Learn about diabetic nephropathy, its symptoms, and effective management strategies. Meri Sehat provides comprehensive information and support.

Diabetic Nephropathy

PNS SHIFA

Online Consultation

Syed Intisar Hussain

Introduction

This is surely not an article on how cannibalism is good. I mean there shouldn&rsquo;t be any articles on &ldquo;how cannibalism is good&rdquo;, right? Rest assured, the information summoned here, is related to the sugary stuff and its effects on your health. So, get ready as you&rsquo;re in for a treat, no pun intended!

&nbsp;

<h5>What Is Diabetic Nephropathy?</h5>

Nephropathy is the progressive deterioration of the kidney&rsquo;s function. Diabetic nephropathy, then, refers to the deterioration of the kidney as a result of longstanding or complicated diabetes<a href="#accordion">[5]</a>. As the disease progresses and reaches the final stage, it is termed kidney failure or end-stage renal disease (ESRD)<a href="#accordion">[2]</a>.&nbsp;

According to the CDC reports, diabetes is the most common cause of ESRD. In 2011, there were around 26 million diabetic people in the U.S., and more than 200,000 people with ESRD were either going through chronic renal dialysis or had kidney transplants<a href="#accordion">[2]</a>.&nbsp;

&nbsp;

There are essentially two types of diabetes:&nbsp;

<ol>
	<li>Type I (Inherited or Juvenile)&nbsp;</li>
	<li>Type II (Adapted)</li>
</ol>

&nbsp;

<a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Type I diabetes</a> is the most likely of the two types of diabetes to progress into ESRD, the fifth and last stage of diabetic nephropathy.&nbsp;Patients who develop type II diabetes mellitus may present with albuminuria (the presence of albumin protein in the urine) at the time of diagnosis. However, diabetic nephropathy in type I diabetes develops over the course of 15-20 years after the diagnosis.

This difference in the timeline is because it&rsquo;s difficult to pinpoint the precise onset of type II diabetes. It&rsquo;s identified only when the kidney&rsquo;s structural and functional changes occur due to diabetes, causing proteinuria and hypertension - the hallmarks of diabetic nephropathy<a href="#accordion">[1]</a>. 
&nbsp;

Understanding Diabetic Nephropathy

These include:

&nbsp;

<ul>
	<li>Ethnic Groups: Some groups of the population, such as&nbsp;African Americans, Native Americans, and Mexican Americans, are more at risk than others. Researchers have noted familial clustering (occurrence of the disease within some families in excess of what would be expected from the occurrence in the population) in these cases, which indicates that genetics also play a vital role in developing nephropathy<a href="#accordion">[1]</a>.&nbsp;</li>
</ul>

&nbsp;

<ul>
	<li>Blood Sugar Level: The high levels of blood sugar associated with diabetes damage the kidney through various pathways. The damage is mostly directed toward&nbsp;the blood vessels that are responsible to filter the blood in order to make urine.</li>
</ul>

&nbsp;

Diabetic nephropathy has a high morbidity and mortality rate mainly because of other issues due to diabetes<a href="#accordion">[1]</a>:

&nbsp;

<ul>
	<li><a href="https://merisehat.pk/disease/chronic-kidney-disease">Chronic Kidney Disease (CKD)</a>: As of now, diabetic nephropathy is the leading cause of CKD in the United States as well as other Western societies<a href="#accordion">[6]</a>.&nbsp;</li>
</ul>

&nbsp;

<ul>
	<li><a href="https://merisehat.pk/disease/hypertension-57">Hypertension</a>: Like CKD, hypertension (commonly known as high blood pressure) is also believed to be both a cause of and a result of the damage that is done by the disease. An individual suffering from uncontrolled hypertension progresses toward stage V diabetic nephropathy faster than those who don&rsquo;t have high blood pressure<a href="#accordion">[2]</a>.&nbsp;</li>
</ul>

<h5>&nbsp;</h5>

<h5>The Technicalities</h5>

On the basis of the clinical presentation, doctors have broken down this kidney disease into 5 stages, depending on the glomerular filtration rate (GFR) which is essentially the rate at which the kidneys filter the blood. GFR is basically a representation of the effectiveness of the kidney function in percentage.

