Diabetic nephropathy is the name given to kidney damage caused by diabetes . According to statistics, 2 out of 5 people with diabetes will have diabetic kidney disease. There are many ways to reduce the risk of developing this complication. In addition, early detection and intervention can also delay the progression of the disease to kidney failure .
Let’s learn about the causes, signs and ways to prevent diabetic kidney complications through the following article.
General information
What is diabetic kidney disease?
Diabetic nephropathy is a serious complication of diabetes . Poorly controlled diabetes causes complications in the body’s large and small blood vessels. Diabetic kidney damage is part of the group of microvascular complications of diabetes, along with retinal complications and nerve complications .
Diabetes affects the kidneys and their basic function of removing waste and excess fluid from the body. The best way to prevent or delay kidney complications in people with diabetes is to build a healthy lifestyle, a balanced diet to control blood sugar and high blood pressure.
Over many years, diabetic nephropathy gradually damages the kidneys’ filtering system, which can lead to nephrotic syndrome and/or kidney failure (also known as end-stage renal disease). Early treatment can help prevent or slow this from happening and reduce the risk of complications.
Diabetic kidney disease staging
Doctors can divide kidney disease into stages, depending on the glomerular filtration rate (GFR).
- Stage 1: Kidney damage but normal kidney function and GFR of 90 ml/min/1.73m2 skin or more.
- Stage 2: Kidney damage, some kidney function loss, and GFR of 60–89 ml/min/1.73m2 skin.
- Stage 3: Mild to severe loss of function and GFR of 30–59 ml/min/1.73m2 skin area.
- Stage 4: Severe loss of function and GFR of 15–29 ml/min/1.73m2 skin area.
- Stage 5: Kidney failure and GFR below 15 ml/min/1.73m2 skin.
Symptom
Signs and symptoms of diabetic kidney disease
In the early stages, the disease may not show any symptoms. In later stages (4-5), symptoms of end-stage diabetic kidney disease may include:
- High blood pressure is getting harder to control.
- Swelling of the feet, ankles, hands, or eyes
- Foamy urine or bloody urine
- Out of breath
- loss of appetite
- Nausea and vomiting
- Itchy
- Tired, sick.
Reason
What causes diabetic kidney disease?
The kidneys have millions of clusters of small units called glomeruli. The glomeruli filter waste from the blood including water, electrolytes, metabolic wastes such as urea, uric acid, etc., and some drugs. Proteins or substances with large molecular weights will be retained in the blood. Normally, there will be no protein in the urine.
Damage from high blood sugar levels in people with diabetes causes blood vessels to leak and not function properly. When this happens, some of the protein in the blood can be filtered and excreted in the urine, called proteinuria . This is often an early sign of kidney disease. Over time, the damage causes the kidneys to lose function and lead to kidney failure.
Risk factors
In people with diabetes, the following may increase the risk of diabetic kidney disease:
- Long-term diabetes. Kidney complications can occur after 5 years of having type 1 diabetes, or at the time of diagnosis of type 2 diabetes. The most likely time is 10-20 years after diagnosis.
- Poorly controlled high blood sugar
- Poorly controlled high blood pressure . High blood pressure can cause further kidney damage by increasing the pressure in the kidneys’ filtering system.
- Dyslipidemia (High Cholesterol)
- Old age
- Obesity
- Smoke
- Eat lots of protein
- Family history of diabetes and kidney disease.
Complications
How dangerous is diabetic kidney disease?
Complications of diabetic kidney disease can occur slowly over months or years and include:
- Fluid retention, manifested by symptoms such as swelling of the hands and feet, high blood pressure, or pulmonary edema
- Little urine, foamy urine or blood in the urine
- Hyperkalemia , hyponatremia, hypocalcemia
- Cardiovascular disease , such as heart attack, stroke
- Anemia
End-stage diabetic complications are irreversible kidney failure.
Other urinary tract abnormalities that occur along with diabetic nephropathy that can accelerate the decline in kidney function include renal tubular necrosis, kidney stones, and urinary tract infections .
Diagnosis and treatment
The information provided is not a substitute for professional medical advice. Always consult your doctor.
