Did you know that diabetes is the foremost cause for kidney disease? If you have type 2 diabetes, you are at an increased risk of developing diabetic nephropathy. This article will discuss what causes diabetic nephropathy, how is it diagnosed and treated, and how to protect your kidneys from diabetes-related complications.
What is Diabetic Nephropathy? How does Diabetes Affect Your Kidneys?
Diabetic nephropathy or diabetic kidney disease is a common long-term complication of both Type 1 and Type 2 Diabetes. When your blood sugar levels are high for a long time, they can damage the inner lining of the walls of your blood vessels of your kidneys. Due to this, cholesterol and debris can accumulate in the damaged walls leading to blockage and narrowing of the blood vessels. Hence, your kidneys are unable to effectively filter out waste materials from your body, causing excretion of important nutrients (proteins) and accumulation of fluid, leading to the development of diabetic nephropathy.
Diabetic Nephropathy Symptoms
The following are the signs and symptoms of diabetic kidney disease.
- Swelling or edema in your ankles, feet and hands
- Puffiness under your eyes
- Itchy skin or rashes
- Blood in your urine
- Fluctuating blood pressure levels
- Nausea and reduced appetite
- Urge to urinate frequently
Consult your doctor if you have diabetes and are experiencing any of these symptoms.
Different Stages of Diabetic Nephropathy
The progression of diabetic nephropathy can be divided into 5 stages based on the glomerular filtration rate (a test used to check how well your kidneys are functioning) of your kidneys. The glomerular apparatus is a structure in your kidney made up of small blood vessels that functions as the filtration unit. Their capacity to filter your blood is measured in mL/min/1.73 m² (mL of blood filtered per minute relative to body surface area). As diabetic kidney disease progresses, the glomeruli become less efficient in filtering waste and their capacity decreases.
Stage of Nephropathy
Stage 1 or Hyperfiltration
>90 mL/min/1.73 m²
Increased renal size and function
Stage 2 or Silent nephropathy
>90 mL/min/1.73 m²
Mild thickening of renal membranes and tissues
Stage 3 or Incipient nephropathy
<60 mL/min/1.73 m²
Mild to moderate thickening, increased levels of proteins in urine, first clinical signs of kidney damage
Stage 4 or Overt nephropathy
<30 mL/min/1.73 m²
Severe thickening and scarring, increased excretion of proteins in urine, significant loss of kidney function
Stage 5 or End Stage Renal Disease (ESRD) or kidney failure
<15 mL/min/1.73 m²
Major loss of kidney function, need for dialysis or kidney transplant
Risk Factors for Diabetic Nephropathy
The following factors can increase your risk of developing diabetic nephropathy.
- Uncontrolled or untreated hyperglycemia (high blood sugar levels)
- Uncontrolled hypertension (high blood pressure)
- High blood cholesterol levels
- Being overweight or obese
- Having cardiovascular disease
- Family history of kidney disorders
Diagnosis and Testing for Diabetic Nephropathy
Diabetic kidney disease can be diagnosed through blood and urine tests like:
Serum creatinine test:
Creatinine is a waste product (formed by the normal breakdown of muscle cells) that is filtered out of your blood by healthy kidneys. High blood creatinine levels indicate that your kidney is unable to function properly.
Urine albumin test:
Albumin, a protein made by your liver, is usually not found in urine. If your urine albumin levels are high, it signals kidney damage.
Glomerular Filtration Rate (GFR) Test:
This test helps to measure the capacity of your kidney to filter out waste from your body. Healthy kidneys have a GFR of >90 mL/min/1.73 m².
Sometimes, X-rays, CT scans or MRIs can be used to diagnose kidney disease to identify the extent of kidney damage.
Complications of Diabetic Nephropathy
Potential complications of Diabetic Nephropathy include:
- Edema or fluid retention
- High blood pressure
- Cardiovascular diseases and stroke
- Disturbed vision
- Electrolyte imbalance
- Bone disorders
- Kidney failure
Treatments For Diabetic Nephropathy
Treatment for diabetic kidney disease is based on controlling the factors that cause kidney damage and reducing the load on your kidneys.
In the initial stages of diabetic nephropathy, the treatment strategy is focused on lowering blood sugar, cholesterol, and blood pressure. Some medicines may be prescribed to prevent kidney inflammation and scarring.
In the later stages of nephropathy, dialysis may be required to eliminate waste from your body due to reduced kidney function.
- Kidney transplant
In cases where the function of both kidneys is severely affected, doctors may recommend a kidney transplant.
Prevention of Diabetic Nephropathy
If you have diabetes, following these precautions can lower your risk of developing nephropathy.
- Control your blood sugar levels
- Manage your hypertension
- Quit smoking.
- Maintain a healthy weight
- Check with your doctor before taking any other medications
- Get regular full body check-ups and make regular appointments with your diabetologis.
When to See a Doctor?
Consult your doctor immediately if you are experiencing muscle cramps, unexplained fatigue, rashes, nausea for more than a week or if you see blood in your urine.
Don’t Have Time To Read?
- Diabetic nephropathy is a common complication in Type 1 and Type 2 Diabetes.
- High blood sugar levels can damage the blood vessels in and around your kidney over time, leading to reduced kidney function.
- Symptoms of diabetic kidney disease include swelling of ankles and feet, high blood pressure, nausea, tiredness, blood in urine, rashes, etc.
- There are 5 stages of diabetic nephropathy: hyperfiltration, silent, incipient, overt, and end stage renal failure.
- Risk factors for diabetic nephropathy include uncontrolled diabetes, hypertension, high cholesterol, smoking, family history of kidney disorders, obesity, and cardiovascular diseases.
- Diabetic nephropathy can be diagnosed by serum creatinine, urine albumin, glomerular filtration rate, and clinical imaging tests.
- If left untreated, diabetic nephropathy can cause complications like hypertension, fluid retention, anemia, vision problems, heart diseases, electrolyte imbalance, kidney failure, etc.
- Treatment for diabetic kidney disease includes medicines, dialysis, and/or kidney transplant.
- Diabetic nephropathy can be prevented by good glycaemic control, good blood pressure control, losing weight, quitting smoking, and regular check-ups and doctor consultations.
- Use the Phable Care App to consult India’s leading diabetologists, order medicines, book lab tests, integrate blood sugar monitoring and other devices to get real-time remote care from the comfort of your home. Also, check out our Diabetes Management program which provides 360º care. Let’s treat diabetes together.
Currently, diabetic nephropathy cannot be cured. It is a condition that needs continuous treatment. Management strategies include lowering your blood sugar levels, cholesterol levels and blood pressure.
Diabetic nephropathy is diagnosed with urine tests (urine albumin, albumin to creatinine ratio) and blood tests (serum creatinine).
If left untreated, diabetic nephropathy can lead to chronic kidney disease and kidney failure, and you may end up requiring dialysis or a kidney transplant for your body to keep functioning normally.
- Eat a balanced diet with more vegetables and fruits
- Cut down on added sugars, salt, and saturated fats
- Get at least 30 minutes of exercise every day
- Lose extra weight
- Quit smoking
- Limit or avoid alcohol consumption
Metformin does not affect your kidneys. But if you have pre-existing kidney function issues (estimated glomerular filtration rate below 45mL/min/1.73 m²), then your doctor may not prescribe metformin. Metformin is primarily eliminated by your kidney but if they are not functioning properly, it could lead to the accumulation of the drug in your body.