What Is Diabetic Nephropathy?

Diabetic nephropathy is a serious kidney disease that is a complication of diabetes. People with type 1 or type 2 diabetes can develop this condition, also known as diabetic kidney disease. It affects 25% of those diagnosed with diabetes.

Over time, diabetic nephropathy slowly damages the normal functioning of the kidneys and impacts their ability to filter waste and fluid appropriately. Managing diabetes and maintaining healthy blood pressure can help to prevent or slow the disease. However, if the disease is left untreated over time, it can lead to kidney failure. Diabetic nephropathy can be life-threatening and in its worst stages, the only forms of treatment are dialysis and kidney transplant.

What Are the Symptoms of Diabetic Nephropathy?

Often, signs of diabetic nephropathy go unnoticed in the early stages. As the disease progresses, common symptoms include:

• Difficulties in controlling blood pressure
• Swelling in feet, ankles, hands, or eyes
• Protein in the urine
• Increased need to urinate
• Confusion or difficulties focusing
• Decreased need for insulin or diabetic medications
• Loss of appetite
• Shortness of breath
• Fatigue
• Nausea and vomiting
• Constant itching
• Muscle weakness or twitching
• Irregular heart beat or rhythm

Left untreated, diabetic nephropathy can lead to kidney failure. Early detection is important for treatment and prevention. Contact your healthcare provider if you are experiencing any of these symptoms.

How Is Diabetic Nephropathy Diagnosed?

There are various methods used in diagnosing diabetic nephropathy. Typically, a medical professional will perform a physical exam and take a thorough medical history. Additional tests to help with diagnosing include:

• Microalbuminuria urine test: This test checks for protein in the urine. The presence of protein in the urine is an indicator of kidney damage.
• BUN blood test: This test looks for the presence of urea nitrogen in the blood. The nitrogen forms when protein is broken down. If there are above normal levels of urea nitrogen in the blood, it may be an indicator of kidney failure.
• Serum creatinine blood test: This test checks to find whether there is creatinine in the blood. Usually, the kidneys act as a filtration system, and creatinine is filtered into the bladder and expelled through the urine. If there is a buildup of creatinine in the blood, it may be a sign of kidney damage. Creatinine levels can also be used to check the glomerular filtration rate, which can show how well the kidneys are functioning.
• Kidney biopsy: If diabetic nephropathy is suspected, a doctor may order a biopsy to gather more data. This is a surgical procedure that takes a small sample from one or both kidneys to be looked at under a microscope.

What Are the Causes of Diabetic Nephropathy?

Diabetic nephropathy is caused by damaged blood vessels and cells in the body, which is a common complication of type 1 and type 2 diabetes. The damaged blood vessels can lead to problems with the kidneys’ filtration system and can ultimately result in kidney failure.

Poorly managed diabetes, over time, can damage the blood vessels that help in the kidneys’ filtration system. This can lead to kidney damage and cause high blood pressure. Additionally, high blood pressure can also cause more damage to the kidneys. Common risk factors include:

• Unmanaged high blood sugar (hyperglycemia)
• Unmanaged high blood pressure (hypertension)
• Being a smoker
• High cholesterol
• Family history of diabetes or kidney disease

Please contact your healthcare provider if you are noticing symptoms of diabetic nephropathy, especially if you have any of the risk factors listed above.

How Is Diabetic Nephropathy Treated?

There is no specific cure for diabetic nephropathy, however, treatment and prevention measures can slow or stop the progression of the disease. The most important steps in treatment are appropriate management of blood sugar levels and blood pressure. It is important to adhere to a treatment plan for managing diabetes, as better diabetes management will work to prevent diabetic nephropathy from developing.

Through necessary lifestyle changes and medications, blood sugar levels and blood pressure should be able to stay within a normal range. If the disease progresses to ESDR, a doctor will require a more invasive treatment approach. Examples of treatments include:

Lifestyle changes

A doctor and dietician will typically work together to create a treatment plan geared toward protecting the kidneys and slowing or stopping the disease. Examples of lifestyle changes may include:

• Reducing protein intake
• Consuming healthy fats and limiting oil and saturated fatty acids
• Limiting sodium intake (1,500-2,000mg or less)
• Decreasing potassium intake (bananas, avocados, spinach)
• Limiting foods high in phosphorus (yogurt, milk, processed meats)

A medical professional may also recommend an exercise plan to help lower blood pressure and maintain healthy kidney functioning.

Medications

Regular and consistent monitoring of blood sugar levels and blood pressure are important to healthy kidney functioning. Insulin is sometimes needed to help manage blood sugar levels, and different medications are sometimes prescribed to help blood pressure to stay within a normal range. Examples of blood pressure medications are ACE inhibitors, angiotensin receptor blockers (ARBs), and many others.

ESDR treatment

If a person has ESDR, it will most likely require both the early stages of treatment as well as the later stages of treatment, which is kidney dialysis or a kidney transplant. Kidney dialysis helps to filter out the waste and fluid from the kidneys. There are two different types of dialysis, and a medical professional will help decide which is best. A kidney transplant requires a donor kidney to be transplanted from a donor into the patient’s body. Individuals vary in how they respond to dialysis and transplants.

Complications

Complications of diabetic nephropathy can develop slowly over months or even years. Complications may include:

• Fluid retention, which can lead to swelling of the arms and legs, high blood pressure, or fluid in the lungs (pulmonary edema)
• Heart and blood vessel disease, which can lead to a stroke
• An increase in potassium levels (hyperkalemia)
• Damage to the blood vessels in the back of the eye (diabetic retinopathy)
• Anemia
• Foot sores, erectile dysfunction, diarrhea and other issues related to damaged nerves and blood vessels
• Pregnancy complications that can put the mother and fetus at risk
• Irreversible damage to the kidneys

If you are noticing any of these symptoms or complications, please contact your Baptist Health provider to set up a treatment plan.