Diabetic Nephropathy & Its Prevention

Chronic kidney disease known as diabetic nephropathy is brought on by high blood sugar levels damaging the tiny blood capillaries in the kidneys. It is a frequent side effect of diabetes and, if unchecked, can cause renal failure. We'll talk about diabetic nephropathy's definition, causes, types, signs and symptoms, diagnostic standards, examination, and treatment in this blog.

Definition:

Diabetic nephropathy is a progressive kidney disease that occurs in people with diabetes. It is characterized by the damage to the small blood vessels in the kidneys, leading to reduced kidney function and increased protein excretion in the urine.

Causes:

Diabetic nephropathy is mostly brought on by excessive blood sugar levels, which is a complication of diabetes. Long-term high blood sugar levels have the potential to harm the kidneys' tiny blood capillaries, resulting in kidney damage and, eventually, renal failure.

Stages:

There are five stages of diabetic nephropathy:

Stage 1: Normal kidney function but increased excretion of albumin (30–299 mg/day) through the urine.

Stage 2: renal impairment associated with elevated urine albumin excretion (30-299 mg/day) and slightly decreased renal function (GFR 60-89 ml/min/1.73 m2).

Stage 3: renal damage accompanied by elevated urine albumin excretion (>300 mg/day) and significantly impaired renal function (GFR 30-59 ml/min/1.73m2).

Stage 4: GFR 15–29 ml/min/1.73 m2 renal disease with substantially impaired kidney function.

Stage 5: renal failure needing dialysis or a kidney transplant (GFR 15 ml/min/1.73 m2).

Symptoms and signs:

In the early stages, diabetic nephropathy may not produce any noticeable symptoms. As the condition progresses, the following signs and symptoms may occur:

·         Proteinuria (presence of protein in urine)

·         Edema (swelling of legs, ankles, or feet)

·         Fatigue

·         Nausea and vomiting

·         Loss of appetite

·         Difficulty sleeping

·         Itching

·         Muscle cramps

·         High blood pressure

·         Diagnostic criteria:

 

To diagnose diabetic nephropathy, the doctor may perform the following tests:

Urine tests: To check for the presence of protein in urine.

Blood tests: To measure kidney function and blood sugar levels.

Imaging tests: To check for kidney damage or abnormalities in the urinary system.

Investigation:

The following investigations may be done to confirm the diagnosis of diabetic nephropathy:

Glomerular filtration rate (GFR): To measure kidney function.

Blood pressure measurement: To check for hypertension.

Blood tests: To check for electrolyte imbalances, anemia, and other conditions that may affect kidney function.

Urine tests: To measure proteinuria and albuminuria.

Kidney biopsy: To confirm the diagnosis and assess the extent of kidney damage.

Treatment:

The American Diabetes Association (ADA) provides guidelines for the management and treatment of diabetic nephropathy. These guidelines aim to reduce the risk of complications and improve outcomes for individuals with diabetic nephropathy. Some of the ADA recommendations for diabetic nephropathy are as follows:

Early detection and management: Regular screening for diabetic nephropathy should be performed in individuals with diabetes. Early detection and management can help prevent or delay the progression of kidney disease.

Glycemic control: Maintaining optimal blood sugar levels is essential for preventing and managing diabetic nephropathy. The ADA recommends a target HbA1c level of less than 7% for most individuals with diabetes.

Blood pressure control: High blood pressure is a significant risk factor for the development and progression of diabetic nephropathy. The ADA recommends a blood pressure target of less than 130/80 mmHg for most individuals with diabetes.

Medications: Certain medications, such as ACE inhibitors and angiotensin receptor blockers, are recommended for the management of diabetic nephropathy. These medications can help slow the progression of kidney disease and reduce the risk of complications.

Lifestyle modifications: Lifestyle modifications, such as weight loss, regular physical activity, and a healthy diet, can help improve outcomes for individuals with diabetic nephropathy.

Referral to a nephrologist: Individuals with advanced kidney disease or those who develop complications should be referred to a nephrologist for specialized care.

Prevention

There are a number of actions you may take to lower your risk and decrease the onset of diabetic nephropathy, even though it may not always be feasible to completely prevent it. Here are some precautions to take:

1. Manage your blood sugar levels: It's essential to maintain your blood sugar levels within a specific range to avoid diabetic nephropathy. Develop a specialised diabetes treatment strategy with the help of your medical team, which should involve regular monitoring, the use of medication or insulin, dietary modifications, and physical activity.
2. Control your blood pressure: Your kidneys can suffer more harm from high blood pressure. As directed by your doctor, try to keep your blood pressure below 130/80 mmHg. This can be accomplished by combining lifestyle modifications (including adopting a balanced diet, cutting back on sodium intake, engaging in regular exercise, restricting alcohol use, and giving up smoking) and medication, if required
3. Adopt a healthy diet: Both diabetes and kidney health can be managed with a balanced diet. Consume whole grains, lean proteins, fruits, veggies, and healthy fats as your main food choices. Reduce your consumption of processed meals, sweet beverages, saturated fats, and too much salt.
4. Monitor and manage your cholesterol levels: Kidney injury can be exacerbated by high cholesterol levels. Maintain a heart-healthy diet, engage in regular exercise, and, if necessary, take medication prescribed by your doctor to lower your cholesterol.
5. Avoid smoking and limit alcohol intake: Smoking and binge drinking can exacerbate renal impairment and raise the possibility of problems. Give up smoking completely, and if you do consume alcohol, do it sparingly or as prescribed by your physician.
6. Regularly monitor kidney function: It's crucial to schedule routine visits with your doctor to evaluate your kidney health and look for any early indications of kidney disease. Kidney function can be determined by testing like blood tests (to measure creatinine and determine glomerular filtration rate) and urine tests (to check for protein in the urine).
7. Maintain a healthy weight and exercise regularly: Obesity or being overweight can raise your chance of developing diabetic nephropathy. By combining a nutritious diet with regular exercise, try to reach and maintain a healthy weight. To create an exercise programme that is appropriate for your requirements and ability, speak with your healthcare professional.
8. Take medications as prescribed: Take drugs as directed if your doctor has prescribed them to treat your diabetes, high blood pressure, or other connected diseases. These drugs can lower your blood pressure and blood sugar levels, lowering your risk of kidney injury.
9. Stay informed and involved: Learn as much as you can about diabetic nephropathy and other related issues. Recognise the signs, danger signs, and safety precautions. Attending routine appointments, asking questions, and acting on the advise of your healthcare practitioner will help you stay involved in your health.

Keep in mind that while taking these preventive steps can lower your risk of developing diabetic nephropathy and slow down its course, they cannot ensure that you won't develop the condition. Working closely with your medical team will help you create a personalised strategy that is based on your unique needs and medical background.

It is essential to work closely with a healthcare provider to develop a personalized treatment plan that takes into account individual needs and preferences. By following the ADA recommendations, individuals with diabetic nephropathy can reduce the risk of complications and improve outcomes.

 

Dr.Muhammad Arsalan Khan
Diabetes Specialist
MBBS, MSc (Diabetes & Endocrinology) - DUHS
CCD-BMJ-AKU-RCP (London)