Diabetic Nephropathy

What is diabetic nephropathy?

Diabetic nephropathy is the most common disorder responsible for renal failure. The primary function of kidneys is removing waste products from blood. Diabetes can cause an alteration in the filtering system of the kidneys over the long term, causing damage to tissues, resulting in kidney disease (nephropathy).

What are its main signs and symptoms?

Kidney diseases do not produce symptoms until most of the kidney function is lost. Also, the symptoms that eventually appear are non-specific. Fluid build-up is the first sign of nephropathy. Other symptoms include:

• Loss of sleep
• Stomach upset
• Poor appetite
• Weakness
• Imbalance in blood pressure
• Protein in urine
• Confusion or difficulty in concentrating
• Persistent itching
• Increased urination
• Nausea and vomiting

What are the main causes of diabetic nephropathy?

Kidneys contain numerous capillaries which filter waste products from the blood. These capillaries have tiny holes (filters), through which, waste products are excreted in the form of urine. Blood cells and protein are bigger than these holes and hence are not passed into the urine.

Increased blood sugar level causes damage to these pores, making them bigger. As a result, blood can also pass through. This causes damage to the glomeruli, filters of the kidney. With time, these filters start to leak and small amounts of essential proteins start to be expelled with urine (microalbuminuria). If left untreated, this condition causes an increase in microalbumin loss which is followed by end-stage-renal-disease (ESRD).

Later, this stress on the kidneys causes loss of filtering capacity. Waste products then accumulate in the blood, and finally, kidney failure occurs.

How is diabetic nephropathy diagnosed and treated?

Your doctor will conduct a physical examination and take your medical history. You may then be advised a few tests including:

• Blood tests to check the condition of the kidneys and assess its functioning
• Urine tests to check the protein content in the urine. High level of protein called microalbumin in the urine indicates early stage of nephropathy
• X-rays, MRI and CT scan to check the blood flow to the kidneys
• Renal function test to check the filtering capacity
• Kidney biopsy

 Medications are used in early stages of nephropathy:

• To control high blood pressure
• To manage high blood sugar level
• To lower blood cholesterol level
• To control protein levels in urine

In later stages, kidney transplant and dialysis may be advised.