Diabetic Nephropathy - Symptoms, Diagnosis, Treatment and Prevention

What Is Diabetic Kidney Disease?

Kidney disease occurring as a complication of diabetes is called diabetic nephropathy. In this disease, the kidney's filters, the glomeruli, get impaired. Because of the impairment, renal function becomes abnormal. The kidneys lead an unusual amount of protein into the urine called proteinuria. The protein that is mainly excreted in the urine is albumin. A rise in the level of albumin in the urine (albuminuria) indicates kidney damage due to diabetes. Depending upon the albumin lost in the urine, diabetic kidney disease is divided into two categories -

• Microalbuminuria- It refers to the presence of a small amount of albumin in urine. Albumin is a type of protein, found in large amounts in the bloodstream. It is a possible sign of kidney damage. It is advisable to take a microalbuminuria test during routine examinations.

• Macroalbuminuria /Proteinuria- As the kidney damage progresses, the amount of albumin in urine increases, and microalbuminuria changes to macroalbuminuria. It is a noticeable sign of kidney damage.

What Causes Diabetic Nephropathy?

• The kidney's normal function includes filtration of the blood, regulation of blood pressure, and water and electrolyte balance. A kidney consists of millions of filtering units called nephrons.

• These nephrons get harmed due to high levels of sugar in the blood. This damage prevents the normal functioning of the kidney and develops leakage of protein and blood into the urine.

• Moreover, the raised blood sugar causes the proteins in the glomeruli to link together, called the "cross-linked" proteins. These cross-linked proteins initiate the localized scarring process. This process is called glomerulosclerosis.

• It takes a long period to develop glomerulosclerosis. The condition worsens when the sclerotic tissue replaces the healthy tissue. Regulation of blood pressure is also hampered in many patients causing high blood pressure (hypertension) and damaging the kidneys.

• Chronic kidney disease requires a long time to develop symptoms after diabetes. The long-term duration of diabetes increases the chances of kidney damage. Diabetic kidney disease is more likely to develop when the blood glucose level and blood pressure are too high.

What Are the Symptoms of Diabetic Nephropathy?

As the condition worsens in chronic kidney disease, the kidneys gradually progress to end-stage renal disease or kidney failure. The first indication of diabetic kidney disease is considered to be microalbuminuria.

• Microalbuminuria - It is considered to be the first sign of kidney damage. It can persist as microalbuminuria or can progress into proteinuria.

• Proteinuria - It is an irreversible condition where protein leaks into the urine. It marks a gradual decline in kidney function and end-stage renal disease.

• Edema - Swelling of the feet, ankles, hands, and eyes. Puffiness around the eyes. Swelling is caused due to fluid retention.

• Delirium - Confusion or difficulty in concentration.

• Apnea - Shortness of breath.

• Polyuria - Increased need for urination.

• Anemia - A decrease in circulating red blood cells causes anemia. A feeling of tiredness is felt due to anemia.

• Electrolyte Imbalance - As the kidney function deteriorates, calcium, phosphate, phosphorus, and magnesium disturb the electrolyte balance. Bone thinning or fractures due to calcium and phosphate imbalance can occur.

What Are the Risk Factors Associated With Diabetic Nephropathy?

Risk factors in people with diabetes that increase the chances of developing kidney disease are

• Tobacco chewing or smoking.

• Intake of foodstuffs containing sugar.

• High intake of salt-containing food.

• Obesity.

• Presence of heart disease.

• Family history of kidney failure.

• Sedentary lifestyle.

• Unhealthy eating patterns.

• Patients not following the course of hypoglycemic medications.

How to Treat Diabetic Nephropathy?

1. To Treat Hypertension -

Angiotensin-converting enzyme inhibitors (ACE) and angiotensin II receptor blockers are the two types of medications used to control high blood pressure. ACE inhibitors work by decreasing the amount of angiotensin II in the bloodstream, which is responsible for constricting the blood vessels. As a result, the blood vessels relax, which further prevents high blood pressure. Angiotensin II receptor blockers can be used in patients allergic to ACE inhibitors.

2. To Control Hyperglycemia -

Hyperglycemia is an increased level of sugar in the blood. Hypoglycemic medication is prescribed to control the blood glucose level. Good management of glucose levels in the blood can help avoid or delay the progression of kidney diseases, cardiovascular diseases, and stroke.

3. To Control Risk Factors -

Drugs are crucial in controlling cholesterol levels, heart disease, peripheral arterial disease, and stroke. One should adopt healthy lifestyle habits to regulate the worsening of the condition. Maintenance of body weight and regular physical activity help keep a check on secondary complications. Quitting tobacco use in any form should be made as timely as possible.

How to Prevent Diabetic Nephropathy?

• People with diabetes should be tested routinely for the presence of any kidney damage, which can prevent or delay kidney damage and end-stage renal disease. Once diabetic kidney disease has been diagnosed, people with diabetes should take steps to prevent it from worsening.

• Kidney damage is inconceivable to get worse when the blood sugar level and blood pressure level is under control. To control blood pressure, regular physical activity, weight loss, reduction in salt intake, limiting alcohol intake, and quitting smoking may have to be done. Drugs like ACE innovators can be prescribed by the physician to lower blood pressure. Following the course of medication can keep a check on high blood pressure.

• Lifestyle changes need to be done with a workout diet plan. It can help in preventing obesity. A reduction in salt and protein intake is suggested.

• Bladder or kidney infections can present signs and symptoms like a burning sensation during urination, a frequent urge to urinate, reddish urine, fever, and pain in the back.

• Avoid the consumption of painkillers like Aspirin. Aspirin and other painkillers can make kidney damage worse. Such painkillers should be taken only after consulting a physician. Too many painkillers can increase the risk of kidney damage.

• The presence of other medical conditions like heart disease, liver disease, and high cholesterol level needs medical attention.

Conclusion:

Every patient who has diabetes does not develop kidney disease. Regularly testing the sugar levels help early diagnosis of chronic kidney disease. Early diabetes treatment is the most effective and can help prevent other medical conditions. Managing blood sugar levels, blood pressure, and cholesterol levels reduce the risk factors for heart disease and stroke. People with prediabetic situations can avoid the occurrence of type II diabetes mellitus, which is a vital step in precluding renal disorders.