Diabetic nephropathy is kidney damage caused by diabetes. If you have diabetes and high blood sugar, it can hurt the part of your kidneys that intercepts your blood. When the filter is broken, it gets leaky, and protein gets into your urine. Diabetic nephropathy can worsen and lead to chronic kidney disease and kidney failure in some people. But most individuals with diabetes do not get kidney disease that worsens and causes them to lose their kidneys.
Diabetes often causes kidney damage. Diabetic nephropathy affects one in four women and one in five men with type 2 diabetes. It happens more often in people with type 1 diabetes. In Australia, diabetic kidney disease is the main cause of kidney failure.
How usual is diabetic nephropathy?
Symptoms
Most of the time, there are no early signs of diabetic nephropathy. You can’t tell if your urine has protein; a urine test is needed to find out. Kidney damage can take a long time to get worse. Symptoms usually don’t show up until the kidney damage is pretty bad. Even then, the signs are often not clear.
If the damage to the kidneys gets bad enough, you may notice the following:
What happens to a person’s kidneys when they have diabetes?
- Weight loss,
- feeling sick or not wanting to eat,
- swollen ankles and feet (from holding on to fluid),
- puffiness around the eyes, dry, itchy skin,
- muscle cramps,
- needing to go to the bathroom more often,
- feeling tired and not being able to focus.
The kidneys’ main job is to filter out waste and extra water from the blood so that they can be passed out of the body as urine. Nephrons made up of tubes and blood vessels, do this job. Inside the nephrons are tiny tubes that collect urine and tiny blood vessels called capillaries.
A glomerulus is a group of blood vessels that act as a filter. It is the most important part of the nephron. High blood glucose levels can make it hard for the glomerulus to do its job. When the kidneys aren’t working right, proteins start leaking from the blood into the urine because the kidneys aren’t filtering blood well enough.
High blood sugar levels can also scar the glomerulus (called glomerulosclerosis). As the scarring worsens, the kidneys can no longer remove waste from the blood. Kidney failure happens if enough glomeruli have been hurt. High blood pressure is ordinary in people with diabetic nephropathy. Damage to the kidneys can also be caused by high blood pressure.
Risks for diabetic nephropathy
Many things can make it more likely that you will get diabetic nephropathy. These things are:
- If your diabetes isn’t well managed,
- your blood sugar levels are high,
- you have high blood pressure,
- you are overweight or obese.
- Smoking.
Your risk also is higher if your diabetes is causing you other problems. Some of these are diabetic neuropathy and diabetic retinopathy.
What are the difficulties?
The main problem with diabetic kidney disease is that it can lead to long-term kidney disease. Kidney failure can happen when chronic kidney disease gets worse. Dialysis or a kidney transplant are the only ways to treat people with kidney failure. All people with diabetes are at risk for heart disease and high blood pressure.
Having kidney disease also makes these things more likely to happen. So your risk is even greater if you have diabetes and kidney disease. Diabetes-related kidney disease also can make other problems with diabetes worse.
Tests and diagnoses
If you suffer from diabetes, your doctor will tell you to go in for regular checkups to see how well you control your blood sugar and to look for any problems caused by diabetes. Your doctor will ask you about any symptoms and do a physical exam to look for any diabetes-related problems. Urine and blood tests are the main ways to determine if you have diabetic nephropathy and how effectively your kidneys work.
Urine tests
Albumin is a protein that is looked for in urine samples. The amount of albumin in the urine shows how much damage there is to the kidneys. Microalbuminuria is a sign that you might get diabetic nephropathy or already have it in its early stages. Proteinuria, also called macroalbuminuria, means that your diabetic nephropathy is getting worse, which could make it harder for your kidneys to filter out waste.
Blood tests
It would help to get blood tests to check how well your kidneys work. The amount of the waste product creatinine in your blood can be used to estimate your glomerular filtration rate (eGFR). The eGFR shows how well your kidneys are doing their job of filtering waste out of your blood. Most of the time, people with diabetes are told to get urine and blood tests yearly to check on how well their kidneys are working.
Treatments for diabetic nephropathy
People with diabetes can stop their kidney disease from worsening if they find and treat diabetic nephropathy early. In its early stages, diabetic nephropathy can even be reversed. Controlling alike your blood sugar and blood pressure is part of the treatment.
To stop or slow the progress of diabetic nephropathy, blood sugar levels should be kept as close to normal as possible. Blood glucose levels can be controlled by diet, exercise, and other lifestyle changes, as well as by taking oral diabetes medicines (oral hypoglycemics) or insulin.
People with type 2 diabetes who need microalbuminuria or proteinuria, which are signs of diabetic nephropathy, are usually also given medicines called angiotensin-converting enzyme inhibitors (ACE inhibitors) or blockers of angiotensin receptors (ARBs).
These medicines are also prescribed to control blood pressure; even if it is common, your doctor may still give you an ACE inhibitor or ARB because they reduce the amount of protein in the urine and can stop or slow the progression of diabetic kidney disease. To assist in controlling high blood pressure, your doctor may also give you other medicines.
Lifestyle measures
Maintaining your blood sugar and blood pressure under control requires eating well and exercising regularly. Your doctor, as well as a diabetes educator, can tell you what to eat and how much you should exercise. If you have diabetic nephropathy, you may be told to avoid high-protein diets because too much protein can even hurt the kidneys.
People with sophisticated diabetic nephropathy may be told to eat less protein to delay the start of kidney failure. It would help if you never cut out major food groups from your diet without first talking to your doctor or diabetes educator. One of the greatest things you can do to improve your health is to stop smoking.
Prevention
You can help keep diabetes from hurting your kidneys by doing the following with your doctor:
Control your blood sugar levels, ensure your blood pressure is in a healthy range, stop smoking if you do, stay at a healthy weight, and keep your cholesterol levels in check.
You can lower your risk of getting diabetic kidney disease or postpone its onset by taking these steps. It would help if you also got your kidneys checked at least every year to make sure they are working well.
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