What is diabetic nephropathy?
Progressive damage to the nephrons in the kidneys due to diabetes, marked by protein loss in urine and rising creatinine levels, is known as Diabetic Nephropathy.
Each human kidney contains about one million tiny filters called nephrons, which filter blood, remove waste from the body, and regulate fluid balance. In individuals with diabetes, these nephrons progressively begin to sustain damage, causing proteins (mainly albumin) to leak into the urine. This gradual decline in kidney function is called diabetic nephropathy, and it often leads to kidney failure. Measuring albumin levels in the urine is essential to diagnose and monitor the progression of diabetic nephropathy. It can occur in both type 1 and type 2 diabetes. With early treatment, the disease’s progression can be slowed. However, once diabetic nephropathy develops, kidney function may decrease by about 10-15% per year, and most patients with diabetic nephropathy ultimately experience kidney failure.
What are the symptoms of diabetic nephropathy?
Symptoms may not be noticed in the early stages of kidney damage, which makes regular screening crucial for early diagnosis. As the condition advances, the following symptoms may develop:
- Swelling of feet and ankles: Fluid retention occurs as kidney function declines, causing noticeable swelling.
- Breathlessness: Reduced kidney function can lead to fluid buildup in the lungs, making it harder to breathe.
- Fatigue most of the time: Waste buildup in the blood can cause persistent tiredness and lack of energy.
- General weakness: Impaired kidney function can lead to overall weakness and difficulty with daily activities.
- Loss of appetite: Waste buildup can affect digestion, leading to a reduced desire to eat.
- Itchy and dry skin: Accumulation of toxins can irritate the skin, making it dry and itchy.
- Nausea or vomiting: High levels of waste in the blood may lead to feelings of nausea and occasional vomiting.
Stages of Diabetic Nephropathy
Diabetic nephropathy progresses in stages, advancing from early kidney damage to complete kidney failure:
- Stage 1 (Hyperfiltration): The kidneys work harder than normal to compensate for early damage, causing a slight increase in glomerular filtration rate (GFR). Protein leakage into the urine is minimal at this stage.
- Stage 2 (Microalbuminuria): A low level of albumin starts to leak into the urine, indicating the beginning of detectable kidney damage, though overall kidney function remains largely normal.
- Stage 3 (Macroalbuminuria): Protein levels in the urine become more pronounced, and kidney function starts to decline. Symptoms like swelling and fatigue may begin to appear.
- Stage 4 (Advanced Diabetic Nephropathy): Significant kidney damage is evident, with a further drop in GFR. Symptoms intensify, and more aggressive treatment is required to manage the condition.
- Stage 5 (End-Stage Renal Disease): Kidney function deteriorates to the point of failure, making dialysis or a kidney transplant necessary to sustain life.
What are the Causes of Diabetic Nephropathy?
The development of diabetic nephropathy is influenced by several factors, with prolonged high blood sugar levels as the leading cause. Key risk factors include:
- Uncontrolled blood sugar: Poorly managed diabetes speeds up kidney damage.
- Duration of diabetes: The risk of nephropathy increases the longer a person has diabetes.
- High blood pressure: Hypertension strains and damages the blood vessels in the kidneys, worsening nephropathy.
- Family history of kidney disease: A genetic predisposition can make some individuals more susceptible.
- Smoking: Smoking restricts blood flow to the kidneys, aggravating kidney damage.
- Overweight: Obesity raises the risk of both diabetes and kidney disease.
How is Diabetic Nephropathy Treated?
Medications play a critical role in managing diabetic nephropathy, particularly by controlling blood pressure to protect kidney function:
- ACE (Angiotensin-Converting Enzyme) Inhibitors and ARBs (Angiotensin Receptor Blockers): These medications reduce blood pressure as well as pressure within the nephrons, shielding the nephrons from damage caused by high pressure.
- Additional Blood Pressure Medications: Other medications may be prescribed to maintain strict blood pressure control. Kidney damage can worsen if blood pressure rises, and, in turn, high blood pressure accelerates kidney damage, creating a harmful cycle.
In addition to medication, several lifestyle precautions can help slow the progression of diabetic nephropathy:
- Regular Monitoring of Blood Sugar Levels: Frequent checks, using a glucometer, help keep blood sugar within target ranges.
- Regular Exercise: Activities like running, jogging, walking, swimming, badminton, and cycling are beneficial.
- Quit Smoking: Smoking cessation reduces strain on the kidneys and improves blood flow.
- Avoid Pain-Killers: Refrain from using pain-killers, as they can further harm kidney function.
- Weight Loss: Aim for a BMI of around 24 to reduce stress on the kidneys.
- Scientific Diet: Following a well-balanced, scientifically supported diet aids in managing both blood sugar and kidney health.
If you’re experiencing symptoms of Diabetic Nephropathy or have been diagnosed with a related issue, it is essential to seek specialized care.
Dr. Kamal Kiran offers expert treatment and personalized care plans to help manage your condition and improve your quality of life. Trust his expertise for top-notch nephrology services tailored to your unique needs.
Pathogenesis of Diabetic Nephropathy
The development of diabetic nephropathy begins with chronic hyperglycemia (high blood sugar), leading to the buildup of advanced glycation end-products (AGEs). These AGEs stimulate oxidative stress and inflammation, which damage the small blood vessels, or glomeruli, within the kidneys. As the glomeruli are damaged, they thicken and begin leaking proteins, primarily albumin, into the urine, a condition called albuminuria.
Over time, the damage escalates as fibrosis (scarring) and glomerulosclerosis (hardening of the glomeruli) replace healthy kidney tissue. High blood pressure contributes further by increasing pressure within the glomeruli, worsening nephron damage. This ongoing damage gradually reduces the glomerular filtration rate (GFR), leading to a steady decline in kidney function. Without intervention, this process culminates in end-stage renal disease (ESRD), where the kidneys fail, making dialysis or a kidney transplant essential for survival.
What are the tests to diagnose diabetic nephropathy?
People with diabetes should have a yearly health check-up to detect early signs of kidney damage, as diabetes is a leading cause of kidney failure. Common tests include:
- Urine examination: albumin or protein is shown as 1+ to 4+ etc.
- Urine albumin – creatinine ratio : Measures the ratio to detect albumin leakage.
- Urine Protein-Creatinine Ratio: Used when albumin levels are very high.
- Blood Urea: Evaluates waste levels in the blood.
- Serum Creatinine: Assesses kidney function and filtration rate.
- Eye Examination: Screens for diabetic retinopathy, which often accompanies kidney damage.
- Kidney Biopsy (if needed): May be recommended for a more detailed assessment of kidney damage.