Diabetic Nephropathy

What is Diabetic Nephropathy?

Diabetic kidney disease (DKD) is a common cause of serious kidney disease — end-stage kidney disease (ESKD) — in developed countries like the United States. It is a complication that impacts the tiny blood vessels, and it can happen whether a person has type 1 or type 2 diabetes. Over time, DKD usually causes persistent protein in the urine and a gradual drop in kidney function.

The good news is that there is a lot of research showing that treating this disease early can help slow it down or even prevent it from getting worse. To identify and track DKD, doctors usually rely on tests that measure the amount of protein in your urine and estimate how well your kidneys are filtering blood. Keeping blood sugar and blood pressure levels in check is also critical because it can help stop DKD from progressing.

What Causes Diabetic Nephropathy?

Between 30 and 40 percent of people with diabetes develop a condition called diabetic nephropathy. The precise reason why this happens is not entirely understood, yet factors such as resistance to insulin, genetic factors, high blood sugar levels, and immune system abnormalities might be the cause.

Risk Factors and Frequency for Diabetic Nephropathy

When a person has type 2 diabetes, they might have an abnormal amount of protein, called albumin, in their urine when they are first diagnosed with diabetes. However, for people with type 1 diabetes, this issue, which is known as diabetic nephropathy, usually happens 15 to 20 years after their diagnosis. This difference exists due to the difficulty in exactly pinpointing when type 2 diabetes begins. When a person has diabetes, it can cause changes in the kidneys, leading to protein in the urine, high blood pressure, and a gradual decrease in kidney function, all of which are main characteristics of diabetic nephropathy.

Certain racial and ethnic groups, such as African Americans, Native Americans, and Mexican Americans, have a higher chance of developing diabetic nephropathy.
There is also evidence suggesting that genetics may play a part in the likelihood of developing this condition, as it tends to run in families.

Signs and Symptoms of Diabetic Nephropathy

Diabetic nephropathy (DN) is a complication of diabetes affecting the kidneys. Several factors increase the risk of developing diabetic nephropathy. These include having diabetes for a long time, poor control of blood sugar levels, and uncontrolled high blood pressure. Other risks include obesity, smoking, high cholesterol, and having family members with high blood pressure or heart disease. There’s also some evidence that certain genes could increase the risk, and men seem to be more likely to develop this condition.

Diagnosis of diabetic nephropathy involves checking for a protein called albumin in the urine. Persistent high levels of this protein on two or more tests, spaced at least three months apart, could indicate DN. However, it’s also essential to rule out a urinary tract infection as the possible cause of the raised protein levels.

In the early stages, people with diabetic nephropathy may have no symptoms and the condition may only be detected through routine screening. As the condition progresses, symptoms can include feeling tired, noticing frothy urine (caused by high protein levels in the urine), and swelling in the lower extremities due to low albumin levels in the blood and nephrotic syndrome. DN can also be associated with peripheral vascular disease, high blood pressure, coronary artery disease, and diabetic eye disease.

Diabetic for a long time
Poor blood glucose control
Uncontrolled hypertension
Obesity
Smoking
High cholesterol
Family history of hypertension or heart disease
Possible genetic predisposition
Being male

Testing for Diabetic Nephropathy

Having protein in your urine is often a sign of diabetic kidney disease. This is less likely to occur in Type 1 Diabetes if there are no signs of the disease in the eyes (retinopathy).

In Type 2 Diabetes, it can be harder to spot kidney disease. This is because it’s often unclear when Type 2 Diabetes started in a patient. A doctor’s examination and learning about the patient’s medical history are very important to identify diabetic kidney disease in Type 2 Diabetes.

To make a diagnosis, the doctor may look for:

* High blood pressure
* A gradual decrease in how well the kidneys are filtering blood
* Constantly high levels of a protein called albumin in the urine, recorded in two visits at least three to six months apart

A urine test can be used to measure the amount of urea, creatinine, and protein. A microscope can also be used to exclude other potential kidney problems. Blood and urine tests can rule out bone marrow cancer, and an ultrasound can help determine the size of the kidney. If the diagnosis is still unclear, a small sample of kidney tissue may be taken for further analysis (biopsy).

Treatment Options for Diabetic Nephropathy

Diabetic nephropathy, a common kidney disease associated with diabetes, is usually tackled on four fronts: reducing cardiovascular risks, controlling blood sugar levels, maintaining reasonable blood pressure, and regulating the renin-angiotensin system (RAS), a hormone system that regulates blood pressure and fluid balance.