How is diabetic kidney disease diagnosed?
Kidney function tests are often done periodically as part of diabetes management. Albumin is a protein in the blood. Normally, the kidneys do not filter albumin from the blood, so it is not found in the urine. Having albumin in the urine suggests that the kidneys are not working well.
How to collect urine to find albumin, what results mean if there is disease? There are 3 ways to collect urine (NT) to find trace albumin:
- Take a random urine sample and measure the albumin/creatinine ratio in the urine, this method is often prescribed by doctors.
- Collect 24-hour urine to measure all the protein in it. Also calculate the total urine volume. This is rarely done because it is difficult to collect a complete 24-hour urine collection.
- Collecting urine over a period of time (4 hours or overnight) and measuring albumin is also inconvenient.
In the early stages of diabetic kidney disease, urinary albumin excretion is 30 to 300 mg albumin/day and is called microalbuminuria or microalbuminuria. After several years, microalbuminuria progresses to macroalbuminuria or macroalbuminuria (> 300 mg/day).
In addition, your doctor will periodically check your blood creatinine to calculate your glomerular filtration rate (GFR). A low number means your kidneys are not working well.
Your doctor may also order X-rays, ultrasounds, or kidney biopsies to more thoroughly and accurately evaluate kidney problems.
Treatment of diabetic kidney disease
The first step is to treat and control diabetes , high blood pressure, and dyslipidemia. Doctors always recommend a target HbA1c level of 7% and a target blood pressure of 130/80 mmHg.
Treatment involves a combination of diet, lifestyle changes, exercise, and prescription medications. This can prevent or delay kidney damage and other complications.
In the early stages of diabetic kidney disease, medication is used to control the following problems:
- High blood pressure: Angiotensin converting enzyme inhibitors , angiotensin 2 receptor blockers .
- High blood sugar : Insulin, metformin, sulfonylureas, DDP4 inhibitors, GLP-1 agonists, and SGLT2 inhibitors. SGLT2 inhibitors or GLP-1 receptor agonists have mechanisms that may protect the heart and kidneys and reduce the risk of progression to adverse cardiovascular or renal events. New guidelines recommend the use of these two drugs in patients with diabetic kidney disease.
- High cholesterol : Statin drugs are used to treat high cholesterol and reduce protein in the urine.
- Kidney scarring: Finerenone may help reduce scar tissue in diabetic kidney disease. Research has shown that the drug may reduce the risk of developing kidney failure, death from cardiovascular disease, and hospitalization for heart failure in adults with chronic kidney disease associated with type 2 diabetes.
- Your doctor may also prescribe vitamin D and calcium because people with kidney disease often have low levels of vitamin D and calcium.
If you take these medications, you will need regular monitoring tests.
Treatment of advanced diabetic kidney disease
For kidney failure (end-stage renal disease), treatment options include:
- Hemodialysis
- Peritoneal dialysis
- Kidney transplant or kidney-pancreas transplant
- Supportive treatment.
Diet for people with diabetic kidney disease
In people with kidney disease, doctors will require limited use of the following substances:
- Water: Although drinking water is essential, drinking too much water can increase your risk of edema and high blood pressure.
- Sodium (salt): This substance can increase blood pressure so eat in moderation, not too salty.
- Protein: For people with kidney disease, protein can cause waste to build up in the blood, putting extra pressure on the kidneys.
- Phosphorus: Found in many protein-rich foods and dairy. Too much phosphorus can weaken bones and put stress on the kidneys.
- Potassium: People with kidney disease may have higher than normal levels of potassium, which can affect nerve cells.
Prevent
Measures to help prevent diabetic kidney disease
To reduce the risk of developing diabetic kidney disease, patients should:
- Regular check-ups to evaluate the effectiveness of blood sugar control and early detection of complications.
- Try to keep your blood sugar at your target level. This can prevent or slow down diabetic kidney disease.
- Treat high blood pressure or other medical conditions.
- Be careful with medications. For people with diabetic kidney disease, certain antibiotics and pain relievers can cause kidney damage.
- Lose weight and maintain a healthy weight.
- Do not smoke because smoking can damage your kidneys or make kidney damage worse.
