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Living with Diabetes
Diabetic Nephropathy: Kidney Disease
Definition
Diabetic nephropathy is kidney disease that is associated with long-standing diabetes. Diabetes is the leading cause of kidney disease in the US. The kidneys have multiple clusters of blood vessels, known as glomeruli, which filter blood and form urine. High glucose levels damage the tiny blood vessels within the kidney. Nephropathy results when the kidneys lose the ability to function properly causing protein to leak into the urine.
Classifications
Microalbuminuria: This is the earliest detectable change in kidney function. At this stage, the kidneys may start allowing more protein (known as albumin) than normal into the urine.
Renal Insufficiency: This occurs when increasing numbers of glomeruli are destroyed and larger amounts of protein are being excreted into the urine. At this stage, the kidneys are still functioning however their ability to perform effectively starts to decline.
End-Stage Kidney Failure: This occurs when the kidneys are no longer able to function at a level that is necessary for day to day life. This occurs when the kidney function is less than 10% of normal. At this point, dialysis or kidney transplantation is needed.
Signs and Symptoms
Signs and symptoms of kidney disease include fatigue, frequent hiccups, general ill feeling, generalized itching, headaches, nausea and vomiting, poor appetite, swelling of the legs, sleepiness or tiredness, and unintentional weight gain.
Tests for Kidney Disease
The first lab abnormality is a positive microalbuminuria test. Positive results on this screening test typically mean that there is some damage to the kidneys from diabetes. At this point, kidney damage may be reversible. A urinalysis that shows proteinuria indicates irreversible kidney damage. As kidney damage gets worse, serum creatinine and BUN (blood urea nitrogen) levels may increase. A kidney biopsy may also confirm the diagnosis of nephropathy.
Treatment
The goal of treatment in patients with diabetes is to slow down the progression of kidney damage. Once protein is detected in the urine, the main treatment is to tightly control blood pressure. A blood pressure medication may be prescribed. Controlling blood pressure is the most effective way of slowing down the progression of kidney damage.
Prevention
To prevent nephropathy, control blood glucose levels, control blood pressure levels, keep cholesterol levels within recommended ranges, and maintain a healthy weight. Stop smoking and minimize alcohol intake. Patients with diabetes should be complete a yearly 24-hour urine test to help detect kidney damage at its earliest stages.
