Diabetic Nephropathy: Causes, Complications and Management

Overview

What is diabetic nephropathy?

Diabetic nephropathy(diabetic kidney disease)is the deterioration of kidney functioning due to long-term diabetes(high blood sugar ). It is one of the severe complications of diabetic people, ultimately leading to kidney failure.

How diabetes affects the kidneys?

Diabetes is the condition of high levels of sugar in our bodies. In this disease, the body cannot correctly process the glucose in our body leading to the accumulation of extra glucose in the blood, which ultimately impairs the glomerular membrane(which plays a role in kidney filtration) and other nephrons (kidney’s filtering units) parts. Impaired glomeruli( groups of tiny blood vessels in the nephron) cannot correctly filter the toxins in the body fluids; as a result, toxins accumulate in the body. Over the years, the toxin accumulation has led to kidney malfunctioning ¹Overview | Researched based study from Nlm.nih.gov.

Facts

Facts about diabetic nephropathy

• Diabetic nephropathy disturbs the kidney’s capacity to filter and remove waste fluids from our bodies.
• Diabetic nephropathy lead to the last stage of kidney disease, and the kidneys cannot function properly.
• The danger of acute kidney damage (AKI) in patients with diabetic nephropathy necessitates the use of nephrotoxic drugs with utmost caution.
• Diabetes nephropathy and diabetic retinopathy(Vision loss in diabetics) are related. ⁹Facts | Researched based study from Nlm.nih.gov
• Diabetic nephropathy patients experience kidney damage symptoms much later (after ten years ).
• A high risk of developing diabetic nephropathy exists in some racial groups, such as African Americans, Native Americans, and Mexican Americans. ⁹Facts | Researched based study from Nlm.nih.gov
• By controlling diabetes and high blood pressure, one can postpone diabetic nephropathy ¹Facts | Researched based study from Nlm.nih.gov

Symptoms

Symptoms of diabetic nephropathy

• Fluid retaining
• High blood pressure
• Swelling of the hands, feet, ankles and eyes
• Excreting protein in the urine
• Foam(bubbles) in urine
• Intense urge to urinate
• Extreme tiredness
• Extreme weakness
• Reduced appetite
• Stomach problem
• Nausea and vomiting
• Headache
• Sleeplessness
• Anxiety
• Confusion
• Abnormal heart rate
• Difficulty in breathing
• Continual itching of the skin
• Muscle spasm
• Decreased need for diabetes medicine²Symptoms | Researched based study from Niddk.nih.gov

Causes

What are the causes of diabetic nephropathy ?

High blood sugar

• Uncontrolled diabetes causes impairment of the glomeruli of the nephron responsible for filtering the toxic waste from our blood leading to diabetic nephropathy.

High blood pressure

• Uncontrolled high blood pressure creates additional pressure in the kidney nephrons, which causes further kidney malfunction and rapid kidney damage ³Causes | Researched based study from Sciencedirect.com

Risk factor

Risk factors of diabetic nephropathy

• Smoking
• Increased body weight
• Hyperglycemia (high blood sugar)
• Hypertension(high blood pressure)
• High cholesterol in the blood
• Have other diabetic complications such as nerve problems and eye problem
• Having a hereditary history of kidney problem
• Having diabetes before the age of 20 ⁴Risk factors | Researched based study from Sciencedirect.com

Diagnosis

Diagnosis of diabetic nephropathy

Blood urea nitrogen (BUN) blood test

• It looks at whether the kidneys are functioning properly
• It looks for urea nitrogen level in the blood which is the kidney’s waste product to be eliminated from the body
• An elevated level of BUN indicates some problem in the kidneys.⁵Diagnosis | Researched based study from Sciencedirect.com

Serum creatine blood test

• It checks for proper kidney functioning
• It checks for the creatine levels in the blood creatine is a waste product made by the body’s muscles
• This test is recommended by doctors when patients have painful urination or foam or bubbles in their urine.⁵Diagnosis | Researched based study from Sciencedirect.com

Microalbuminuria urine test

• It is a test to screen for kidney disease
• It checks for excess albumin in the urine, and the condition is called microalbuminuria.

Kidney biopsy

• A doctor recommends a kidney biopsy to confirm the kidney disease
• The procedure takes small kidney tissue samples that are examined with a microscope ⁵Diagnosis | Researched based study from Sciencedirect.com .

