Diabetic Nephropathy

Diabetic nephropathy is the disease of the kidneys caused due to diabetes. Diabetic nephropathy is one of the leading causes of end-stage kidney disease and countless mortalities; however, diabetic nephropathy can be avoided.

How does Diabetes affect the Kidneys?

Diabetes is known to affect both the blood vessels and the nerves of the entire body. When the blood vessels of the kidneys are affected by diabetes, it leads to diabetic nephropathy. And, coupled with high blood pressure, diabetes causes major vascular complications leading to kidney failure and mortalities.

The functions of the kidneys are to eliminate waste products from the body, regulate blood pressure, regulate the acid levels of the body, and red blood cell regulation.

In people with diabetes, due to the damage to the blood vessels and nerves, the capacity of the kidneys to filter waste products reduces. Nerve damage also leads to difficulty in emptying the bladder. Diabetic nephropathy takes a long time to develop and it begins with a condition called albuminuria. Before albuminuria, a stage called microalbuminuria occurs.

Poor control of diabetes leads to hyperglycemia (high blood sugar levels). Consistent hyperglycemia leads to changes in the structure of the proteins due to the presence of high glucose in the blood. This leads to microalbuminuria.

Damage to the glomeruli (the filtration units of the kidney) results in the presence of albumin (a protein made in the liver) in the urine. This is called albuminuria. As the disease progresses, the glomerular filtration process is impaired due to more and more damage to the glomeruli.

Also, people with diabetes are prone to urinary and kidney infections due to the presence of high sugar content in the urine. This adds up to the kidney damage further.

Added to this, if people with diabetes have hypertension, damage to the glomeruli increases further. Along with damage to the glomeruli, there is damage to the basement membrane of the kidneys leading to thickening of the tissues. In this stage, most people have macroalbuminuria. Later, there is progressive damage to the kidneys leading to end-stage kidney disease.

Diabetic Nephropathy Symptoms:

  • Leg/ankle swelling along with cramps.
  • Excessive urination especially during the nighttime.
  • General weakness and malaise.
  • Morning sickness, vomiting.
  • Anemia.
  • Itching.
  • Protein in the urine.
  • High blood pressure.

Diagnostic Tests to screen for Diabetic Nephropathy:

Urinalysis (test to detect the presence of protein in urine)
Complete Urine Examination (CUE).
Serum Creatinine.
Estimated Glomerular Filtration Rate (eGFR).

How to Prevent Diabetic Nephropathy:

  • Tight control over blood glucose levels. It is very important to control your diabetes in order to avoid diabetic nephropathy. For this, one needs self-monitoring of blood glucose levels, strict adherence to medications, and modifications in diet.
  • Tight control over blood pressure. This ensures reduction of albuminuria significantly and delays diabetic nephropathy.
  • Restriction of proteins in the diet. To manage this, one to coordinate with a qualified dietician.
  • Attaining target cholesterol levels.
  • Regular screening for diabetic nephropathy.
  • Lifestyle interventions like smoking cessation, weight control, avoiding consumption of alcohol, and getting adequate exercise.