The decrease of cardiovascular risks involves lifestyle changes, such as quitting smoking and regulating cholesterol levels.

Intensive control of diabetes, especially in Type 1 Diabetes Mellitus (T1DM), has been related to a significant lower risk of developing proteinuria and microalbuminuria, conditions linking to kidney damage. This positive effect continues even after a long time, implying the importance of achieving good blood sugar control as early as possible when diabetic nephropathy sets in.

In Type 2 Diabetes Mellitus (T2DM), it’s observed that targeting a HbA1C (a measure of glucose control) of 7% results in a decreased risk of microvascular complications, including kidney disease. At the same time, maintaining good blood pressure also contributes to lowering cardiovascular risks.

Angiotensin receptor blockers, known as ARBs, have been revealed to delay the progress of kidney disease, by maintaining good blood pressure control. While rigorous control of systolic blood pressure to less than 120 mm Hg is considered unnecessary, a blood pressure less than 140/90 mm Hg is recommended for most Type 2 diabetes patients suffering from kidney disease.

Regulating the renin-angiotensin system (RAS), a process crucial to prevent diabetic nephropathy, shows varied results. Initial medication therapy tends to be ineffective for Type 1 diabetes patients, but can prevent the development of microalbuminuria in Type 2 diabetes. Furthermore, ARB treatment has been shown to effectively prevent proteinuria in patients with microalbuminuria, a condition marking an early stage of kidney disease. Although doubly blocking the RAS with two different types of medication was thought to improve outcomes, it has been linked with harmful effects like acute renal failure, therefore it’s not a commonly recommended treatment currently.

Newer drugs like finerenone and SGLT2 inhibitors have shown potential in managing diabetic nephropathy, adding to the chances of decreasing associated cardiovascular risks. However, these drugs are still subjected to ongoing studies for a detailed understanding of their effects.

When diabetic nephropathy advances to end-stage renal disease, where the kidneys function at a greatly diminished capacity, renal replacement therapy such as dialysis or renal transplant, might be required. Among these, a renal transplant is often considered the best option.

Bone marrow cancer (multiple myeloma)
A kidney disorder that causes your body to excrete too much protein in your urine (nephrotic syndrome)
Narrowing of the arteries that carry blood to your kidneys (renal artery stenosis)
Inflammation in your kidneys that can affect how they function (tubulointerstitial nephritis)

What to expect with Diabetic Nephropathy

Diabetic nephropathy, a kidney disease linked to diabetes, has a high risk of causing severe illness and death. Having small amounts of the protein albumin in the urine, referred to as ‘microalbuminuria’, can independently increase the risk of death from heart-related problems. Most patients with this condition ultimately succumb to end-stage kidney disease. Additionally, a diabetes-related eye disease called diabetic retinopathy often goes hand in hand with diabetic nephropathy.

Preventing Diabetic Nephropathy

People should aim to consume approximately 0.8 grams of protein for each kilogram of their body weight. It’s also essential to keep the Hemoglobin A1c value below 7.5% in order to maintain a healthy blood sugar level.

Furthermore, a good target for blood pressure is a reading that’s lower than 120/80 mmHg, which is considered within a normal range. Caution should be taken to stay away from agents and drugs that can potentially cause damage to the kidneys, often referred to as nephrotoxic.

It’s necessary to perform regular checks on one’s urine for the presence of a protein called albumin. This process is a preventive measure to monitor kidney health and detect any potential issues early.

Frequently asked questions

Diabetic Nephropathy is a common cause of serious kidney disease in developed countries like the United States. It is a complication that impacts the tiny blood vessels and can occur in both type 1 and type 2 diabetes. It usually causes persistent protein in the urine and a gradual drop in kidney function.

Between 30 and 40 percent of people with diabetes develop diabetic nephropathy.

