What Is Diabetic Nephropathy?
Diabetic nephropathy refers to kidney disease that occurs in people with diabetes. The kidneys help regulate the amount of fluids and salts in the body, which helps to control blood pressure and releases different types of hormones. Nephropathy is the term used when the kidneys start to incur damage, which can ultimately lead to kidney failure. In this article, we look at the link between diabetes and kidney failure. Contents of this article: What is diabetic nephropathy? Kidney problems are relatively common in people with diabetes. This is because diabetes affects the arteries in the body and the kidney filters blood from those arteries. It is estimated that around 40 percent of people who have type 2 diabetes develop nephropathy. People with either type 1 or type 2 diabetes can be affected by nephropathy. Diabetic nephropathy is a significant cause of long-term kidney disease and end-stage renal disease (ESRD), which is when the kidneys no longer work well enough to meet the needs of daily life. There are five stages of diabetic nephropathy, and ESRD is the last. Diabetic nephropathy is the most frequent cause of ESRD in the United States, with between 40 and 50 percent of all ESRD cases directly related to it. A person with ESRD will require dialysis. Causes Diabetic nephropathy is when the kidneys become leaky, allowing albumin (a protein made by the liver) to pass into the urine. The condition worsens as the level of albumin increases. Diabetic nephropathy develops slowly and is more common in people who have had diabetes for 20 years or more. Diabetic nephropathy is more likely to develop in people with diabetes who also have higher blood glucose levels. Doctors also believe that nephropathy is directly influenced by high blood pressure (hypertension), which may Continue reading >>
What Is Diabetic Nephropathy?
Diabetic nephropathy -- kidney disease that results from diabetes -- is the number one cause of kidney failure. Almost a third of people with diabetes develop diabetic nephropathy. People with diabetes and kidney disease do worse overall than people with kidney disease alone. This is because people with diabetes tend to have other long-standing medical conditions, like high blood pressure, high cholesterol, and blood vessel disease (atherosclerosis). People with diabetes also are more likely to have other kidney-related problems, such as bladder infections and nerve damage to the bladder. Kidney disease in type 1 diabetes is slightly different than in type 2 diabetes. In type 1 diabetes, kidney disease rarely begins in the first 10 years after diagnosis of diabetes. In type 2 diabetes, some patients already have kidney disease by the time they are diagnosed with diabetes. There are often no symptoms with early diabetic nephropathy. As the kidney function worsens, symptoms may include: Swelling of the hands, feet, and face Trouble sleeping or concentrating Poor appetite 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 As kidney damage progresses, your kidneys cannot remove the waste from your blood. The waste then builds up in your body and can reach poisonous levels, a condition known as uremia. People with uremia are often confused and occasionally become comatose. Certain blood tests that look for specific blood chemistry can be used to diagnose kidney damage. It also can be detected early by finding protein in the urine. Treatments are available that can help slow progression to kidney failure. That's why you should Continue reading >>
Maintenance of glycosylated Hb (HbA1c) 7.0 Aggressive BP control, beginning with angiotensin inhibition Primary treatment is strict glucose control to maintain HbA1c 7.0; maintenance of euglycemia reduces microalbuminuria but may not retard disease progression once DN is well established. Glucose control must also be accompanied by strict control of BP to < 130/80 mm Hg, although some experts now recommend BP < 140/90 mm Hg. Some suggest BP should be 110 to 120/65 to 80 mm Hg, particularly in patients with protein excretion of > 1 g/day; however, others claim that BP values < 120/85 mm Hg are associated with increased cardiovascular mortality and heart failure. Angiotensin inhibition is first-line therapy. Thus, ACE inhibitors or angiotensin II receptor blockers are the antihypertensives of choice; they reduce BP and proteinuria and slow the progression of DN. ACE inhibitors are usually less expensive, but angiotensin II receptor blockers can be used instead if ACE inhibitors cause persistent cough. Treatment should be started when microalbuminuria is detected regardless of whether hypertension is present; some experts recommend drugs be used even before signs of renal disease appear. Diuretics are required by most patients in addition to angiotensin inhibition to reach target BP levels. Dose should be decreased if symptoms of orthostatic hypotension develop or serum creatinine increases by more than 30%. Nondihydropyridine calcium channel blockers (diltiazem and verapamil) are also antiproteinuric and renoprotective and can be used if proteinuria does not meaningfully decrease when target BP is reached or as alternatives for patients with hyperkalemia or other contraindications to ACE inhibitors or angiotensin II receptor blockers. In contrast, dihydropyridine calcium Continue reading >>