&nbsp;

The stages are as follows<a href="#accordion">[3]</a>:

<ul>
	<li>Stage 1: The kidney is damaged; however, the kidney function is normal and a GFR of 90% or above is seen.</li>
	<li>Stage 2: The kidney faces some degree of damage and a GFR of 60&ndash;89% is observed.</li>
	<li>Stage 3: Mild to severe loss of kidney function is recorded with a GFR of 30&ndash;59%.</li>
	<li>Stage 4: This stage refers to the severe loss of function and a GFR of 15&ndash;29%.</li>
	<li>Stage 5: Kidney failure and a GFR of under 15% define stage 5. 
	&nbsp;</li>
</ul>

Diabetic nephropathy is always a cause for alarm if the individual has diabetes mellitus as a comorbidity along with a history of the following<a href="#accordion">[1]</a>:

<ol>
	<li>Foamy urine</li>
	<li>An unexplained proteinuria</li>
	<li>Diabetic retinopathy, i.e., diabetes affecting the visual sense</li>
	<li>Fatigue and foot edema because of hypoalbuminemia, i.e., decreased levels of albumin protein)</li>
	<li>Hypertension</li>
	<li>Coronary artery disease</li>
</ol>

&nbsp;

Diabetic nephropathy sounds dangerous, and rightfully so! However, there are ways to lower the risk<a href="#accordion">[3]</a><a href="#accordion">[4]</a>:&nbsp;

<ul>
	<li>Keep up with regular checkups; an annual appointment with a healthcare team helps with diabetes management, hence, helping avoid complications like diabetic nephropathy, retinopathy, and neuropathy.&nbsp;</li>
	<li>Take antidiabetic drugs with utmost efficiency. When it&rsquo;s impossible to resist chocolate cake, tiramisus, or maybe some soft succulent, and sweet gulab jamuns, why hold back on the medicines that actually allow devouring these delicacies in moderation? There is no doubt that medication can be very effective and may even help prevent diabetic nephropathy.&nbsp;</li>
	<li>Manage blood pressure as it increases the risk of kidney disease. Moreover, take care while taking nonprescription pain relievers (e.g., aspirin) and nonsteroidal anti-inflammatory drugs (e.g., naproxen and ibuprofen) as they can lead to kidney damage in case of diabetic nephropathy.&nbsp;</li>
	<li>Also try to maintain a balanced body mass index.&nbsp;</li>
	<li>Another crucial thing to take care of in order to avoid diabetic nephropathy and its complications is smoking. The solution is pretty simple: don&rsquo;t smoke. Cigarette smoking is responsible for damaging the kidneys and can even make existing kidney damage worse.</li>
</ul>

&nbsp;

A doctor advising medical intervention will discuss the best drug according to the severity of the disease. Therapeutic agents for glycemic (sugar) control in diabetic patients, who have developed kidney disease as well, include:

<ul>
	<li>Dipeptidyl Peptidase Inhibitors, e.g., Sitagliptin</li>
	<li>Alpha-Glucosidase Inhibitors, e.g., Acarbose</li>
	<li>Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors, e.g., Canagliflozin&nbsp;</li>
	<li>Glucagon-like peptide-1 (GLP-1) Receptor Agonists or Incretin Mimetics, e.g., Dulaglutide&nbsp;</li>
	<li>Amylin Analogs, e.g., Pramlintide</li>
	<li>Nonsteroidal, Selective Mineralocorticoid Receptor (MR) Antagonists, e.g., Finerenone&nbsp; 
	&nbsp;</li>
</ul>

It may take months or years for complications of diabetic nephropathy to develop. Whatever the reason, whether it was non-compliance on your part or whether it was due to the fact that the disease was already in its advanced stages, it is important to know the current status of your condition so that it can be treated accordingly before it develops into the following complications<a href="#accordion">[4]</a>:

&nbsp;

<ul>
	<li>Fluid Retention: Fluid retention can cause swelling in the arms and legs, hypertension, or even cause pulmonary edema, whereby fluid builds up in the lungs.</li>
	<li>Hyperkalemia: Hyperkalemia is an increase in potassium levels in the blood and it can lead to abnormal heart rhythms.</li>
	<li>Cardiovascular Disease: Another major complication is cardiovascular diseases which, in turn, can lead to stroke.</li>
	<li>Diabetic Retinopathy:&nbsp;Uncontrolled diabetic nephropathy can also damage the blood vessels of the retina, and the light-sensitive tissue at the back of the eye, and cause diabetic retinopathy.</li>
	<li>Blood Loss: It will lead to a reduced number of red blood cells to transport oxygen, a condition known as anemia</li>
	<li>Bone And Mineral Disorders: Since the kidneys are losing their ability to function properly, it will affect the level of calcium and phosphorus in the blood.</li>
	<li>Miscellaneous Conditions: Some other conditions caused due to diabetic nephropathy are foot sores, erectile dysfunction, diarrhea, damaged nerves and blood vessels, and pregnancy complications. 
	&nbsp;</li>
</ul>

Dialysis or a kidney transplant is used as the last resort, i.e., if the kidneys are damaged beyond repair, then the patient may need dialysis on a regular basis - at least until they can get a transplant - to survive.

