Diabetic Nephropathy

Overview

Diabetic nephropathy is a life-threatening complication of type 1 and type 2 diabetes. 
Also known as diabetic kidney disease. 
In the United States, approximately one-third of diabetics have diabetic nephropathy.



Diabetic nephropathy impairs the kidneys’ ability to perform their normal function of removing waste and excess fluid from the body. 
The most effective way to prevent or delay diabetic nephropathy is to maintain a healthy lifestyle and effectively manage diabetes and hypertension.



The condition gradually deteriorates the kidneys’ delicate filtering mechanisms over many years. 
Early treatment may prevent or slow the progression of the disease and decrease the likelihood of complications.
Kidney disease can progress to end-stage kidney disease, also known as kidney failure. 
Kidney failure is a potentially fatal condition. 
At this stage, dialysis or a kidney transplant are the only treatment options.

Types

Nephropathy is the deterioration of kidney function. The final stage of nephropathy is called kidney failure, end-stage renal disease, or ESRD.

According to the CDC, diabetes is the most common cause of ESRD. In 2011, about 26 million people in the U.S. were reported to have diabetes, and more than 200,000 people with ESRD due to diabetes were either on chronic renal dialysis or had a kidney transplant. Both type 1 and type 2 diabetes can lead to diabetic nephropathy, although type 1 is more likely to lead to ESRD.

There are five stages of diabetic nephropathy. The fifth stage is ESRD. Progress from one stage to the next can take many years.

Causes

Causes of diabetic nephropathy:
 
  • Diabetes type 1 and type 2 frequently result in diabetic nephropathy.
  • Uncontrolled diabetes can damage blood vessel clusters in the kidneys that filter waste from the blood over time. This can cause damage to the kidneys and high blood pressure.
By increasing the pressure in the delicate filtering system of the kidneys, high blood pressure can exacerbate kidney damage.
hazard factors
The following factors can increase your risk of diabetic nephropathy if you have diabetes:
Uncontrolled hyperglycemia (hyperglycemia)
Hypertension not under control (hypertension)
Being a smoker
elevated blood cholesterol
Obesity
a history of diabetes and kidney disease in the family

Symptoms

In the earliest stages of diabetic nephropathy, you are unlikely to experience any symptoms. 
In advanced stages, the following symptoms may be present:


deteriorating blood pressure management

the presence of protein in the urine

Inflammation of the feet, ankles, hands, or eyes

Increased urine output

Reduced insulin or diabetes medication requirements

Confusion or concentration issues

Shortness of breath Appetite loss

Nausea and vomiting

Persistent itching

Fatigue

Complications

Complications of diabetic nephropathy can develop gradually over the course of several months or years. 
They may consist of:



As a result of fluid retention, you may experience swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema)

 

A rise in blood potassium concentration (hyperkalemia)

 

Heart and blood vessel disease (cardiovascular disease), which may result in a stroke

 

Blood vessel damage to the light-sensitive tissue at the back of the eye (diabetic retinopathy)

 

fewer red blood cells available to transport oxygen (anemia)

 

Foot ulcers, erectile dysfunction, diarrhea, and other conditions caused by nerve and blood vessel damage include:

 

Bone and mineral disorders caused by the kidneys’ inability to maintain the proper calcium and phosphorus balance in the blood.

 

Complications of pregnancy that pose risks to the mother and the developing fetus.
End-stage kidney disease is irreversible kidney damage that requires dialysis or a kidney transplant for survival.

Diagnostics

Typically, diabetic nephropathy is diagnosed during routine testing performed as part of diabetes management. Diabetics with type 1 diabetes should begin screening for diabetic nephropathy five years after their initial diagnosis. If type 2 diabetes is diagnosed, screening will commence at the time of diagnosis.

Examples of routine screening tests include:

Test for urinary albumin. This test can detect the presence of albumin in the urine. Typically, albumin is not removed from the blood by the kidneys. An excessive amount of protein in the urine may indicate impaired kidney function.
Ratio of albumin to creatinine. Creatinine is a chemical waste product that is removed from the blood by healthy kidneys. The albumin/creatinine ratio, which measures the amount of albumin in urine relative to the amount of creatinine, is another indicator of kidney function.
Glomerular filtration rate (GFR). The amount of creatinine in a blood sample can be used to estimate the kidneys’ blood filtration rate (glomerular filtration rate). A low filtration rate is indicative of impaired renal function.
Other diagnostic procedures might include:

Imaging tests. Your doctor may use X-rays and ultrasound to evaluate the structure and size of your kidneys. You may also undergo CT scanning and magnetic resonance imaging (MRI) to determine the health of your kidneys’ blood circulation. In some instances, other imaging tests may be utilized.
Kidney biopsy. Your physician may recommend a kidney biopsy to obtain a tissue sample from the kidney. You will be administered numbing medication (local anesthetic). The physician will then use a thin needle to remove small pieces of kidney tissue for microscopic examination.

Treatment

Treatment
The initial step in treating diabetic nephropathy is treating and controlling diabetes and hypertension (hypertension). This includes diet, lifestyle modifications, physical activity, and prescription medications. You may be able to prevent or delay kidney dysfunction and other complications if you effectively manage your blood sugar and hypertension.

Medications
In the initial stages of diabetic nephropathy, your treatment plan may include the following medications:

Blood pressure control. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (ARBs) are medications used to treat hypertension.
Blood sugar control. Medication can assist diabetic nephropathy patients in controlling their high blood sugar levels. Metformin (Fortamet, Glumetza, and others) increases insulin sensitivity and decreases liver glucose production. In response to rising glucose levels, Glucagon-like peptide 1 (GLP-1) receptor agonists slow digestion and stimulate insulin secretion to help reduce blood sugar levels. SGLT2 inhibitors restrict glucose’s return to the bloodstream, resulting in increased glucose excretion in the urine.
Elevated cholesterol. Statins are used to reduce protein levels in the urine and treat high cholesterol.
Renal scarring. Finerenone (Kerendia) inhibits the molecular activity believed to be responsible for the inflammation and scarring of diabetic nephropathy tissues. In adults with type 2 diabetes and chronic kidney disease, the drug may reduce the risk of kidney function decline, kidney failure, cardiovascular death, nonfatal heart attacks, and hospitalization for heart failure.
Your physician will likely recommend periodic tests to determine whether your kidney disease remains stable or worsens.

Advanced diabetic nephropathy treatment
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If your disease progresses to kidney failure (end-stage kidney disease), your physician will likely discuss treatment options aimed at either replacing your kidneys’ function or making you more comfortable. Examples include:

Renal dialysis. This treatment eliminates waste and excess fluid from the blood. Hemodialysis and peritoneal dialysis are the two primary types of dialysis. In the first, more prevalent method, you may be required to visit a dialysis center and be connected to an artificial kidney machine approximately three times per week, or you may have dialysis performed at home by a trained caregiver. Each session lasts three to five hours. The second method may also be performed at home.
Transplant. In certain circumstances, a kidney transplant or kidney-pancreas transplant is the best treatment option. If you and your doctor decide to undergo transplantation, you will be evaluated to determine your suitability for the procedure.
Symptom management. If you elect not to undergo dialysis or a kidney transplant, your life expectancy is typically only a few months. You may receive treatment intended to maintain your comfort.
Potential future treatments
People with diabetic nephropathy may benefit in the future from regenerative medicine-based treatments. These techniques may assist in reversing or slowing the disease-induced kidney damage. Some researchers believe that if a future treatment, such as a pancreas islet cell transplant or stem cell therapy, can cure a person’s diabetes, kidney function may improve. These treatments, as well as new medications, are still the subject of research.