Diabetic Kidney Problems
If you have diabetes, your blood glucose, or blood sugar, levels are too high. Over time, this can damage your kidneys. Your kidneys clean your blood. If they are damaged, waste and fluids build up in your blood instead of leaving your body. Kidney damage from diabetes is called diabetic nephropathy. It begins long before you have symptoms. People with diabetes should get regular screenings for kidney disease. Tests include a urine test to detect protein in your urine and a blood test to show how well your kidneys are working. If the damage continues, your kidneys could fail. In fact, diabetes is the most common cause of kidney failure in the United States. People with kidney failure need either dialysis or a kidney transplant. You can slow down kidney damage or keep it from getting worse. Controlling your blood sugar and blood pressure, taking your medicines and not eating too much protein can help. NIH: National Institute of Diabetes and Digestive and Kidney Diseases Continue reading >>
Diabetes can affect many parts of the body, including the kidneys. In healthy kidneys, many tiny blood vessels filter waste products from your body. These blood vessels have holes that are big enough to allow tiny waste products to pass through into the urine. But the blood vessels are still small enough to keep useful products (such as protein and red blood cells) in the blood. High levels of sugar in the blood can damage these vessels if diabetes is not controlled. This can cause kidney disease, which is also called nephropathy. If the damage is bad enough, your kidneys could stop working. Diabetic nephropathy does not usually cause any symptoms until kidney damage is severe. As the condition progresses, symptoms can include the following: If you have been diagnosed with diabetic nephropathy, you can slow down the damage. Here are some of the most important things you can do to protect your kidneys: Keep your blood pressure lower than 140 over 90. High blood pressure can speed up damage to the kidneys. Your doctor may give you medicine to help lower your blood pressure. Control your blood sugar level. You should take your diabetes medicines and/or insulin exactly as your doctor prescribes. Stick to a healthy diet. People who have diabetic nephropathy may need to eat less protein. Stop smoking. Check with your doctor before taking any new medicines. This includes vitamins, herbal medicines, and over-the-counter medicines. Keep all of your doctor appointments. Even with the right treatments, diabetic nephropathy can get worse over time. Your kidneys could stop working. This is called kidney failure. If this happens, waste products build up in your body. This can cause nausea, vomiting, weakness, shortness of breath, and confusion. In severe cases, kidney failure can cau Continue reading >>
Diabetic Nephropathy – Complications And Treatment
Background Diabetic nephropathy (DN) or diabetic kidney disease is a syndrome characterized by the presence of pathological quantities of urine albumin excretion, diabetic glomerular lesions, and loss of glomerular filtration rate (GFR) in diabetics. Diabetes may be classified as type 1 (autoimmune β-cell destruction and absolute insulin deficiency), type 2 (relative insulin deficiency and resistance), and other types (eg, pancreatic disease). Epidemiology The prevalence of diabetes is phenomenal and the projections are staggering. When one considers the morbidity, mortality, and cost of health care, the burden of the diabetes epidemic becomes apparent. Worldwide, the prevalence of diabetes was estimated at 171 million in 2000, increasing to 382 million in 2013; and is projected to reach 592 million by 2035. This represents 8%–10% of the global population, resulting in at least 548 billion dollars in health expenditure on diabetes care. Type 2 diabetes constitutes about 85%–95% of all diabetes cases.1 In the US alone for 2011, 25.8 million children and adults have diabetes with another 79 million having a prediabetic state.2 The diabetes epidemic has resulted in DN becoming the most frequent cause of end-stage renal disease (ESRD) in most countries. In 2009–2011, diabetes was the primary cause of ESRD in about 60% of patients in Malaysia, Mexico, and Singapore. Countries with an ESRD incidence of 40%–50% include Israel, Korea, Hong Kong, Taiwan, Philippines, Japan, the US, and New Zealand.2 The incidence of ESRD due to diabetes also rises in the older age group. In 2011, the incident rates of ESRD due to diabetes in the US were 44, 266, and 584 per million for the age groups 20–44, 45–64, and 65–74 years, respectively. A similar finding was noted in the A Continue reading >>
