Diabetic nephropathy.
Diabetic nephropathy is characterized by impaired kidney function and high protein levels in the urine. The condition is one of diabetes complications.
 Nephron is the functional unit of the kidney. Each kidney contains more than one million nephrons which filter blood and produce urine.
Because of diabetes nephrons gradually get damaged and consequently, kidney allows more protein than normal to pass in the urine. This can be detected by sensitive urinalysis techniques for albumin which is the name of the excreted protein. A kidney biopsy can verify the existence of diabetic nephropathy.
Traces of protein may exist for up to ten years, before other symptoms appear. However, diabetic nephropathy may be present even a lot earlier than this phase. High blood pressure may be associated with early stages of diabetic nephropathy and definitely it is the aftermath of the disease.
Over time, the kidney's ability to function properly declines. Diabetic nephropathy may gradually lead to chronic kidney disease and eventually to total failure. Diabetic nephropathy is the most common cause of chronic kidney failure and end-stage kidney disease.
Diagnosis of diabetic nephropathy.
As it has mentioned above, in its early phases, diabetic nephropathy is non-symptomatic. Symptoms appear at late stages and may be a result of either excessive protein excretion or kidney failure or both. Quite often, the diagnosis is established, when a diabetic's routine urinalysis shows significant amounts of protein in the urine, despite the absence of clinical signs.
Common symptoms include poor appetite, swelling in the legs and around the eyes, unexplained weight gain, frothy urine, nausea, vomiting, frequent hiccups, generalized itching, persistent headache, weakness and fatigue.
A kidney biopsy, if necessary, confirms the diagnosis. However, if the case is characterized with a monitored progression of proteinuria and combined presence of diabetic retinopathy, biopsy is not required.
Treatment of diabetic nephropathy.
Treatment aims to slow the progression of kidney damage and control related complications. In the early phases this can be achieved with good management of diabetes. Blood glucose level should be closely monitored and controlled. This may slow the progression of the condition, especially at the very early stages, providing diabetes pills and insulin are taken faithfully. An important issue is that in later phases of kidney failure, less insulin is excreted. Therefore, smaller amounts of the hormone may be needed to control blood glucose level.
Control of high blood pressure is perhaps the most effective means of slowing kidney damage from diabetic nephropathy.
Dialysis may be necessary, once, end-stage renal disease develops. At this stage a kidney transplantation must be considered.
Complications of diabetic nephropathy.
Apart from chronic kidney failure and end-stage kidney disease, other possible complications include severe hypertension, hyperkalemia and hypoglycemia due to decreased insulin excretion.
Prevention of diabetic nephropathy.
Blood glucose levels should be controlled and monitored as closely as possible in diabetics. Control of blood pressure, cholesterol levels and weight management are essential. |
