Diabetic nephropathy, also termed diabetes-related kidney disease, is a condition that affects the kidneys over time and is commonly found in individuals with diabetes. It is responsible for the highest incidence of end-stage renal (kidney) disease worldwide and affects around 40% of individuals with diabetes.

High levels of blood sugar can harm the tiny blood vessels in the kidneys, which makes it harder for the kidneys to adequately filter waste products from the blood. As a result, toxins may get accumulated in the body and cause damage to the kidneys. 

What raises one’s risk of developing diabetic nephropathy?

Diabetes, particularly uncontrolled high blood sugar levels over an extended period of time, is the primary cause of diabetic nephropathy. 

Apart from high blood sugar levels, there are various other risk factors that can increase a person’s chances of developing diabetic nephropathy. These risk factors include:

  1. Uncontrolled high blood pressure: High blood pressure can cause damage to the blood vessels in the kidneys, which can increase the risk of diabetic nephropathy
  2. Long duration of diabetes: Diabetic nephropathy is more likely to occur in those who have diabetes for a longer period of time.
  3. High cholesterol levels:  A person’s possibility of getting diabetic nephropathy might increase if their cholesterol levels are high. 
  4. Genetics: A family history of diabetes and kidney disease can increase a person’s likelihood of developing diabetic nephropathy.
  5. Smoking: Smoking is a significant risk factor for developing kidney disease.
  6. Obesity: Excessive weight or obesity can escalate the risk of developing diabetes, increasing the probability of developing diabetic nephropathy. 

What are the symptoms of diabetic nephropathy?

  1. Swollen feet, ankles, and face 
  2. Feeling tired 
  3. Nausea and vomiting
  4. Shortness of breath
  5. Difficulty focusing or confusion
  6. Worsening blood pressure control 
  7. Increased need to urinate and protein in the urine
  8. Reduction in the amount of insulin or other diabetes medications needed
  9. Dry skin and itching   

It is important to note that some diabetic nephropathy patients may not experience any symptoms until the condition has progressed considerably.  As a result, it is crucial for diabetics to have frequent checkups and kidney function testing to look out for the development of diabetic nephropathy. 

How is diabetic nephropathy diagnosed?

  1. Urine tests: A urine albumin test checks for a protein called albumin in the urine.  Abnormal amounts of protein in the urine can be an indication of kidney impairment. A healthcare provider may perform a urine test to check for proteinuria (elevated levels of protein in the urine)
  2. Blood tests:  A healthcare provider may order blood tests to evaluate kidney function by measuring levels of waste products such as creatinine in the blood. The levels of these waste products can indicate how well the kidneys are functioning.  A blood test may also be used to evaluate the glomerular filtration rate (GFR), which measures how well the kidneys filter waste products, toxins, and excess fluid from the blood. Kidney function is poor when the filtration rate is low. 
  3. Imaging tests: Imaging tests, such as an ultrasound or CT scan or MRI may help detect any abnormalities or damage to the kidneys.
  4. Kidney biopsy: In some cases, a healthcare provider may perform a kidney biopsy to examine a small piece of kidney tissue under a microscope. The person is given a numbing medication (local anesthetic) and a thin needle is used to remove small pieces of kidney tissue for examination under a microscope. This can help identify any damage or abnormalities in the kidneys.

How is diabetic nephropathy treated?

The first step in treating diabetic nephropathy is controlling diabetes. This may involve:Lifestyle changes, including high fiber, low fat, and calorie diet

  • Taking diabetes medications or insulin regularly and as prescribed
  • Regular exercise
  • Weight control
  • Quitting smoking

It is also important to properly control blood pressure if you have it.  Medications such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are commonly prescribed to control blood pressure and slow the progression of diabetic nephropathy. Additionally, other medications, such as diuretics and calcium channel blockers, may also be used to control blood pressure.

  1. Statins are medications used to lower cholesterol levels, and they can be administered to individuals with high levels of cholesterol. These drugs work by decreasing the levels of bad cholesterol while increasing the levels of good cholesterol. In addition, statins have been shown to reduce proteinuria, which is an excess amount of protein in the urine, making them a useful treatment option for individuals with diabetic nephropathy.
  2. In severe cases of diabetic nephropathy dialysis or kidney transplant may be required to restore the function of the damaged kidneys.
  3. Dialysis – This treatment involves using a machine to filter waste products and excess fluid from the blood, performing the function of the kidneys.
  4. Kidney transplant – In this surgery, the diseased kidney is replaced with a healthy kidney from a donor and implanted into the recipient.

What can I anticipate if I develop diabetic nephropathy?

Diabetic nephropathy typically progresses slowly, and any kidney damage that has occurred cannot be reversed. However, early detection and management of diabetic nephropathy can help prevent or slow the progression of the disease. If a treatment plan is not followed, the condition can deteriorate and eventually lead to kidney failure which may be life-threatening. The treatment options for kidney failure are dialysis or a kidney transplant.

What self-care strategies I can follow to reduce the risk of developing diabetic nephropathy?

Self-care strategies that may help reduce the risk of developing diabetic nephropathy include:

  • Tight control of blood pressure and sugar levels by taking blood pressure and diabetes medications as directed by healthcare providers
  • Maintaining a healthy diet and exercising for at least 30 minutes a day most days of the week.
  • Refrain from taking medications that can damage your kidneys. This may include certain non-steroidal anti-inflammatory medicines (NSAIDs)
  • Stop smoking and limit alcohol use
  • Make sure you get 7 to 9 hours of sleep. 
  • Regular follow-up visits with the healthcare provider and blood checkups

How can I keep my kidneys healthy?

  • Aim to keep your blood sugar levels in your target range as much as possible.
  • Schedule an HbA1C test at least twice a year, more frequently if there is a change in medicines or if you suffer from other health conditions.
  • Monitor your blood pressure regularly and keep it below 140/90 mm/Hg or as your healthcare provider advises.
  • Keep your cholesterol levels within the healthy range.
  • Choose foods with lower sodium content.
  • Increase intake of fruits and vegetables.
  • Keep yourself active and fit with regular physical activity 
  • Take your medicines as prescribed.

In conclusion, it is critical for people with diabetes to effectively manage diabetic nephropathy to avoid kidney damage and other severe complications. This can be achieved by maintaining proper blood sugar levels, managing blood pressure, engaging in regular physical activity, quitting smoking, attending regular check-ups, and following self-care strategies recommended by the healthcare provider. By following these steps, individuals with diabetes can significantly minimize the risk of developing diabetic nephropathy and other related complications.

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