The signs and symptoms of Diabetic Nephropathy can vary depending on the stage of the condition. In the early stages, there may be no symptoms and the condition may only be detected through routine screening. However, as the condition progresses, the following signs and symptoms may occur: 1. Feeling tired: People with diabetic nephropathy may experience fatigue and a lack of energy. 2. Frothy urine: High protein levels in the urine can cause the urine to appear frothy. 3. Swelling in the lower extremities: Low levels of albumin in the blood can lead to swelling in the legs, ankles, and feet. 4. Nephrotic syndrome: This is a condition characterized by high levels of protein in the urine, low levels of albumin in the blood, and swelling in various parts of the body. 5. Peripheral vascular disease: Diabetic nephropathy can be associated with peripheral vascular disease, which affects the blood vessels outside of the heart and brain. 6. High blood pressure: Uncontrolled high blood pressure is a risk factor for diabetic nephropathy and can also be a symptom of the condition. 7. Coronary artery disease: Diabetic nephropathy can be linked to coronary artery disease, which affects the blood vessels that supply the heart. 8. Diabetic eye disease: This condition, also known as diabetic retinopathy, is a complication of diabetes that can affect the eyes and is associated with diabetic nephropathy. It's important to note that these symptoms may not be specific to diabetic nephropathy and can also be caused by other conditions. Therefore, it's crucial to consult a healthcare professional for an accurate diagnosis.

Factors that can contribute to the development of Diabetic Nephropathy include having diabetes for a long time, poor control of blood sugar levels, uncontrolled high blood pressure, obesity, smoking, high cholesterol, having a family history of hypertension or heart disease, possible genetic predisposition, and being male.

The doctor needs to rule out the following conditions when diagnosing Diabetic Nephropathy: - Bone marrow cancer (multiple myeloma) - A kidney disorder that causes your body to excrete too much protein in your urine (nephrotic syndrome) - Narrowing of the arteries that carry blood to your kidneys (renal artery stenosis) - Inflammation in your kidneys that can affect how they function (tubulointerstitial nephritis)

To properly diagnose Diabetic Nephropathy, a doctor may order the following tests: - Urine test to measure the amount of urea, creatinine, and protein - Microscopic examination of urine to exclude other potential kidney problems - Blood tests to rule out bone marrow cancer and assess kidney function - Ultrasound to determine the size of the kidney - Kidney biopsy, if the diagnosis is still unclear, to obtain a small sample of kidney tissue for further analysis In addition to these diagnostic tests, managing Diabetic Nephropathy involves lifestyle changes, such as quitting smoking and regulating cholesterol levels, as well as controlling blood sugar levels and maintaining reasonable blood pressure. Medications like angiotensin receptor blockers (ARBs) may be prescribed to delay the progression of kidney disease. Newer drugs like finerenone and SGLT2 inhibitors are also being studied for their potential effects on managing Diabetic Nephropathy. In advanced cases, renal replacement therapy such as dialysis or renal transplant may be required.

Diabetic nephropathy is usually treated on four fronts: reducing cardiovascular risks, controlling blood sugar levels, maintaining reasonable blood pressure, and regulating the renin-angiotensin system (RAS). Lifestyle changes, such as quitting smoking and regulating cholesterol levels, are recommended to decrease cardiovascular risks. Intensive control of diabetes, especially in Type 1 Diabetes Mellitus (T1DM), has been shown to lower the risk of developing kidney damage. In Type 2 Diabetes Mellitus (T2DM), targeting a HbA1C of 7% and maintaining good blood pressure control can decrease the risk of microvascular complications, including kidney disease. Angiotensin receptor blockers (ARBs) are used to maintain good blood pressure control and delay the progress of kidney disease. Regulating the RAS shows varied results, with initial medication therapy being ineffective for Type 1 diabetes patients but preventing the development of microalbuminuria in Type 2 diabetes. Newer drugs like finerenone and SGLT2 inhibitors are being studied for their potential in managing diabetic nephropathy. In advanced stages, renal replacement therapy such as dialysis or renal transplant might be required.

Acute renal failure is a potential risk associated with dual blocking of the renin-angiotensin system (RAS) using two types of medications. This treatment strategy, once thought to improve outcomes, has been found to cause harmful effects like kidney failure, which is why it is no longer commonly recommended. Other treatments, such as ARBs, finerenone, and SGLT2 inhibitors show potential in managing diabetic nephropathy however, these newer drugs are still being studied for their full range of effects.

The prognosis for Diabetic Nephropathy is as follows: - Diabetic Nephropathy has a high risk of causing severe illness and death. - Most patients with this condition ultimately succumb to end-stage kidney disease. - Having small amounts of the protein albumin in the urine, referred to as 'microalbuminuria', can independently increase the risk of death from heart-related problems. - Diabetic retinopathy, a diabetes-related eye disease, often goes hand in hand with diabetic nephropathy.

A nephrologist.

Diabetes Kidney Disease Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus