Diabetic Nephropathy

Diabetic nephropathy is a complication of diabetes that leads to damaged kidneys. It develops slowly. The function of healthy kidneys is to filter and clean blood. Kidneys also get rid of body waste products and extra fluid. When the kidney filters are damaged, there is protein loss in the urine, a decline in kidney function, a buildup of kidney waste products and fluid, and high blood pressure. The damage progresses until the kidneys fail.

RISK FACTORS

  • High blood pressure (hypertension).

  • High blood sugar (hyperglycemia).

  • Family history.

  • Aging.

  • Obstruction problems affecting the kidneys, the tubes that drain the kidneys (ureters), or the bladder.

  • Taking certain drugs or medicines.

SYMPTOMS

Symptoms may not be seen or felt for many years. You may not notice any signs of kidney failure until your kidneys have lost much of their ability to function. An early sign of damage is when small amounts of protein (albumin) leak into the urine. However, this can only be found through a urine test. Without physical symptoms, a urine test is often not performed.

When the kidneys fail, you may feel one or more of the following:

  • Swelling of the hands and feet from the extra fluid in your body.

  • Constant upset stomach.

  • Constant fatigue.

DIAGNOSIS

When someone has diabetes, screening tests are done to look for any early signs of problems before symptoms develop and before damage has already been done. These tests may include:

  • Annual urine tests to screen for trace amounts of protein in the urine (microalbuminuria).

  • Urine collection over 24 hours to measure kidney function.

  • Blood tests that measure kidney function.

Your caregiver is aware that problems other than diabetes can damage kidneys. If screening tests show early kidney damage, but it is thought that a different problem is causing the damage, other tests may be performed. Examples of these tests include:

  • An ultrasound of your kidney.

  • Taking a tissue sample (biopsy) from the kidney.

TREATMENT

The goal of treatment is to prevent or slow down damage to your kidneys. Controlling hypertension and hyperglycemia is critical. Your goal is to maintain a blood pressure below 130/80. If you have certain other medical problems, this goal may be different. Talk to your caregiver to make sure that your blood pressure goal is right for your needs. Regular testing of your blood glucose at home is important. Your goal is to have a normal blood glucose (110 or less when fasting) as often as possible.

In addition, maintaining your hemoglobin A1c level at less than 7% reduces your risk for complications, including kidney damage. Common treatments include:

  • Dieting by controlling what you eat as well as the portion sizes.

  • Exercising to control blood pressure and blood glucose.  

  • Taking medicines.

  • Giving yourself insulin injections if your caregiver feels that it is necessary. 

  • Getting early treatment for urinary tract infections.

  • Regularly following up with your caregiver.

If your disease progresses to end-stage kidney failure, you will need dialysis or a transplant. Dialysis can be done in 1 of 2 ways:

  • Hemodialysis. Your blood flows from a tube in your arm through a machine. The machine filters waste and extra fluid. The clean blood flows back into your arm.

  • Peritoneal dialysis. Your abdomen is filled with a special fluid. The fluid collects waste products and extra fluid from your blood. The fluid is then drained from your abdomen and discarded.

SEEK MEDICAL CARE IF:

  • You are having problems keeping your blood glucose in the goal range.

  • You have swelling of the hands or feet.

  • You have weakness.

  • You have muscles spasms.

  • You have a constant upset stomach.

  • You feel tired all the time and this is not normal for you.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have unusual dizziness or weakness.

  • You have excessive sleepiness.

  • You have a seizure or convulsion.

  • You have severe, painful muscle spasms.

  • You have shortness of breath or trouble breathing.

  • You pass out or have a fainting episode.

  • You have chest pains.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.