Diabetic Nephropathy
What is it?
Diabetic nephropathy is a serious complication of
diabetes in which elevated blood sugar levels eventually
damage the kidneys. Nephropathy means disease or
abnormality of the kidney. Diabetic nephropathy is also
called diabetic kidney disease.
Who gets it?
People with diabetes are at high risk for developing
diabetic nephropathy. The risk increases when blood sugar
levels are not controlled, blood pressure or blood
cholesterol levels are high, or if the diabetic patient
smokes. The risk for developing diabetic nephropathy is
also higher in patients who have a genetic predisposition
toward kidney disease, and in those who have had diabetes
for a long period of time.
What causes it?
High blood sugar levels eventually damage many systems
and structures in the body, including the blood vessels.
When this happens, the blood vessels are unable to carry
sufficient amounts of blood and waste products to the
kidneys, and therefore, the kidneys aren’t able to do
their job and filter the wastes out of the blood.
Eventually, the filtering structures in the kidneys,
called glomeruli, become damaged and the kidneys are
unable to filter enough wastes and fluids from the blood.
In addition, they begin to leak protein into the urine.
This protein is called albumin, and is needed for the body
to function properly. As wastes and fluids build up in the
blood, the kidneys fail.
What are the symptoms?
People with diabetes can have diabetic nephropathy and
not know it because they do not experience symptoms until
the kidneys are actually failing. Once the kidneys begin
to fail, you will notice swelling (edema), usually in the
hands, feet, face, and abdomen. The extra fluid also
causes the blood pressure to rise. Other symptoms may
include nausea, fatigue, confusion, foul smelling breath,
joint pain, reduced urination, blood in the urine,
seizures, headaches, itching, pain in the kidney area, and
a yellowish-brown appearance of the skin.
How is it diagnosed?
To diagnose diabetic nephropathy, your doctor will
perform a complete physical examination and order urine
and blood tests. He or she will look for a condition
called proteinuria, which is marked by high levels of
protein in the urine. He or she will also check your blood
for high levels of waste products called creatinine and
urea, which indicate kidney failure. Your doctor may also
order ultrasound, computed tomography (CT), or magnetic
resonance imaging (MRI) scans, which produce a picture of
the kidneys and surrounding structures. In some cases, a
biopsy is necessary. In this procedure, a small sample of
kidney tissue is removed for examination under a
microscope. Because diabetic nephropathy occurs before any
symptoms are felt, it is extremely important that people
with diabetes have regular tests of their kidney function.
Your doctor should test a sample of your urine at least
once per year to check for albumin. Small levels of
albumin, called microalbuminuria, are an early sign of
kidney disease. With treatment, you can prevent these
albumin levels from increasing. High albumin levels also
increase your risk of heart disease and stroke, so your
doctor will also monitor you for these conditions.
What is the treatment?
Research has found that a medication called an ACE (angiotensin
I-converting enzyme) inhibitor, used to treat high blood
pressure, also helps control the kidney’s release of
protein into the urine. People with diabetes who take an
ACE inhibitor can, therefore, slow down the development of
kidney damage. There are some restrictions for taking this
medication, which your doctor should discuss with you.
Following your doctor’s recommendations for diabetes
treatment, including controlling your blood sugar and
blood pressure levels, will also help reduce your risk of
kidney disease. Once kidney failure has occurred, you will
need dialysis, a procedure in which waste products are
filtered from the blood for the kidneys, or a kidney
transplant.
Self-care tips
If you have diabetes, follow your doctor’s
recommendations for a healthy diet and control of your
condition. Don’t smoke, and participate in an approved
exercise program regularly. Make sure you have your urine
tested regularly for protein levels, and report any signs
of bladder or kidney infections to your doctor
immediately. Avoid any medications that your doctor has
identified as having a potentially harmful effect on the
kidneys.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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