Stages

Different stages in diabetic nephropathy (kidney disease)

Depending on the patient’s glomerular filtration rate (GFR), the kidney disease is divided into the following stages ⁶Stages| Researched based study from Sciencedirect.com

Stage 1 chronic kidney disease

• Kidney impairment is present
• Kidney functioning is normal
• GFR rate is 90% or more

Stage 2 chronic kidney disease

• Kidney impairment with a little loss of kidney function
• GFR rate is 60 to 89%

Stage 3 chronic kidney disease

• Mild to moderate loss of kidney function
• GFR rate is 30 to 59%

Stage 4 chronic kidney disease

• Severe loss of kidney function
• GFR rate is 15 to 29%

Stage 5 chronic kidney disease (end-stage renal disease or end-stage kidney disease )

• Very close to failure or complete kidney failure
• GFR rate is below 15% ⁶Stages | Researched based study from Sciencedirect.com

Management

Management of diabetic nephropathy

Diabetic nephropathy is incurable, but treatments can slow the disease’s advancement.

Medicine

Angiotensin receptor blockers

• Used to treat high blood pressure and heart failure ( i.e.heart muscle does not pump enough blood)

Angiotensin-converting enzyme (ACE) inhibitors

• Used to treat high blood pressure ⁸Management | Researched based study from Nlm.nih.gov
• Prevents narrowing of the blood vessels

Kerendia

• Prevents worsening of kidney disease
• Reduces the GFR( glomerular filtration rate) decline
• Reduces the risk of heart attack

Diet modification

• Eating healthy fats such as salmons, sardines, walnuts
• Reducing salt intake
• Restricted protein uptake
• Limiting potassium-containing foods like spinach, avocados and bananas
• Limiting high-phosphorus foods like processed meat, milk, and yogurt ⁷Management | Researched based study from Sciencedirect.com

Lifestyle modification

Regular physical exercise, walking and jogging can

• reduce one’s blood sugar and
• manage stress
• Reduce the risk of heart disease
• Delay diabetic nephropathy

Periodically doing yoga and meditation can

• Reduce the stress in our body
• Control blood sugar and blood pressure and
• Slows the progression of the kidney disease

End-stage renal disease treatment

Dialysis

• Dialysis is recommended for patients with kidney malfunctioning ⁷Management | Researched based study from Sciencedirect.com
• Dialysis performs the kidney function artificially outside of the body
• Removes unwanted body toxins and excess fluids from the blood

Kidney transplant

• Recommended to patients with total kidney damage
• Surgery is performed to replace the damaged kidney with the donor’s kidney
• The donor kidney should be a good match with the patient’s kidney ⁷Management | Researched based study from Sciencedirect.com ,⁸Management | Researched based study from Nlm.nih.gov

Complications

Complication of diabetic nephropathy

Hyperkalemia

• increased potassium level in the blood ⁸Complications | Researched based study from Nlm.nih.gov

Diabetic retinopathy

• It affects blood vessels of the retina and causes blindness ⁸Complications | Researched based study from Nlm.nih.gov

Pulmonary edema

• Abnormal fluid builds up in the lungs and
• Swelling due to fluid retention is seen in arms and legs

Cardiovascular disease

• A disease of the blood vessels and heart ⁸Complications | Researched based study from Nlm.nih.gov
• It can lead to stroke (cut off of blood supply to part of the brain due to blocked artery)

Bone mineral disorder

• Calcium and phosphate levels in the blood change
• It also causes hormonal imbalances

Anemia

• Lack of healthy RBC (red blood cells) to carry oxygen to the body’s cells

Foot sores

• Swelling and inflammation in the foot area that does not heal easily

Pregnancy complication

• Premature birth ⁸Complications | Researched based study from Nlm.nih.gov
• High blood pressure in the mother
• Causes life risks for both the mother and fetus

Diarrhea

• Frequent loose, watery stool

Erectile dysfunction

• It is a sexual dysfunction in males ⁸Complications | Researched based study from Nlm.nih.gov
• Causes difficulty in maintaining penile erection

Complete kidney damage

• Needs dialysis and kidney transplant ⁸Complications | Researched based study from Nlm.nih.gov

Prevention

Prevention of diabetic nephropathy

• Maintaining a good diet with high fibre and low sodium, carbohydrate and sugar
• Avoiding processed food high in salt
• Controlling high blood pressure by requisite treatment
• Maintaining the body weight
• Exercising regularly
• Avoiding tobacco and alcohol
• Complete cessation of smoking
• Reducing body stress
• Following the treatment strategy as directed by the physician
• Often visiting a physician to control diabetes ⁷Prevention | Researched based study from Sciencedirect.com

Takeaways

Key Takeaways

• People with diabetic nephropathy should manage their blood pressure, body weight and blood sugar.
• Earlier starting of the diabetes treatment delays the kidney disease
• People with diabetes should visit the physician regularly and take required precautions as recommended to prevent the kidney disease from advancing