Diabetic nephropathy is a type of progressive kidney disease that may occur in people who have diabetes. It affects people with type 1 and type 2 diabetes, and risk increases with the duration of the disease and other risk factors like high blood pressure and a family history of kidney disease. Over 40 percent of cases of kidney failure are caused by diabetes, and it’s estimated that approximately 180,000 people are living with kidney failure caused by complications of diabetes. Diabetes is also the most common cause of end-stage renal disease (ESRD). ESRD is the fifth and final stage of diabetic nephropathy. Diabetic nephropathy progresses slowly. With early treatment, you can slow or even stop the progression of the disease. Not everyone who develops diabetic nephropathy will progress to kidney failure or ESRD, and having diabetes does not mean you will develop diabetic nephropathy. The early stages of kidney damage often do not cause noticeable symptoms. You may not experience any symptoms until you are in the late stages of chronic kidney disease. Symptoms of ESRD may include: fatigue general overall unwell feeling loss of appetite headache itchy and dry skin nausea or vomiting swelling of your arms and legs 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 diab Continue reading >>
Overview Diabetic nephropathy is a serious kidney-related complication of type 1 diabetes and type 2 diabetes. It is also called diabetic kidney disease. Up to 40 percent of people with diabetes eventually develop kidney disease. Diabetic nephropathy affects the ability of your kidneys to do their usual work of removing waste products and extra fluid from your body. The best way to prevent or delay diabetic nephropathy is by maintaining a healthy lifestyle and treating your diabetes and high blood pressure. Over many years, the condition slowly damages your kidneys' delicate filtering system. Early treatment may prevent or slow disease progression and reduce the chance of complications. Your kidney disease may progress to kidney failure, also called end-stage kidney disease. Kidney failure is a life-threatening condition. At this stage your treatment options are dialysis or a kidney transplant. Symptoms In the early stages of diabetic nephropathy, you may not notice any signs or symptoms. In later stages, the signs and symptoms include: Worsening blood pressure control Protein in the urine Swelling of feet, ankles, hands or eyes Increased need to urinate Less need for insulin or diabetes medicine Confusion or difficulty concentrating Loss of appetite Nausea and vomiting Persistent itching Fatigue When to see a doctor Make an appointment with your doctor if you have any signs or symptoms of kidney disease. If you have diabetes, visit your doctor yearly for a urine test that detects protein. This helps determine how well the kidneys are functioning. Causes Diabetic nephropathy results when diabetes damages blood vessels and other cells in your kidneys. How the kidneys work Your kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your Continue reading >>
What Is Diabetic Nephropathy?
Diabetic nephropathy is the damage caused to the kidneys by diabetes mellitus. Around 50% of individuals with type 1 diabetes will develop nephropathy within 10 years of having the disease and around 20% of those with type 2 disease will develop it within 20 years. The persistently high blood sugar that occurs in diabetes can eventually cause damage to various organs including the kidneys, eyes and heart. Diabetic nephropathy usually has a silent onset, meaning it may not be detected until much of the kidney is damaged. Research provides insights into mechanisms governing healthy longevity Some of the features of diabetic nephropathy include: Raised level of the protein albumin in the urine. Damaged kidneys may let large molecules such as albumin pass though into the urine, causing urine levels of albumin to rise. Raised blood levels of creatinine. Creatinine is normally filtered out from the body by the kidneys but if the kidneys are damaged, the blood levels of creatinine may be raised. There may be other organ damage caused by diabetes such as heart disease or diabetic retinopathy (eye damage). Without treatment, diabetic nephropathy may eventually leads to end stage renal disease. In the initial stages of disease, diabetic nephropathy does not cause pathological damage to the kidneys and is reversible. If the condition progresses, the kidneys will start to become damaged and the gromerular filtration rate will decrease. The extent of kidney damage can range from mild and symptomless, as in stage 2 disease, through to end stage renal disease which is characterized by a significantly lowered filtration rate causing a build up of waste products in the blood. Individuals with disease that is this advanced eventually require dialysis or a kidney transplant to stay alive Continue reading >>
What Is Diabetic Nephropathy?
