Diabetic nephropathy

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Obesity, Sleep & Internal medicine
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Diabetic nephropathy
Synonyms	Diabetic kidney disease
Pronounce	N/A
Specialty	N/A
Symptoms	Proteinuria, hypertension, edema, fatigue
Complications	Chronic kidney disease, end-stage renal disease, cardiovascular disease
Onset	Typically 5-10 years after onset of diabetes mellitus
Duration	Chronic
Types	Type 1 diabetes, Type 2 diabetes
Causes	Diabetes mellitus
Risks	Poor glycemic control, hypertension, smoking, genetic predisposition
Diagnosis	Urinalysis, blood tests, kidney biopsy
Differential diagnosis	Hypertensive nephropathy, glomerulonephritis, polycystic kidney disease
Prevention	Blood sugar control, blood pressure management, lifestyle modification
Treatment	ACE inhibitors, angiotensin II receptor blockers, dietary changes, dialysis, kidney transplant
Medication	ACE inhibitors, ARBs, statins
Prognosis	Progressive without treatment, can lead to end-stage renal disease
Frequency	Affects 20-40% of patients with diabetes
Deaths	N/A

Diabetic nephropathy, also called kidney disease is a type of kidney disease caused by diabetes.

Diabetes and kidney disease

Diabetes is the leading cause of kidney disease - about 1 in 4 adults with diabetes has kidney disease. Kidney damage caused by diabetes usually occurs slowly, over many years. You can take steps to protect your kidneys and to prevent or delay kidney damage.

Other names

Diabetic kidney disease is also called DKD, chronic kidney disease, CKD, kidney disease of diabetes, or diabetic nephropathy.

Diabetic Nephropathy

Pathophysiology

High blood glucose, also called blood sugar, can damage the blood vessels in your kidneys. When the blood vessels are damaged, they don’t work as well. Many people with diabetes also develop high blood pressure, which can also damage your kidneys.

Signs and symptoms

Most people with diabetic kidney disease do not have symptoms, especially in the early stages. The only way to know if you have diabetic kidney disease is to get your kidneys checked. Symptoms such as the following may be seen in the later stages.

Diabetic glomerulosclerosis

• edema: swelling, usually around the eyes in the mornings; later, general body swelling may result, such as swelling of the legs
• Foamy appearance or excessive frothing of the urine (caused by the proteinuria)
• Unintentional weight gain
• anorexia (poor appetite)
• Nausea and vomiting
• Malaise (general ill feeling)
• fatigue
• Headache
• Hiccups

Investigations

• BUN, Creatinine
• Glomerular filtration rate (GFR) - one of the most common blood tests to check for chronic kidney disease. It tells how well your kidneys are filtering.
• Creatinine blood and urine tests - check the levels of creatinine, a waste product that your kidneys remove from your blood
• Albumin urine test - checks for albumin, a protein that can pass into the urine if the kidneys are damaged
• Imaging tests, such as an ultrasound - provide pictures of the kidneys. The pictures help the health care provider see the size and shape of the kidneys, and check for anything unusual.
• Kidney biopsy - a procedure that involves taking a small piece of kidney tissue for examination with a microscope. It checks for the cause of kidney disease and how damaged your kidneys are.

Stages

CKD Stage	eGFR level (mL/min/1.73 m2)
Stage 1	‚â• 90
Stage 2	60–89
Stage 3	30–59
Stage 4	15–29
Stage 5	< 15

Staging

To stage the degree of damage in this (and any) kidney disease, the serum creatinine is determined and used to calculate the estimated glomerular filtration rate (eGFR). Normal eGFR is equal to or greater than 90ml/min/1.73 m².

Treatment

• Prevention - Prevention is better than cure - so preventing diabetes and managing blood sugars well reduces the risk.
• Medications - angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers can help reduce kidney damage.
• Dialysis - or other renal replacement therapy
• Kidney transplant - kidney transplant with a healthy donor kidney

Prevention

• Control diabetes better
• Control blood pressure
• Do not smoke
• Follow your diabetes eating plan
• Reduce salt
• Be more active
• Lose weight if overweight