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Diabetic nephropathy

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Introduction to diabetic nephropathy

Diabetic nephropathy is a condition or clinical syndrome, where the ‘kidney is damaged’ due to long-term complications of diabetes. It is characterized by the following:1

  • Albuminuria
  • Decline in glomerular filtration rate
  • Elevated arterial pressure

It starts as a minor damage with poor filtration by the kidneys. As the condition advances and left untreated, it leads to chronic kidney failure and requires dialysis or kidney transplant. Kidney failure will finally lead to death.

Epidemiology ( Occurrence of diabetic nephropathy in different groups)

The incidence of the end-stage renal disease in people suffering from type 2 diabetes is increasing stridently in many regions of the world.2 Recent studies suggest that 25% of the patients who suffer from diabetes develop microalbuminuria or diabetic nephropathy by 10 years.3 Once diabetic nephropathy is confirmed, the rate of worsening is 2–3% every year. According to another study, 14% of their study population suffering from type 1 diabetes developed end-stage diabetic renal disease after a period of 10 years.4 As the incidence of diabetes increases, the prevalence of diabetic nephropathy also rises.5

Symptoms of diabetic nephropathy

In the initial stages of this condition, symptoms cannot be observed, but as the disease advances, the following symptoms can be observed.

  • Frequent urination
  • Presence of excess serum protein in urine
  • Anorexia  or poor appetite
  • Ill feeling and fatigue
  • Generalized itching
  • Blood in urine
  • Discolored reddish urine
  • Increased blood pressure
  • Fluid retention in the body (edema)

Risk Factors for diabetic nephropathy

The major risk factors for diabetic nephropathy include:

  • Hyperglycemia
  • Hypertension
  • Long duration of diabetes
  • High intake of proteins
  • Genetic or environmental factors6

There is a greater risk of losing life, when a person has associated coronary artery disease. However, as the treatment options for coronary artery diseases are improving, persons with type 2 diabetes may survive long enough to develop end stage renal disease.

Treatment of diabetic nephropathy

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Treatment involves the following:7

  • Controlling the blood sugar levels
  • Treating hypertension
  • Restriction in protein intake
  • Lowering of serum lipids
  • Recommending angiotensin converting enzyme inhibitors
  • Dialysis necessary once end-stage renal disease develops
  • Renal replacement therapies
  • Others therapies include treating the risk factors

Management of diabetic nephropathy

Diabetic nephropathy can be managed by following some guidelines like:8

  • Maintaining blood sugar level to normal, by regular monitoring
  • Frequent checking of blood pressure and also maintaining it within normal limits
  • Taking blood pressure medicines without fail
  • Avoiding medicines which can damage the kidneys like nonsteroidal antiinflamatory drugs
  • Eating a balanced diet  and involving a low fat diet
  • Exercising regularly and maintaining a normal weight
  • Avoid smoking and tobacco products
  • Decreased protein intake
  • Limiting salt intake

Conclusion

Diabetes has emerged at a major public health, since it affects all the organs, especially when it is long-standing. The kidneys are one of the organs frequently affected in poorly controlled, long-standing diabetes. This if not managed properly, leads to renal failure and ultimately to death. Hence, it is extremely important that blood sugars are maintained within normal limits and in case of complications, early diagnosis and treatment are essential.

References

1.Cooper ME. Pathogenesis, prevention, and treatment of diabetic nephropathy. Lancet. 1998; 352(9123): 213–219.

2.Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH. Effects of losartan on renal and cardiovascular outcomes in patients with Type 2 diabetes and nephropathy. N Engl J Med 2001; 345: 861–869.

3.Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR, on behalf of the UKPDS Group. Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int. 2003; 63: 225–232.

4.Klein R, Klein SE, Moss SE, Cruickshanks KJ, Brazy PC. The 10-year incidence of renal insufficiency in people with type 1 diabetes. Diabetes Care. 1999; 22: 743–751.

5.Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR, on behalf of the UKPDS Group. Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int. 2003; 63: 225–232.

6.The Diabetes Control and Complications Trial Research Group. Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. Kidney Int. 1995; 47: 1703–1720.

7.Cooper ME. Pathogenesis, prevention, and treatment of diabetic nephropathy. Lancet. 1998; 352: 213–219.   

8.American Diabetes Association. Standards of medical care in diabetes. Clinical Practice Recommendations. 2007. Diabet Care. 2007; 30(Suppl 1): S4–S41.