&nbsp;

Additionally, the doctor may give some instructions regarding their diet to avoid an unfortunate event<a href="#accordion">[3]</a>:

<ul>
	<li>Water: Water is definitely essential; however, an excess of fluid can increase the risk of swelling and hypertension.</li>
	<li>Sodium: An excessive intake of sodium can raise blood pressure pathologically.</li>
	<li>Protein: A drawback of kidney disease is the consumption of too much protein can lead to a buildup of waste products in the blood, putting unnecessary pressure on the kidneys.</li>
	<li>Phosphorus: Phosphorus is found in high quantities in dairy products. A high level of phosphorus can weaken the bones and again put excessive pressure on the kidneys.</li>
	<li>Potassium: People with kidney disease reportedly have a higher level of potassium than a healthy adult; too much and/or too little&nbsp;potassium is bad for the neurons. 
	&nbsp;</li>
</ul>

Conclusion

Diabetes takes away a person&rsquo;s integrity slowly and bit by bit. However, with due management and precautionary methods, it can be kept at bay and the patient can live a fairly decent life filled with heavenly desserts (in moderation of course)! 
&nbsp;

Key Points

<ul>
	<li>Nephropathy is the progressive deterioration of the kidney&rsquo;s function. Diabetic nephropathy, by extension, is the deterioration of the kidney as a result of long-standing or complicated diabetes.</li>
	<li>According to the CDC reports, diabetes is the most common cause of ESRD.</li>
	<li>In 2011, there were around 26 million diabetic people in the U.S., and more than 200,000 people with ESRD were either going through chronic renal dialysis or had undergone a kidney transplant.</li>
	<li>There are essentially 5 stages of diabetic nephropathy; ESRD is the fifth and last stage.</li>
	<li>Some groups, such as African Americans, Native Americans, and Mexican Americans are at a high risk of developing diabetic nephropathy.</li>
	<li>Researchers have noted familial clustering, which means that genetics play a vital role in developing nephropathy.</li>
	<li>Diabetic nephropathy is one of the most prominent long-term complications when it comes to morbidity and mortality of a diabetic person.</li>
	<li>Hypertension is an inevitable threat posed by diabetes. It is also a major reason why diabetic nephropathy develops in the first instance.</li>
	<li>The damage is mostly directed towards the blood vessels responsible to filter the blood in order to make urine.</li>
	<li>If the kidney&rsquo;s structural and functional changes occur due to diabetes, it results in proteinuria and hypertension, which are the hallmarks of diabetic nephropathy.</li>
	<li>Diabetic nephropathy is an alarming condition given the patient also has diabetes mellitus as a comorbidity.</li>
	<li>Do not skip regular checkups. An annual appointment with the healthcare team is necessary since it sheds light on how well the person is able to manage diabetes, and thereby, avoid complications like diabetic nephropathy, retinopathy, and neuropathy.</li>
	<li>Moreover, take nonprescription pain relievers (e.g., aspirin) and nonsteroidal anti-inflammatory drugs (e.g., naproxen and ibuprofen) as prescribed by the doctor since their side effects often include kidney damage.</li>
	<li>Cigarette smoking is responsible for damaging the kidneys and can even make existing kidney damage worse.</li>
	<li>Kidney disease is categorized into 5 stages, depending on the glomerular filtration rate.</li>
	<li>In Stage 1, the kidney is damaged; however, the kidney function is normal and a GFR of 90% or above is seen.</li>
	<li>In Stage 2, the kidney faces some degree of damage, and a GFR of 60&ndash;89% is observed.</li>
	<li>Stage 3 is when there is mild to severe loss of kidney function and a GFR of 30&ndash;59%.</li>
	<li>Stage 4 refers to the severe loss of function and a GFR of 15&ndash;29%.</li>
	<li>Stage 5 is defined by kidney failure and a GFR of under 15%.</li>
	<li>The doctor may suggest a medical intervention to discuss the treatment options according to the severity of the disease.</li>
	<li>Complications of diabetic nephropathy include fluid retention, diabetic retinopathy, and hyperkalemia.</li>
	<li>If a person has diabetic nephropathy, then they need to keep a check on their intake of sodium, phosphorus, and water specifically. 
	&nbsp;</li>
</ul>

[1] Diabetic nephropathy - statpearls - NCBI bookshelf.

[2] Diabetic nephropathy (kidney disease). Diabetic Nephropathy (Kidney Disease) | Johns Hopkins Medicine.

[3] Diabetic nephropathy: Symptoms, stages, causes, and treatment. Medical News Today.

[4] Diabetic nephropathy (kidney disease). Mayo Clinic.

[5] EmmaHook. Diabetic nephropathy (kidney disease). Diabetes UK.

[6] Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy: Diagnosis, prevention, and treatment. American Diabetes Association.