Diabetic kidney disease

 

Kidney damage due to the effects of diabetes mellitus is termed as diabetic nephropathy. It may eventually progress to end stage kidney disease, which is one of the leading causes of kidney failure.

 

 

Diabetic nephropathy usually causes no symptoms until the damage to the kidneys is advanced. When the disease is advanced, patients may develop symptoms related to poor kidney function and buildup of fluid and waste in the body. These symptoms include swelling over legs and face, weakness, itching, difficulty breathing, poor appetite, etc. Urine output generally remains stable although patients may report foaminess of urine.

 

 

Factors that can increase the risk of developing diabetic nephropathy include:

1. Uncontrolled blood sugar levels

2. Being overweight or obese

3. Smoking

4. Evidence of diabetic changes in other organs such as eyes (diabetic retinopathy) or nerves (diabetic neuropathy)

5. Certain ethnic groups (African American, Mexican, and Pima Indian) have an increased risk of diabetic nephropathy

 

 

The key test for early diagnosis of diabetic nephropathy involves checking for the presence of microalbuminuria. The preferred screening test for microalbuminuria is measurement of the urine albumin-to-creatinine ratio in an untimed urinary sample.

 

Other investigations include:

1. Blood tests: Serum creatinine, calculation of estimated GFR (glomerular filtration rate), and blood urea nitrogen. Rise in serum creatinine is not a very sensitive marker to detect this disease early and often the serum creatinine may remain normal even though the disease has already begun.

2. Urinalysis typically has a bland sediment and may occasionally show microscopic hematuria.

3. Ultrasound of the kidneys may show large sized kidneys due to renal and glomerular hypertrophy. It will also help in excluding other causes of kidney dysfunction like obstruction, urinary retention, etc.

 

 

The key complication of diabetic nephropathy is chronic kidney disease which can progress to end stage kidney disease.

 

 

Treatment for diabetic nephropathy involves a multidisciplinary approach including:

1. Strict blood sugar control

2. Strict blood pressure control

3. Control of lipid abnormalities

4. Adopting a healthy lifestyle which includes: Healthy eating, limiting the amount of salt in the diet, quit smoking, avoiding tobacco in any form, and regular exercise.