Diabetic Nephropathy

Diabetic nephropathy is a significant consequence of both type 1 and type 2 diabetes. It's also known as diabetic kidney disease. Diabetic nephropathy impairs the kidneys' normal function of eliminating waste materials and excess fluid from the body. The best strategy to prevent or delay diabetic nephropathy is to maintain a healthy lifestyle and control diabetes and high blood pressure levels. Over time, diabetic nephropathy gradually deteriorates the kidney's filtering system. Early treatment may prevent or slow this illness, reducing the risk of consequences. Diabetic renal disease can cause kidney failure. This is also known as end-stage kidney disease. Kidney failure is potentially fatal. Kidney failure can be treated with dialysis or a kidney transplant.

Symptoms

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

High blood pressure becomes more difficult to control.
Swelling in the feet, ankles, hands, and eyes.
Urine is foamy.
Confusion or difficulty in thinking.
Shortness of breath.
Appetite loss.
Nausea and vomiting occurred.
Itching.
Tiredness and weakness.

Causes

Diabetic nephropathy occurs when diabetes causes damage to blood vessels and other kidney cells. Diabetic nephropathy is a prevalent consequence of both type 1 and type 2 diabetes. Uncontrolled diabetes can eventually damage blood vessels in the kidneys that filter waste from the blood. This can result in renal damage and excessive blood pressure. High blood pressure can lead to further kidney damage by increasing pressure in the kidney's filtering system.

Risk factors

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

Uncontrolled high blood sugar, also known as hyperglycemia.
Hypertension refers to uncontrolled high blood pressure.
Smoking.
High blood cholesterol.
Obesity.
Diabetes and kidney disease run in my family.

Complications

Complications of diabetic nephropathy might develop slowly over months or years. They may include excessive bodily fluid buildup, hyperkalemia, heart and blood vessel disease, anemia, pregnancy difficulties, and irreversible kidney damage.

Prevention

To reduce your chance of developing diabetic nephropathy, contact your health care team regularly to manage diabetes, treat your diabetes, control high blood pressure or other medical conditions, take non-prescription medications only as prescribed, maintain a healthy weight, and avoid smoking.

Diagnosis

Routine screening tests may include:

Urinary albumin test: This test can detect a blood protein called albumin in urine. Typically, the kidneys don't filter albumin out of the blood. Too much albumin in your urine can mean that the kidneys aren't working well.
Albumin/creatinine ratio: Creatinine is a chemical waste product that healthy kidneys filter out of the blood. The albumin/creatinine ratio measures how much albumin compared to creatinine is in a urine sample. It shows how well the kidneys are working.
Glomerular filtration rate (GFR): The measure of creatinine in a blood sample may be used to see how quickly the kidneys filter blood. This is called the glomerular filtration rate. A low rate means the kidneys aren't working well.

Other diagnostic tests may include:

Imaging tests: X-rays and ultrasound can show the makeup and size of the kidneys. CT and MRI scans can show how well blood is moving within the kidneys. You may need other imaging tests as well.
Kidney biopsy: This is a procedure to take a sample of kidney tissue to be studied in a lab. It involves numbing medicine called a local anesthetic. A thin needle is used to remove small pieces of kidney tissue.

Treatment

The first step in treating diabetic nephropathy is to treat and control diabetes and high blood pressure. Treatment includes diet, lifestyle changes, exercise, and prescription medicines. Controlling blood sugar and blood pressure might prevent or delay kidney issues and other complications.

Medications

In the early stages of diabetic nephropathy, your treatment might include medicines to manage the following:

Blood pressure: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (ARBs) are used to treat high blood pressure.
Blood sugar: Medicines can help control high blood sugar in people with diabetic nephropathy. They include older diabetes medicines such as insulin. Newer drugs 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 work for you. These treatments can protect the heart and kidneys from damage due to diabetes.

Treatment for advanced diabetic nephropathy

For kidney failure, also called end-stage kidney disease, treatment focuses on either replacing the work of your kidneys or making you more comfortable. Options include kidney dialysis.

Peritoneal dialysis uses the inner lining of the abdomen, called the peritoneum, to filter waste. A cleansing fluid flows through a tube to the peritoneum. This treatment can be done at home or work. However, not everyone can use this method of dialysis. Sometimes, a kidney transplant or a kidney-pancreas transplant is the best treatment choice for kidney failure. If you and your healthcare team decide on a transplant, you'll be assessed to find out if you can have the surgery.

Lifestyle and home remedies

To control blood sugar and high blood pressure, you must eat right, exercise, and care for yourself. Your diabetes care team can assist you with the following goals: monitoring your blood sugar, being active most days of the week, eating a good diet, quitting smoking, maintaining a healthy weight, taking aspirin daily, and communicating with your health care team.

Conclusion

Diabetic nephropathy is a progressive diabetes condition that must be managed proactively to avoid kidney failure and associated problems. Key strategies include keeping blood sugar and blood pressure under control, eating a kidney-friendly diet, managing cholesterol levels, and adopting a healthy lifestyle. Early detection and comprehensive treatment can frequently dramatically reduce the progression of diabetic nephropathy, improving quality of life and long-term results. Regular monitoring and collaboration with healthcare experts are critical for providing personalized treatment and timely interventions.