Living With Diabetes Starts With Proper Management Ok, so over the past couple of weeks, Ive received several questions relating to the issues diabetics face in relation to kidney problems also known as nephropathy . Diabetic nephropathy is the most common cause of renal failure, accounting for more than half of all cases of end-stage renal disease in the United States. Renal disease will affect between 20-40% of diabetics in their lifetime, so lets take a closer look at what its all about and more importantly, what we can do to avoid it! Stop me if youve heard this one before, but as were aware, diabetes can affect many parts of the body, including the kidneys. In healthy kidneys, many tiny blood vessels filter waste products from your body. The blood vessels have holes that are big enough to allow tiny waste products to pass through into the urine but are still small enough to keep useful products (such as protein and red blood cells) in the blood. High levels of sugar in the blood can damage these vessels over time if diabetes is not controlled. This can cause kidney disease, which is also called nephropathy (say: nef-rah-puh-thee). If youre not well controlled and the damage is bad enough, your kidneys could stop working. Early signs and symptoms of kidney disease in patients with diabetes are typically unusual. However, signs and symptoms listed below may manifest when kidney disease has progressed: Going to the bathroom more often at night High levels of blood urea nitrogen (BUN) and serum creatinine Less need for insulin or antidiabetic medications The differential diagnosis of diabeticnephropathy are extensive, but they include the following in a patient with known type 1 and type 2 diabetes: The first sign of kidney damage from diabetes is protein in the urine Continue reading >>
What Is Diabetic Neuropathy?
Diabetes can harm your nerves. That damage, called neuropathy, may be painful. It can happen in several ways, and they all seem to be related to blood sugar levels being too high for too long. To prevent it, work with your doctor to manage your blood sugar. You may hear your doctor mention the four types of diabetes-related neuropathy: peripheral, autonomic, proximal, and focal. Peripheral Neuropathy This type usually affects the feet and legs. Rare cases affect the arms, abdomen, and back. Symptoms include: Tingling Numbness (which may become permanent) Burning (especially in the evening) Pain Early symptoms usually get better when your blood sugar is under control. There are medications to help manage the discomfort. What you should do: Check your feet and legs daily. Use lotion on your feet if they're dry. Take care of your toenails. Ask your doctor if you should go to a podiatrist. Wear shoes that fit well. Wear them all the time, so your feet don't get injured. Autonomic Neuropathy This type usually affects the digestive system, especially the stomach. It can also affect the blood vessels, urinary system, and sex organs. In your digestive system: Symptoms include: Bloating Diarrhea Constipation Heartburn Nausea Vomiting Feeling full after small meals What you should do: You may need to eat smaller meals and take medication to treat it. In blood vessels: Symptoms include: Blacking out when you stand up quickly Faster heartbeat Dizziness Low blood pressure Nausea Vomiting Feeling full sooner than normal If you have it: Avoid standing up too quickly. You may also need to wear special stockings (ask your doctor about them) and take medicine. In Men: Symptoms include: He may not be able to have or keep an erection, or he may have “dry” or reduced ejaculations. What Continue reading >>
Diabetic Nephropathy: Diagnosis, Prevention, And Treatment
Diabetic nephropathy is the leading cause of kidney disease in patients starting renal replacement therapy and affects ∼40% of type 1 and type 2 diabetic patients. It increases the risk of death, mainly from cardiovascular causes, and is defined by increased urinary albumin excretion (UAE) in the absence of other renal diseases. Diabetic nephropathy is categorized into stages: microalbuminuria (UAE >20 μg/min and ≤199 μg/min) and macroalbuminuria (UAE ≥200 μg/min). Hyperglycemia, increased blood pressure levels, and genetic predisposition are the main risk factors for the development of diabetic nephropathy. Elevated serum lipids, smoking habits, and the amount and origin of dietary protein also seem to play a role as risk factors. Screening for microalbuminuria should be performed yearly, starting 5 years after diagnosis in type 1 diabetes or earlier in the presence of puberty or poor metabolic control. In patients with type 2 diabetes, screening should be performed at diagnosis and yearly thereafter. Patients with micro- and macroalbuminuria should undergo an evaluation regarding the presence of comorbid associations, especially retinopathy and macrovascular disease. Achieving the best metabolic control (A1c <7%), treating hypertension (<130/80 mmHg or <125/75 mmHg if proteinuria >1.0 g/24 h and increased serum creatinine), using drugs with blockade effect on the renin-angiotensin-aldosterone system, and treating dyslipidemia (LDL cholesterol <100 mg/dl) are effective strategies for preventing the development of microalbuminuria, in delaying the progression to more advanced stages of nephropathy and in reducing cardiovascular mortality in patients with type 1 and type 2 diabetes. DEFINITION AND EPIDEMIOLOGY Diabetic nephropathy is the leading cause of chronic Continue reading >>
