Diabetic nephropathy

Diabetic nephropathy (DN) is one of the most feared diabetic chronic microvascular complications and the major cause of end-stage renal disease (ESRD). The classical presentation of DN is characterized by hyperfiltration and albuminuria in the early phases which is then followed by a progressive renal function decline. The presentation of diabetic kidney disease (DKD) can vary especially in patients with T2DM where concomitant presence of other glomerular/tubular pathologies and severe peripheral vascular disease can become important confounders. All-cause mortality in individuals with DKD is approximately 30 times higher than that in diabetic patients without nephropathy and a great majority of patients with DKD will die from cardiovascular disease before they reach ESRD. The management of metabolic and hemodynamic perturbations for the prevention and for the delay of progression of DKD is very important. DKD is a global challenge and a significant social and economic burden; research should aim at developing new ideas to tackle this devastating condition.

Diabetic nephropathy is a common complication of type 1 and type 2 diabetes. Over time, poorly controlled diabetes can cause damage to blood vessel clusters in your kidneys that filter waste from your blood. This can lead to kidney damage and cause high blood pressure.

Symptoms

Worsening blood pressure control.

Protein in the urine.

Swelling of feet, ankles, hands or eyes.

Increased need to urinate.

Reduced need for insulin or diabetes medicine.

Confusion or difficulty concentrating.

Shortness of breath.

Loss of appetite.

Damage to the kidneys puts stress on these vital organs and prevents them from working properly.

When this happens:

the body starts to lose protein through the urine

the kidneys cannot remove waste products from the blood

the kidneys cannot maintain healthy fluid levels in the body

Diabetic nephropathy develops slowly. According to one study, a third of people show high levels of albumin in their urine 15 yearsTrusted Source after a diagnosis of diabetes. However, fewer than half of these people will develop full nephropathy.

Statistics have suggested that kidney disease is uncommon in people who have had diabetes for less than 10 years. Also, if a person has no clinical signs of nephropathy 20–25 years after diabetes starts, they have a low chance of developing it thereafter.

Diabetic nephropathy is less likely if a person with diabetes manages their glucose levels effectively.

High blood glucose levels increase the risk of high blood pressure because of the damage to blood vessels. Having high blood pressure, or hypertension, may contribute to kidney disease

 Risk of diabetic nephropathy include:

Uncontrolled high blood sugar (hyperglycemia)

Uncontrolled high blood pressure (hypertension)

Being a smoker.

High blood cholesterol.

Obesity.

A family history of diabetes and kidney disease.

Diabetic neuropathy can contribute to a number of high-risk complications, ranging from heart rate changes to visual disturbances.

Possible complications include losing sensation in the feet.

This can lead to an inability to feel cuts or sores, and infection might occur as a result. Untreated infection in a limb can result in the need for amputation.

Severe bladder and kidney infections might also occur, causing health problems.

To prevent the complications of diabetic peripheral neuropathy, good foot care is essential.

People with the condition should inspect their feet every day for injuries or sores.

Smoking also increases the risk of foot problems in people with certain types of diabetic neuropathy. A podiatrist can help with foot care, and a healthcare provider can give advice on

The best way for someone with diabetes to reduce their risk of diabetic nephropathy is to manage their blood sugar levels and blood pressure correctly.

Lifestyle changes that can help with this include:

eating a nutritious diet that is high in fiber and low in sugar, processed carbohydrates, and salt

exercising regularly

limiting alcohol intake

avoiding tobacco

checking blood glucose levels regularly

following any treatment plan their doctor suggests

limiting stress where possible

Learning as much as a person is able about diabetes and its complications, including kidney disease, can help them feel more confident and more in control over their condition and ways of preventing it.