalbuminuria) several treatments may keep kidney disease from getting worse.

Having larger amounts of protein in the urine is called macroalbuminuria. When kidney disease is caught later (during macroalbuminuria) end-stage renal disease or ESRD, usually follows.

In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail (ESRD) and a person with ESRD needs to have a kidney transplant or to have the blood filtered regularly by machine (dialysis).

Prevent Progression in Diabetic Nephropathy:

Several studies have clearly shown that in people with either Type 1 or Type 2 diabetes and who already have microalbuminuria; ACE inhibition is effective in reducing renal progression. It has been proposed that the benefit is independent of blood pressure.

In patients with macroalbuminuria and abnormal GFR, blood pressure reduction, usually with an ARB or ACE inhibitor, has dramatically improved the renalcondition.

Prevent Diabetes Nephropathy -

The best way to prevent diabetic nephropathy is to control your blood sugar.

 

Your blood pressure should be monitored frequently, and blood pressure should be kept below a peak level (systolic pressure, the "top" blood pressure number) of 130 millimeters of mercury (mmHg), and kept below a bottom number (diastolic pressure) of 80mmHg. These goals for blood pressure are lower than that used for people who do not have diabetes.

Any person who has diabetes and who also has high blood pressure should regularly take  blood pressure lowering medications.

Avoiding medications that can sometimes have harmful side effects upon the kidneys also can help to prevent kidney disease.

A low-protein diet (10% to 12% or less of total calories) also may slow or halt the progression of kidney disease. 

If you smoke cigarettes, you should quit.