Diabetic Kidney Disease
Diabetic kidney disease is a complication that occurs in some people with diabetes. It can progress to kidney failure in some cases. Treatment aims to prevent or delay the progression of the disease. Also, it aims to reduce the risk of developing cardiovascular diseases such as heart attack and stroke which are much more common than average in people with this disease. To find out more about the kidneys and urine see also separate leaflet called The Kidneys and Urinary Tract. What is diabetic kidney disease? Diabetic kidney disease (diabetic nephropathy) is a complication that occurs in some people with diabetes. In this condition the filters of the kidneys, the glomeruli, become damaged. Because of this the kidneys 'leak' abnormal amounts of protein from the blood into the urine. The main protein that leaks out from the damaged kidneys is called albumin. In normal healthy kidneys only a tiny amount of albumin is found in the urine. A raised level of albumin in the urine is the typical first sign that the kidneys have become damaged by diabetes. Diabetic kidney disease is divided into two main categories, depending on how much albumin is lost through the kidneys: Microalbuminuria: in this condition, the amount of albumin that leaks into the urine is between 30 and 300 mg per day. It is sometimes called incipient nephropathy. Proteinuria: in this condition the amount of albumin that leaks into the urine is more than 300 mg per day. It is sometimes called macroalbuminuria or overt nephropathy. How does diabetic kidney disease develop and progress? A raised blood sugar (glucose) level that occurs in people with diabetes can cause a rise in the level of some chemicals within the kidney. These chemicals tend to make the glomeruli more 'leaky' which then allows albumin to lea Continue reading >>
What Causes Diabetic Nephropathy (kidney Disease)?
In many diabetics, the kidneys slowly thicken and become progressively scarred over time. The nephrons, which are the basic functional and structural units of the kidneys, become leaky and allow albumin, a protein made by the liver, to pass freely into the urine. The damage to the kidney may be ongoing for many years before a patient becomes symptomatic and loses the ability to filter the blood, control the fluid balance of the body, and remove waste products. By definition, diabetic nephropathy (DN) is typically macroalbuminuria and abnormal kidney function. Macroalbuminuria is regarded as an excretion of albumin in the urine in excess of 300 mg over a 24-hour period. Kidney function is taken as abnormal in cases where there are abnormalities in serum creatinine, the calculated clearance of serum creatinine or glomerular filtration rate (GFR). DN is considered the case when there is macroalbuminuria alone or macroalbuminuria together with abnormal renal function. Clinical signs of DN include increasing amounts of albumin in the urine with reduced GFR and high blood pressure with increased risk of cardiovascular morbidity and mortality. Etiology of Diabetic Nephropathy While the exact cause of DN remains unknown, several mechanisms have been postulated. These include, hyperglycemia, glycation products, and the activation of pro-inflammatory cytokines. Some studies believe that poor glycemic control and hyperglycemia causes hyper-filtration and kidney injury. Moreover, genetic and/ or familial factors may also play a role. African Americans, Hispanics, and native American Indians have been observed as being at a higher risk of developing DN. Kidney damage is also more likely to occur in those who smoke, have high blood pressure, and have had type 1 diabetes before the se Continue reading >>
Diabetic nephropathy (diabetic kidney disease) (DN) is the chronic loss of kidney function occurring in those with diabetes mellitus. It is a serious complication, affecting around one-quarter of adult diabetics in the United States. It usually is slowly progressive over years.  Pathophysiologic abnormalities in DN begin with long-standing poorly controlled blood glucose levels. This is followed by multiple changes in the filtration units of the kidneys, the nephrons. (There are normally about 3/4-1 1/2 million nephrons in each adult kidney). Initially, there is constriction of the efferent arterioles and dilation of afferent arterioles, with resulting glomerular capillary hypertension and hyperfiltration; this gradually changes to hypofiltration over time. Concurrently, there are changes within the glomerulus itself: these include a thickening of the basement membrane, a widening of the slit membranes of the podocytes, an increase in the number of mesangial cells, and an increase in mesangial matrix. This matrix invades the glomerular capillaries and produces deposits called Kimmelstiel-Wilson nodules. The mesangial cells and matrix can progressively expand and consume the entire glomerulus, shutting off filtration. The status of DN may be monitored by measuring two values: the amount of protein in the urine - proteinuria; and a blood test called the serum creatinine. The amount of the proteinuria is a reflection of the degree of damage to any still-functioning glomeruli. The value of the serum creatinine can be used to calculate the estimated glomerular filtration rate (eGFR), which reflects the percentage of glomeruli which are no longer filtering the blood. Treatment with an angiotensin converting enzyme inhibitor (ACEI) or angiotensi Continue reading >>