Metabolic Health

Diabetic Nephropathy - Diagnosis and Treatment

Reviewed by

Shifa Fathima

Diabetic nephropathy, also known as diabetic kidney disease, is a complication resulting from type 1 and type 2 diabetes. Your kidneys contain tiny clusters of blood vessels that filter the waste from your blood. Poorly controlled diabetes over time can harm the clusters of blood vessels in your kidneys, causing diabetic nephropathy. Hypertension may further damage your kidneys by increasing pressure on the filtering structure of your kidneys.

Diabetic Nephropathy : Symptoms

Early symptoms of diabetic nephropathy may go unnoticed. The symptoms observed later on are:

Uncontrollable blood pressure levels

Increased frequency of urination

Confusion or poor concentration

Nausea and vomiting

Fatigue

Shortness of breath

Poor appetite

Constant itching

Diabetic Nephropathy : Risk Factors

The following factors increase the risk of diabetic nephropathy for people living with diabetes:

Hypertension  

Poorly controlled blood sugar levels

Smoking

Obesity

High Cholesterol in the blood

Family medical history of diabetes and kidney problems

Many complications due to diabetic nephropathy appear gradually over time. They are:

Increased levels of potassium in your blood

Cardiovascular conditions that may lead to stroke

Swelling in the arms and legs due to fluid retention  

Reduction in the number of red blood cells that carry oxygen

Bone disorders due to the incapability of the kidneys to maintain the correct balance of phosphorus and calcium in the blood

Severe damage to the kidneys that require dialysis or a kidney transplant to survive

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Diabetic Nephropathy : Diagnosis

The diagnosis of diabetic nephropathy takes place during your regular diabetes testing. For people with type 1 diabetes, it is recommended to screen for diabetes nephropathy five years after being diagnosed. For people with type 2 diabetes, screening for diabetes nephropathy begins at the time of diagnosis.

Regular screening tests for diabetic nephropathy consist of:

Urinary albumin test: The test detects the presence of the protein albumin in the urine test sample. Kidneys do not usually remove albumin from your blood. The presence of too much albumin in urine indicates poorly functioning kidneys.  

Ratio of albumin and creatinine: Creatinine is a waste product that kidneys remove from your blood. The ratio of the measure of albumin to the measure of creatinine in your urine test sample shows how well your kidneys have been functioning.

Glomerular filtration rate: The glomerular filtration rate measures how quickly your kidneys can filter blood. The glomerular filtration rate is calculated by measuring the amount of creatinine in a blood sample.

Other tests for diabetic nephropathy diagnosis are:

Imaging tests: You may need to undergo X-ray and ultrasound scans. Your doctor will be able to check the size and structure of the kidneys. Magnetic resonance imaging (MRI) and CT scan may also be required to assess the blood circulation in your kidneys.

Kidney biopsy: To examine a small portion of your kidney tissue, a kidney biopsy may be recommended. Your doctor will give you a local anaesthetic and remove tiny bits of tissue from your kidney with the help of a thin needle and send it for examination.

Diabetic Nephropathy : Treatment

Diabetic nephropathy treatment begins with the control of diabetes and hypertension. You must follow a healthy diet, maintain an active lifestyle, and take your prescription medication to keep hypertension and blood sugar levels in control. With proper management of diabetes and hypertension, it is possible to delay or prevent kidney dysfunction.

Choose an active lifestyle.

Diabetes can be managed by staying active and exercising regularly. Take a brisk walk for 30 minutes 5 times a week. Eat a well-balanced diet and practice relaxation techniques such as yoga and meditation.

Medications for diabetic nephropathy treatment

During the early stages, your doctor will prescribe medications to control diabetes, hypertension, cholesterol, and kidney scarring.

Metformin: Reduces insulin resistance and reduces the production of glucose in the liver.

Glucagon-like peptide 1 receptor agonists: This drug reduces blood sugar by slowing down the process of digestion and improving insulin secretion to manage increasing blood sugar levels.

SGLT2 inhibitors: Control the amount of glucose that returns to your bloodstream.

Medications to control blood pressure: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (ARBs) are used in the treatment of high blood pressure.

Medications to control high cholesterol: Statins are prescribed to treat cholesterol and reduce the amount of protein in your urine.

Medications to treat kidney scarring: To reduce molecular activity that causes inflammation and scarring of kidney tissues, finerenone is generally prescribed. This drug may help in reducing the possibility of kidney failure and minor heart attacks in people with long -term kidney disease due to type 2 diabetes.  

Diabetic nephropathy treatment for severe kidney problems

If the kidney disease advances to severe kidney damage, you will be presented with the following options to substitute the role of kidneys in your body.

Kidney dialysis: Since your kidneys would not be able to remove waste products from the blood effectively, dialysis is conducted to remove waste products from your blood.

There are two kinds of dialysis.

Hemodialysis: Hemodialysis will be administered at a dialysis centre about 3 times a week, where dialysis will be performed by an artificial kidney machine that removes waste from your blood.

Peritoneal dialysis: In this type of dialysis, a catheter is placed surgically in your belly and your abdominal cavity will be filled with dialysis solution which removes waste and extra fluid from your blood.

Kidney transplant: Sometimes, a kidney transplant might be suggested, in which case you will be evaluated for eligibility for a kidney transplant.

Symptom management: When you decide not to go for a kidney transplant or dialysis, life expectancy will be very short and you will receive medications and treatment to keep you manage your symptoms at this time.

Bottomline

Diabetic nephropathy is a complication of type 1 and type 2 diabetes. Symptoms of diabetic nephropathy include frequent urination, fatigue, shortness of breath, high blood pressure, poor appetite, and itching. Managing diabetes and controlling hypertension can prevent or delay further damage to your kidneys. Exercise regularly, eat a balanced diet, and take your medication on time to control your sugar levels. Advanced diabetic nephropathy needs treatments such as dialysis or kidney transplant depending upon the functioning of your kidneys.

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