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.
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