Diabetes complications – Diabetic Nephropathy

Diabetes complications - Nephropathy

There are numerous complications due to diabetes. It is probably one of the most silent and devastating of all non-communicable diseases. It is said that most people with diabetes ultimately have long-term complications like cardiovascular diseases, heart problems, peripheral artery disease, and kidney problems.

Among the complications due to diabetes, diabetic nephropathy is a major complication as it can lead to end-stage kidney disease needing dialysis or kidney transplantation. As such chronic kidney disease is a huge healthcare threat. Added to that, any treatment for diabetic kidney problems are life-long and very expensive.

When it comes to kidney transplantations, it is said that there are more than 2, 00,000 people waiting for kidney transplantation, but only 5000 of them get it in a year. Compounding the woes further, there is a shortage of nephrologists in India making treatment that much more complicated.

That is why diabetic nephropathy and other complications due to diabetes need to be prevented. 

What is 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 fatalities; 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.

It is important to deal with diabetes in an aggressive manner as soon as it is diagnosed. This is because controlling blood sugar levels on a daily basis can lead to better health and would reduce the risk of complications due to diabetes.

What you need to do to control diabetes?

  • Stick to the treatment prescribed by the diabetes doctor
  • Never avoid even a single dose of your diabetes medication unless suggested by your doctor
  • Monitor blood sugar at home with a glucometer
  • Follow a diabetes diet plan
  • Get at least 150 minutes of physical activity per week
  • Keep your blood sugar levels, total cholesterol levels, and your blood pressure in target range
  • Get periodical screening tests for diabetes complications. Tests like fundus exam, urinalysis, HbA1c, foot exam, lipid profile test, and heart risk assessment are vital
  • Quit smoking
  • Consume alcohol only in moderation (as per the advice of your diabetologist)

 Remember, diabetic nephropathy does not show up any symptoms in the initial stages. So, if you have diabetes, it is time to pay attention to preventive care!