Diabetes patients may develop diabetic nephropathy, a chronic kidney condition. It happens when a person’s kidneys suffer damage from excessive blood glucose levels.

Chronic kidney disease of this kind is known as diabetic nephropathy (CKD). The body’s fluid and salt balance is maintained by the kidneys, which is essential for lowering blood pressure and safeguarding cardiovascular health.

Diabetes, whether type 1, type 2, or gestational diabetes, occurs when the body is unable to use or make insulin as it should. Pregnancy-related gestational diabetes raises the possibility of developing type 2 diabetes in later life.

High blood sugar levels are a side effect of diabetes. These elevated glucose levels have the potential to harm the kidneys and the cardiovascular system over time. Diabetic nephropathy is the term used to describe the resulting kidney damage.

One of the main causes of chronic kidney disease and end-stage renal disease is diabetic nephropathy (ESRD). The kidneys can no longer function adequately to meet daily requirements in ESRD. Kidney failure brought on by ESRD has the potential to be fatal.

What is diabetic nephropathy?

Patients with diabetes may develop diabetic nephropathy, a progressive kidney disease of this nature. Both type 1 and type 2 diabetics are at risk, and the likelihood of developing it rises with time as well as due to additional risk factors such high blood pressure and a family history of renal disease.

Diabetes is thought to be the primary cause of almost 40% of kidney failure cases, and it is estimated that 180,000 people have kidney failure brought on by diabetic complications. End-stage renal disease is also most frequently brought on by diabetes (ESRD). The fifth and last stage of diabetic nephropathy is called ESRD.

Slow progress is made in diabetic nephropathy. You can reduce or even halt the disease’s progression with early treatment. Not everyone who develops diabetic nephropathy will progress to kidney failure or end-stage renal disease (ESRD), and having diabetes does not guarantee that you will do so.

Stages of diabetic nephropathy

Depending on the GFR, which also measures the proportion of functional kidney function, a clinician may classify the stages of renal disease.

• 1st Stage: Kidney damage is present, but kidney function is normal, and the GFR is 90% or higher.
• 2nd Stage: GFR between 60 and 89% and kidney injury with partial loss of function.
• 3rd Stage: A GFR of 30-59%, mild to severe loss of function.
• 4th Stage: GFR of 15 to 29% and severe loss of function in stage 4.
• 5th Stage: GFR less than 15% and kidney failure in stage 5.

Symptoms of diabetic nephropathy

A person might not have any symptoms in the early stages. They may feel ill and exhibit the following symptoms in stage 4 or 5:

• water retention-related swelling of the hands, foot, lower legs, or ankles
• blood in the pee causes darker urine.
• breathing difficulty
• tiredness brought on by a blood oxygen shortage
• dizziness or vomiting
• a mouthfeel that is metallic
• Cardiovascular illness is one of the side effects of advanced renal disease.

A person with diabetes can better manage their blood sugar levels, lower their risk of kidney complications, and determine whether they need to take any action by adhering to their treatment plan and getting frequent health checkups.

What causes diabetic nephropathy?

Kidney damage stresses these important organs and stops them from functioning normally.

When this takes place:

• Protein begins to leave the body through the urine.
• The kidneys are unable to eliminate waste from the circulation.
• The kidneys cannot keep the body’s fluid balance in a healthy state.

The onset of diabetic nephropathy is gradual. One study found that 15 years after a diabetes diagnosis, a third of patients had high levels of albumin in their urine. Less than half of these individuals will experience complete nephropathy, though.

According to statistics, kidney disease is less likely among patients with diabetes who have had the disease for less than ten years. A person also has a minimal likelihood of developing kidney damage if they don’t exhibit any clinical indications of nephropathy 20–25 years after developing diabetes.

If a person with diabetes efficiently controls their glucose levels, diabetic nephropathy is less likely to occur. Due to the harm done to blood vessels by high blood glucose levels, high blood pressure is more likely to occur. Hypertension, or high blood pressure, may be a factor in kidney disease.

Risk elements of diabetic nephropathy

If you have diabetes, the following things can make you more likely to develop diabetic nephropathy:

• Uncontrolled blood sugar levels (hyperglycemia)
• Continually elevated blood pressure (hypertension)
• Using tobacco
• high cholesterol levels
• Obesity
• a history of diabetes and renal disease in the family

Complications of diabetic nephropathy

Diabetic nephropathy complications can appear gradually over months or years. They may consist of:

• Fluid retention, which can cause edoema in the arms and legs, hypertension, or fluid in the lungs (pulmonary edema)
• an increase in blood potassium levels (hyperkalemia)
• Stroke risk is increased by heart and blood vessel disease (cardiovascular disease).
• damage to the blood vessels in the rear of the eye’s light-sensitive tissue (diabetic retinopathy)
• fewer red blood cells are needed to carry oxygen (anemia)
• diarrhoea, foot ulcers, erectile dysfunction, and other issues because of damaged blood vessels and nerves
• bone and mineral problems brought on by the kidneys’ inability to keep the blood’s calcium and phosphorus levels in the proper range
• Complications of pregnancy that put the mother’s health and the unborn child at danger
• End-stage renal disease causes irreversible kidney failure, necessitating dialysis or a kidney transplant in order to survive.

Treatment of diabetic nephropathy

Diabetic nephropathy can be delayed or prevented with early treatment. Maintaining and controlling blood pressure and blood glucose levels is the major goal of treatment. The usage of drugs could be involved in this.

• Drug treatment
• Dietary changes
• Managing blood sugar levels
• Late-stage treatment options
  • Dialysis
  • Kidney transplant

Prevention of diabetic nephropathy

To lessen the possibility of getting diabetic nephropathy:

• Maintain routine appointments for managing diabetes. Maintain annual appointments, or more frequent ones if your medical team so advises, to check on how well you are controlling your diabetes and to screen for problems such diabetic nephropathy.
• Medicate for diabetes. You can stop or delay diabetic nephropathy with appropriate diabetes management.
• Control other medical issues, such as excessive blood pressure. Work with your doctor to manage any problems, such as high blood pressure, that put you at risk for renal disease.
• Take prescription and over-the-counter drugs as directed. Observe the directions on the packaging of over-the-counter painkillers such aspirin and nonsteroidal anti-inflammatory medications like naproxen (Aleve) and ibuprofen (Advil, Motrin IB, others). These kinds of painkillers can harm the kidneys in patients with diabetic nephropathy.
• Keep a healthy weight. When you reach a healthy weight, make an effort to keep it there by staying active most days of the week. Consult your doctor if you need to reduce weight to learn about weight-loss techniques including upping your daily physical activity and cutting calories.
• Avoid smoking. Smoking cigarettes can harm your kidneys and exacerbate whatever kidney problems you already have. Ask your doctor for advice on how to stop smoking if you smoke. You can get aid to stop from support groups, counselling, and some drugs.

REFERENCES:

• https://www.healthline.com/health/type-2-diabetes/nephropathy
• https://www.medicalnewstoday.com/articles/319686
• https://www.mayoclinic.org/diseases-conditions/diabetic-nephropathy/symptoms-causes/syc-20354556
• https://www.webmd.com/diabetes/diabetes-kidney-disease

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