Diabetic nephropathy: Causes, symptoms & treatment

What is diabetic nephropathy:

Diabetic nephropathy is also known as diabetic kidney disease. It is a kidney-related condition as a result of diabetes mellitus. Diabetes can damage the delicate filtering system of collecting waste from the blood inside the kidneys. Severe damage leads to kidney failure or other end-stage kidney conditions. One-fourth of diabetes patients are affected by diabetic nephropathy. 

Diabetic nephropathy if left untreated can lead to kidney failure and kidney failure is a serious complication. The only possible treatment for it is dialysis or a kidney transplant. 

40% of kidney failure cases are a result of diabetic nephropathy. Diabetic nephropathy is a slowly progressing disease.

Diabetic nephropathy

Diabetic nephropathy stages:

There are 5 stages of diabetic nephropathy. Early treatment can stop the progression from one stage to the next. The first stage has very mild symptoms and the fifth stage has very serious symptoms and is a serious case of kidney failure.

Glomerular filtration rate (GFR): This is used to determine the stage of the kidney condition. This is vital as the treatment plan varies according to the stage one is diagnosed with. The important function of the kidney is to filter the blood. GFR is a test to check the functioning of the kidney, it gives the value of how much blood passes through the filters in the kidney. 

Stage 1: Mildest symptoms. There is a little bit of damage to the kidneys but the functioning of the kidney is normal. It is characterized by a GFR equal to or above 90.

Stage 2: There is damage to the kidney leading to some loss of functions. It is characterized by a GFR value between 60 to 89.

Stage 3: Also known as incipient diabetic nephropathy. Almost half the functionality of the kidney is lost. It is characterized by a GFR value between 30 to 59. 

Stage 4: It is called overt diabetic nephropathy. Stage 4 is characterized by severe kidney damage and a GFR between 15 to 29. 

Stage 5: Stage 5 also known as an end-stage renal disease (ESRD), is a serious case of kidney failure. It can have serious symptoms. The only form of treatment is dialysis or a kidney transplant. Usually, it is important to undergo treatment before reaching this advanced stage of kidney damage. GFR value below 15 implies that one is diagnosed with kidney failure. 

kidney failure

What causes diabetic nephropathy:

The most important function of the kidney is to filter the blood i.e. waste products are filtered out and excess water in the bloodstream is excreted out in the form of urine. This is carried out by nephrons. Nephrons are a system of tubes and blood vessels. Each kidney has about 1 million nephrons. A group of vessels present inside the nephron acts as the filter. This group of vessels are called the glomerulus. 

Diabetes interferes with the working of the glomerulus. This leads to poor filtering function of the kidneys. There are also chances that proteins may leak from the blood into the urine. 

Diabetes can also cause scarring in the nephrons, this condition is called glomerulosclerosis. It leads to a gradual reduction in the functioning of the kidney. The kidney hence loses its ability to filter and remove the water from the body. 

When a significant amount of glomerulus is damaged, it leads to kidney failure.

Damage to the kidney can lead to:

  • The body losing protein through urine
  • The inability of the kidneys to remove waste products from the blood 
  • The Inability to maintain healthy fluids in the body.

There are also certain risk factors that increase the risk of one being affected by diabetic nephropathy.

Risk factors:

Risk factors that increase the chance of being affected by diabetic nephropathy are:

  • Ethnicity: Belonging to a certain ethnic background increases the risk of diabetic nephropathy. Especially if you are African-American, Hispanic, or American Indian. 
  • Smoking: Kidney damage results from a link between smoking and inflammation.
  • High blood pressure
  • Gender: More common in men than women.
  • Age: People above 65 years are at a higher risk of diabetic nephropathy
  • Overweight or obese
  • Other medical conditions
  • Longer periods of having diabetes
  • Family history

Symptoms of diabetic nephropathy:

In the early stages of diabetic nephropathy, the symptoms aren’t present. As it progresses to Stage 3 or more, the symptoms include:

  • Swollen ankles and feet
  • Dark coloured urine
  • Loss of weight
    Symptoms of diabetic nephropathy
  • Fatigue
  • Unwell feeling
  • Dry, itchy skin
  • Nausea or vomiting

Can diabetic nephropathy be reversed?

It is easier to reverse diabetic nephropathy in the beginning stages. Early treatment can prevent the onset of advanced stages of diabetic nephropathy. The main purpose of treatment is to maintain the optimum level of blood sugar. Some forms of treatment are:

Drug treatment: Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) can prove effective in treatment. There are other drugs and medications that can be recommended by doctors.

Change in diet: Doctors recommend the patients to keep track of nutrients like sodium, potassium, phosphorus and proteins. It is also essential to keep the water level in check too.

Managing blood sugar level: There are various ways of maintaining blood sugar levels. Usage of insulin and lifestyle changes can also prove effective.

Dialysis: It is done as a treatment for advanced stages of diabetic nephropathy.

Kidney transplant: A kidney transplant is done when there is a case of kidney failure. 

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