Diabetic nephropathy is a type of progressive kidney disease that occurs in people who have diabetes. The University of Washington estimates that 20 to 40 percent of people with diabetes will get diabetic nephropathy at some point in their lives (UW, 2012). Diabetes is the most common cause of end-stage renal disease (ESRD) among Americans and Europeans (ADA, 2004). ESRD is the fifth final stage of diabetic nephropathy
Diabetic nephropathy progresses slowly. According to the University of Rochester Medical Center, the average time it takes to progress from the beginning stage of kidney failure to ESRD is 23 years (URMC, 2012). However, not everyone progresses to stage five of the disease.
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 makes 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, leading to 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 diabetic nephropathy. Persistently high blood sugar or blood pressure levels are two things that can damage your kidneys, making them unable to filter waste and remove water from your body.
Other factors have been shown to increase your risk of getting diabetic nephropathy, such as:
- being African-American, Hispanic, or American Indian
- developing type 1 diabetes before you are 20 years old
The early stages of kidney damage often do not cause noticeable symptoms. You may not experience any symptoms until your kidney disease progresses to ESRD.
Symptoms of ESRD may include:
- a general overall unwell feeling
- loss of appetite
- itchy and dry skin
- nausea or vomiting
- swelling of your arms and legs
Your doctor will mostly likely perform yearly blood and urine tests on you to check for early signs of kidney damage. Common tests include:
Microalbuminuria Urine Test
A microalbuminuria urine test checks for albumin in your urine. Normal urine does not contain albumin, so the presence of the protein in your urine is a sign of kidney damage.
BUN Blood Test
A BUN blood test checks for the presence of urea nitrogen in your blood. Urea nitrogen forms when protein is broken down. Higher than normal levels of urea nitrogen in your blood may be a sign of kidney failure
Serum Creatinine Blood Test
A serum creatinine blood test measures creatinine levels in your blood. Your kidneys remove creatinine from your body by sending creatinine to the bladder, where it is released with urine. If your kidneys are damaged, they cannot remove the creatinine properly from your blood. High creatinine levels in your blood may mean that your kidneys are not functioning correctly.
If your doctor suspects that you have diabetic nephropathy but is not sure, he or she may perform a kidney biopsy. A kidney biopsy is a surgical procedure in which a small sample of one or both of your kidneys is removed, so it can be viewed under a microscope.
There is no cure for diabetic nephropathy, but treatments can delay or stop the progression of the disease. Treatments consist of keeping blood sugar levels under control and blood pressure levels down through medications (as needed) and lifestyle changes. Your doctor will also recommend a special diet. If your kidney disease progresses to ESRD, you will require more invasive treatments.
Regularly monitoring your blood sugar levels, using proper dosages of insulin, and taking medications as directed by your doctor can keep your blood sugar levels under control. Your doctor may prescribe ACE inhibitors, angiotensin receptor blockers (ARBs), or other blood pressure medications to keep your blood pressure levels down.
Your doctor or dietitian will help you plan a special diet that is easy on your kidneys. These diets are often low in fat, sodium, potassium, phosphorus, and fluids. Your doctor may also recommend an exercise plan for you to help keep your blood pressure low and your kidneys healthy.
If you have ESRD, you will likely need dialysis or a kidney transplant, in addition to treatments for earlier stages of kidney disease.
Dialysis is a procedure in which a special machine filters the waste out of your blood. Many people require dialysis treatments three times a week for four hours a day. You may need less or more frequent treatments. The other option for treatment is a kidney transplant. For a kidney transplant, a kidney from a donor will be placed into your body. The success of dialysis and kidney transplants differs with each person.
Disease progression depends on many factors. In some cases, diabetic nephropathy can cause eye damage and heart disease. In cases where the disease has progressed to ESRD, it can be deadly.
But following a treatment plan and making recommended lifestyle changes can slow the disease’s progression and keep your kidneys healthy longer.