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What is Diabetic Nephropathy?
Diabetic Nephropathy, also known as “diabetic kidney disease,” is the loss of kidney function resulting from diabetes. It is a complication of patients with type 1 and types 2 diabetes. Patients suffering from Diabetes Mellitus have very high blood sugar levels, and over time, this can slow down the function of the nephrons (the filtering part of the kidney). When the nephrons begin to lose their filtering ability, it can lead to chronic kidney disease (CKD) and even kidney failure or end-stage renal disease (ESRD). Suppose the preventive measure is not taken to control sugar levels in diabetic patients. In that case, they can easily develop kidney disease, especially those with type 1 diabetes. The ratio to which people with diabetic Mellitus develop CKD is common and high. Research states that 1 in 4 females and 1 in 5 males with diabetes progress to having kidney disease.
Diabetic nephropathy is a complication of Type 1 and Type 2 diabetes. It occurs when diabetes causes the kidney to lose function by damaging the part and blood vessels in the kidney (nephron and glomeruli) that filter waste products from the body. This can result in overall kidney damage and cause hypertension.
What are the risk factors associated with diabetic nephropathy?
Several factors can increase the rate at which the patient can have diabetic nephropathy. They include:
- Type of diabetes; type 1 has more risk of developing the condition faster.
- Uncontrolled hyperglycemia (high blood sugar/glucose level)
- Increased cholesterol levels in the blood.
- Uncontrolled hypertension (high blood pressure)
- Duration of diabetes; the longer the patient has been affected with diabetes, the greater the risk of having diabetic kidney disease.
- Family history of diabetic mellitus and kidney disease.
- Age; the older we are, the greater the risk of developing the condition because our glomeruli filtration rate (GFR) reduces as we age.
- Gender; males are at more risk of developing diabetic nephropathy than females.
- Smoking; smoking does a lot of damage to the kidney, and if the diabetic patient smokes, they are at a very high risk of developing the condition.
The symptoms of diabetic nephropathy are broken down into the stages of chronic kidney disease (CKD).
- Stages 1 and 2 are the stages of mild loss of kidney function and rarely show any signs.
- Stage 3 begins to show not too many signs but relatable signs enough to hint at function loss.
- Stages 4 and 5 comprise severe and chronic kidney damage with obvious signs of loss of function. Stage 5 is mostly referred to as end-stage renal failure, where dialysis and, subsequently, kidney transplants are needed.
However, this progresses very slowly, and if diabetes is managed properly, it can take 15 to 25 years before signs can show. When signs begin to show, they include the following:
- Nausea and vomiting
- Nocturia; frequent urination at night
- Sour or metallic taste buds
- Breathing difficulties
- Swollen face, joints, feet, and hands.
- Hematuria (blood in urine or dark urine)
- Protein in urine
- Lack of appetite
- Weight loss
- Sleeping and concentration troubles.
- Muscle cramps
- Itchy skin
How is diabetic nephropathy diagnosed?
Investigations for Diabetic Nephropathy
- Urine culture – Exclude infection
- Microscopy of the urine – Check for red cells in glomerulonephritis.
- Complement level – Exclusion of autoimmune disease
- Igs; Protein electrophoretic strip – Exclude multiple myeloma
- Renal ultrasound – Excludes obstructive kidney disease; evaluate renal anatomy and size.
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Diabetic nephropathy can be diagnosed through the following tests:
- Urine test; to check the protein (albumin) level and blood in the urine.
- Blood Test; to evaluate the amount of creatinine, a chemical waste product, in the blood.
- Albumin/creatinine ratio; this test helps us to measure how much albumin is in a urine sample relative to how much creatinine there is.
- Glomerular Filtration Rate (GFR); to calculate the amount of waste product the kidneys filter in a minute.
- Imagery Tests, like CT, MRI scans, and X-rays, check the outline of the kidney for increase or damage.
- Kidney Biopsy; during this test, a small sample of kidney tissue is taken and sent for histopathological studies.
Treatment often depends on the stage of diabetic nephropathy and the symptoms that may occur. Mostly, early treatments are to control blood sugar and pressure level. These treatments may include:
Medications are used to control some of the causes and symptoms of the condition. Some are:
- Angiotensin-converting enzyme (ACE) inhibitors to curb hypertension.
- Angiotensin II receptor blockers (ARBs) control high blood pressure.
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors to reduce high blood sugar.
- Glucagon-like peptide-1 receptor agonists (GLP-1RAs) to prevent cardiovascular disease
- Vitamin D to reduce cholesterol levels.
- Drugs to reduce protein in the urine.
In advanced stages of kidney disease, which are stage 4 and stage 5 of CKD, treatments may include:
This involves the use of a machine to remove waste products from the blood and body. There are two types:
A surgical procedure involves the removal of damaged kidneys and replacing them with a kidney from a living or deceased donor.
What are the complications associated with diabetic nephropathy?
Diabetic nephropathy can lead to the following complications in human health.
- End-stage renal (kidney) disease (ESRD)
- Pulmonary edema; blood clots that move to and block the lungs
- Cardiovascular diseases
- Heart failure
- Hyperkalemia; high blood potassium level.
- Diabetic Retinopathy: Damage to the blood vessels of the retina.
- Foot sores
- Erectile dysfunctions
- Complications in pregnancy.
Can diabetic nephropathy be prevented?
To prevent the development of diabetic nephropathy or control the condition, one has to:
- Make dietary changes; reduce the intake of anything that can lead to complications, such as water, to ease frequent urination and reduce the consumption of sodium, potassium, protein, and phosphorus.
- Quit damaging habits such as smoking, street drugs, and alcohol.
- Control high blood sugar and pressure levels.
- Maintain a healthy weight.
Diabetic nephropathy cannot be cured. The treatments available are used to slow down the progression of the condition by controlling its causes and symptoms.
The stages of diabetic nephropathy follow the stages of chronic kidney disease.
1) Stage 1: records little or very minimal damage to the kidney with a GFR of 90% and above.
2) Stage 2: minimal damage to the kidney with 60 to 89% GFR.
3) Stage 3: Increased damage to the kidney with few and upcoming symptoms. GFR of 30 to 59%.
4) Stage 4: Severe damage to the kidney with obvious symptoms. Records a GFR of 15% to 29%.
5) Stage 5: End-stage renal (kidney) failure. Kidney losses all its functions with less than 15% GFR.
Diabetic nephropathy, like every nephropathy, is very slow progress. Once diabetes has begun to make the kidney lose its function, it can take 10 to 30 years for it to end in ESRD. This duration depends on how well we control our blood sugar levels and high blood pressure.
Type 1 patients often show a change in the functions of their kidneys 2 to 5 years after they have been diagnosed with diabetes. Type 2 diabetes patients may begin losing their function 3 to 7 years after diagnosis. However, research shows that 20 to 40% of diabetes patients advance to more severe cases of kidney failure within 10 to 30 years.
Diabetic nephropathy is a type of kidney disease that arises in diabetes patients due to the damage Diabetes Mellitus does to the kidney. In comparison, diabetic neuropathy is damage to the nervous system caused by diabetes.
Several studies have demonstrated that diabetic nephropathy can be reversed by a relatively simple diet intervention. It is assumed that reduced glucose metabolism mediates the protective effect of the ketogenic diet remains to be determined .