Diabetic Nephropathy

What is diabetic nephropathy?

Damage to kidneys due to exposure to high blood sugar for prolonged time is called diabetic nephropathy Diabetic nephropathy is one of the many complications of diabetes.

In severe cases diabetic nephropathy may lead to kidney failure. Although having diabetes carries the risk of developing diabetic nephropathy, but everyone with diabetes does not necessarily develop diabetic nephropathy. On an average 4 out of 10 diabetics will eventually develop nephropathy.Kidneys are made up of millions of microscopic structures called glomerulus. As with any blood vessel, high blood sugar in diabetes damages the blood vessels of the kidneys also. Due to the prolonged damage, the filtration capacity of the kidneys decreases and they become leaky. This damage to the kidneys due to high blood sugar in diabetes is called diabetic nephropathy. If ignored, the damage will further continue unabated and a stage may come when the kidneys will stop functioning, which is called kidney failure.

What are the risk factors?

Apart from diabetes, smoking, hypertension, high cholesterol and heredity are the major risk factors for diabetic nephropathy.

What are the symptoms of diabetic nephropathy?

In the early stages there are no symptoms even if your kidneys are continuously being damaged by hyperglycemia (high blood sugar). That is the reason you should get regular urine tests for possible kidney damage on annual basis. The earliest problem (not an overt symptom) will be that small amounts of protein from blood will start leaking out into your urine (Called as microalbuminuria). The pathologist will check if there is any protein in your urine. Sometimes microalbuminuria in its preliminary stage can be reversed by medicines.

If you do not control blood sugar and the initial stages of nephropathy go undetected and untreated, your nephropathy gets worse. As a result, your blood pressure, cholesterol and triglyceride levels rise. You may notice some swellings in your body, initially in the legs and feet.

How is diabetic nephropathy diagnosed?

The job of kidneys is to excrete the waste products into urine and prevent protein and other nutrients from draining away into urine. The kidneys get leaky in diabetic nephropathy. They are not able to filter the blood properly. So protein which should not be found in urine is found in the affected person’s urine. A simple urine test will show whether there is protein in the urine or not. The presence of the blood protein- albumin in urine is called microalbuminuria.

Early detection of diabetic nephropathy will help getting it worse. This can be achieved by proper and timely medical treatment.

How is diabetic nephropathy treated?

The main components of treatment of diabetic nephropathy are

1. Medicines to lower your blood pressure thereby preventing or reverting the damage to the kidneys. These medicines include

2. 1) angiotensin-converting enzyme inhibitors or ACE inhibitors for short ;

   2) Angiotensin II receptor blockers or ARBs for short

2. The treatment also includes action from your side. For example:

Work with your family physician:

1. To keep your blood pressure normal or near normal (below 130/80).
2. To keep your cholesterol level in normal range (visit this page for more info on cholesterol). You may need to take medication for lowering cholesterol.
3. To keep your heart healthy by eating a low-fat diet and in particular diet having no trans-fats and minimum saturated fats. Visit this page for more info on fats and oils.
4. Exercising regularly. Visit this page for more info on exercise.
5. Watch how much protein you eat. Eating too much will overload your kidneys. Most doctors recommend that not more than 10% of your total calories should come from protein for patients of diabetic nephropathy.
6. Watch how much salt you eat. Eating less salt helps keep high blood pressure from getting worse.
7. Don't smoke or use other tobacco products.

Preventing heart disease is most important for people with type-2 diabetes, because they are 2 to 4 times more likely to have heart attack. People with diabetic nephropathy are at higher risk for heart disease. Prevention or damage control for patients of diabetic nephropathy can be accomplished if the following things are done:

1. If you have type 2 diabetes, Start undergoing annual urine test for microalbuminuria at the time you are diagnosed with diabetes.
2. Watch intake of salt. Eating less salt helps keep hypertension under control. Don't smoke or use other tobacco products.

How can diabetic nephropathy be prevented?

Controlling blood sugar within normal or near normal range is the basic requirement for prevention of diabetic nephropathy

Next comes the control of blood pressure. Keep it below 130/85 if you are a diabetic. Cholesterol should also be kept under control.

Click here to go to Complications of Diabetes page