Diabetic Nephropathy

Diabetic nephropathy is a kidney disease that results from diabetes is the main cause of kidney failure. Almost a third of people with diabetes develop diabetic nephropathy.

Causes of Diabetic Nephropathy #

• Each of your kidneys has about one million nephrons.

• Nephrons are small structures that filter waste from your blood.

• Diabetes can cause the nephrons to thicken and scar, which make them less able to filter waste and remove fluid from the body.

• This causes them to leak a type of protein called albumin into your urine. Albumin can be measured to help diagnose and determine the progression of diabetic nephropathy.

• The exact reason this occurs in people with diabetes is unknown, but high blood sugar levels and high blood pressure are thought to contribute to diabetic nephropathy.

• Persistently high blood sugar or blood pressure levels are two things that can damage your kidneys, making them unable to filter waste and remove water from your body.

Symptoms of Diabetic Nephropathy #

• Swelling of the hands, feet, and face

• Trouble sleeping or concentrating

• Poor appetite

• Nausea

• Weakness

• Itching (end-stage kidney disease) and extremely dry skin

• Drowsiness (end-stage kidney disease)

• Abnormalities in the hearts’ regular rhythm, because of increased potassium in the blood

• Muscle twitching

Diagnosis of Diabetic Nephropathy #

Microalbuminuria urine test #

A microalbuminuria urine test checks for albumin in your urine. Normal urine does not contain albumin, so the presence of the protein in your urine is a sign of kidney damage.

BUN blood test #

A BUN blood test checks for the presence of urea nitrogen in your blood. Urea nitrogen forms when protein is broken down. Higher than normal levels of urea nitrogen in your blood may be a sign of kidney failure

Serum creatinine blood test #

• A serum creatinine blood test measures creatinine levels in your blood.

• Your kidneys remove creatinine from your body by sending creatinine to the bladder, where it is released with urine.

• If your kidneys are damaged, they cannot remove the creatinine properly from your blood.

• High creatinine levels in your blood may mean that your kidneys are not functioning correctly.

• Your doctor will use your creatinine level to estimate your glomerular filtration rate (eGFR), which helps to determine how well your kidneys are working.

Kidney biopsy #

If your doctor suspects that you have diabetic nephropathy, they may order a kidney biopsy. A kidney biopsy is a surgical procedure in which a small sample of one or both of your kidneys is removed, so it can be viewed under a microscope.

Treatment of Diabetic Nephropathy #

Medications #

• Regularly monitoring your blood sugar levels, using proper dosages of insulin, and taking medications as directed by your doctor can keep your blood sugar levels under control.

• Your doctor may prescribe ACE inhibitors, angiotensin receptor blockers (ARBs), or other blood pressure medications to keep your blood pressure levels down.

• Kerendia (finerenone) is a prescription medicine that can reduce the risk of sustained GFR decline, end-stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure in adults with CKD associated with type 2 diabetes.

Diet and other lifestyle changes #

Your doctor or dietitian will help you plan a special diet that is easy on your kidneys. These diets are more restrictive than a standard diet for people with diabetes. Your doctor may recommend:

• Limiting protein intake

• Consuming healthy fats, but limiting consumption of oils and saturated fatty acids

• Reducing sodium intake to 1,500 to 2,000 mg/dL or less

• Limiting potassium consumption, which could include reducing or restricting your intake of high potassium foods like bananas, avocados, and spinach

• Limiting consumption of foods high in phosphorus, such as yogurt, milk, and processed meats

ESRD treatment #

• If you have ESRD, you will likely need dialysis or a kidney transplant, in addition to treatments for earlier stages of kidney disease.

• The other option for treatment is a kidney transplant. For a kidney transplant, a kidney from a donor will be placed into your body. The success of dialysis and kidney transplants differs with each person.