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Diabetic Nephropathy

About Diabetic Kidney Disease (Diabetic Nephropathy)

In this section, you or a loved one can find out more about diabetic kidney disease (diabetic nephropathy). Read on to find answers to some of your questions as well as links to other information. Being informed is an important first step toward becoming an active decision-maker in your care plan.

What Is Diabetic Kidney Disease (Diabetic Nephropathy)?

Diabetic kidney disease, or diabetic nephropathy, is a complication of type 1 or type 2 diabetes caused by damage to the kidneys' delicate filtering system. Kidney disease or kidney damage often occurs over time in people with diabetes. This type of kidney disease is called diabetic kidney disease or diabetic nephropathy. Patients who have diabetic nephropathy need to monitor their kidney function through medical tests including measurement of urine albumin (protein), blood creatinine and estimated glomerular filtration rate (eGFR) to prevent their condition from worsening, and to understand and manage the risk of heart disease, which often occurs in patients with diabetic nephropathy.

What Causes Diabetic Kidney Disease (Diabetic Nephropathy)?

In people with diabetes, the nephrons, the basic units of the kidney that filter blood, remove waste, and control fluid balance, slowly thicken. The nephrons eventually begin to leak, and protein passes into the urine. This kind of damage can happen years before a patient becomes aware of the problem. 

Many things can contribute to the development of diabetic nephropathy. They include: 

  • Having uncontrolled blood sugar
  • Having high blood pressure 
  • Having type 1 diabetes that began before the age of 20 
  • Having family members who have diabetes and kidney problems 
  • Smoking 
  • Being of a specific heritage including African American, Mexican American or Native American
What Are the Effects of Diabetic Kidney Disease (Diabetic Nephropathy)?

Damage to the kidneys can begin 5 to 10 years before symptoms show. 

People who have more severe and long-term (chronic) diabetic kidney disease may have symptoms such as: 

  • Increased risk of infections 
  • Fatigue 
  • General feeling of being ill 
  • Headache 
  • Itchy skin 
  • Nausea and vomiting 
  • Poor appetite 
  • Swelling of the legs 
  • Weakness 
  • Loss of sleep 
  • Difficulty concentrating
Symptoms of Diabetic Kidney Disease (Diabetic Nephropathy)

The first sign of diabetic nephropathy is often fluid buildup. This can occur anywhere throughout the body, but is most often seen in the lower limbs.

Kidney failure leads to a buildup of waste products in the blood, which affects the balance of fluids in the body, ultimately affecting other organs such as the brain, heart and lungs. This can lead to heart or respiratory failure, which may end in death.

Lifestyle Options

For most people, regardless of having diabetic kidney disease (diabetic nephropathy) or not, exercise, healthy eating and good sleep habits are recommended. Smoking cessation is highly recommended. A healthy lifestyle can lead to enhanced quality of life for most people. Talk to your doctor before making any lifestyle changes.

Manage blood sugar

Keeping your blood sugar well controlled can help decrease the risk of diabetic kidney disease. While the best range of blood sugar is different for everyone, determining the best range for you should be done with your healthcare team.

Manage blood pressure

Blood pressure has a dramatic effect on the rate at which kidney disease progresses. Even a mild rise in blood pressure can quickly make kidney disease worse. Here are four lifestyle options to lower your blood pressure:

  • Maintain a healthy weight
  • Eat less salt
  • Avoid alcohol and tobacco
  • Get regular exercise

If these methods fail, there are medicines that can help lower blood pressure. Doctors usually recommend that drugs called ACE inhibitors or angiotensin receptor blockers be used in patients with diabetes and high blood pressure.

Diet

High protein intake may increase the work load of the kidney in some patients. Whether you need a lower protein diet or not will be determined by your doctor.

Medical Treatment

Treatment plans are usually tailored to each individual's unique circumstances, but here are some general options for treating diabetic nephropathy:

Medications

Kidney disease can cause imbalances in levels of sodium, calcium, phosphorus or glucose. Your doctor may need to prescribe medications to balance the blood sodium level. In order to keep your bones healthy, medicines to control Vitamin D, calcium and phosphorus may be needed. Similarly, if the body's potassium levels are too high, a medicine to lower the blood potassium in addition to dietary restriction of potassium may be necessary. If the body's potassium levels are too low, supplementation may be necessary. Abnormal potassium levels can cause irregular heartbeats and muscle weakness.

Dialysis and transplant

Chronic kidney disease is a progressive process and once the kidneys are injured, the damage becomes progressive. Once the kidneys fail, this becomes a permanent, life-threatening condition as the patient is not able to clean his/her own blood. This is known as end-stage renal disease and requires renal replacement therapy, which can be either kidney transplant or dialysis. These treatments are managed by kidney specialists known as nephrologists. Dialysis involves using a machine to clean the blood. Kidney transplant is a preferred treatment but also requires life-long medication.

Please be sure to consult with your physician.

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