What is Diabetic Nephropathy
Diabetic nephropathy is kidney disease that is caused by diabetes (diabetes mellitus). Kidneys are organs that filter and clean blood and get rid of body waste products and extra fluid.
Diabetes can cause gradual kidney damage over many years. Diabetic nephropathy that continues to get worse (progress) can lead to kidney failure.
What are the causes?
This condition is caused by kidney damage from diabetes that is not well controlled with treatment. Having high blood sugar (glucose) for a long time can damage blood vessels in the kidneys and cause them to thicken and become scarred. Those changes prevent the kidneys from functioning normally.
What increases the risk?
This condition is more likely to develop in people with diabetes who:
- Have had diabetes for many years.
- Have high blood pressure.
- Have high blood glucose levels over a long period of time.
- Have a family history of kidney disease.
- Have a history of tobacco use.
- Have certain genes that are passed from parent to child (inherited).
- Are of African-American, Hispanic, Native American, Asian, or Pacific Islander descent.
What are the signs or symptoms?
This condition may not cause symptoms at first. If you do have symptoms, they may include:
- Swelling of your hands, feet, or ankles.
- Weakness.
- Poor appetite.
- Nausea.
- Confusion.
- Fatigue.
- Trouble sleeping.
- Dry, itchy skin.
If nephropathy leads to kidney failure, symptoms may include:
- Vomiting.
- Shortness of breath.
- Jerky movements that you cannot control (seizure).
- Coma.
How is this diagnosed?
It is important to diagnose this condition before symptoms develop. You may be screened for diabetic nephropathy at a routine health care visit. Screening tests may include:
- Yearly (annual) urine tests.
- Urine collection over a 24-hour period to measure kidney function.
- Blood tests to measure blood glucose levels and kidney function.
- Regular blood pressure monitoring.
If your health care provider suspects diabetic nephropathy, he or she may:
- Review your medical history and symptoms.
- Do a physical exam.
- Do an ultrasound of your kidneys.
- Perform a procedure to take a sample of kidney tissue for testing (biopsy).
How is this treated?
The goal of treatment is to prevent or slow down any damage to your kidneys by managing your diabetes. To do this, it is important to control:
- Your
blood pressure.
- Your target blood pressure may vary depending on your medical conditions, your age, and other factors.
- To help control blood pressure, you may be prescribed medicines to lower your blood pressure (ACE inhibitors) or to help your body get rid of excess fluid (diuretics).
- Your A1c (hemoglobin A1c) level. Generally, the goal of treatment is to maintain an A1c level of less than 7%.
- Your blood glucose level.
- Your blood lipids. If you have high cholesterol, you may need to take lipid-lowering drugs, such as statins.
Other treatments may include:
- Medicines, including insulin injections.
- Lifestyle
changes, such as:
- Losing weight.
- Quitting smoking (smoking cessation).
- Changes to your diet, which may include limiting your salt (sodium), protein, and fluid intake.
If your disease progresses to end-stage kidney failure, treatment may include:
- Dialysis. This is a procedure to filter your blood with a machine.
- Kidney transplant.
Follow these instructions at home:
Lifestyle
- Maintain a healthy weight. Work with your health care provider to lose weight, if needed.
- Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
- Be physically active every day. Ask your health care provider what type of exercise is best for you.
- Eat healthy foods, and eat healthy snacks between meals. Follow instructions from your health care provider about eating and drinking restrictions.
- Limit your sodium, protein, or fluid intake as directed.
- Work with your health care provider to manage your blood pressure.
General instructions
- Follow
your diabetes management plan as directed.
- Check your blood glucose levels as directed by your health care provider.
- Keep your blood glucose in your target range as directed by your health care provider.
- Have your A1c level checked two or more times a year, or as often as told by your health care provider.
- Measure your blood pressure regularly at home, as told by your health care provider.
- Take over-the-counter and prescription medicines only as told by your health care provider. These include insulin and supplements.
Keep all follow-up visits and routine visits as told by your health care provider. This is important. Make sure to get screening tests as directed.
Contact a health care provider if:
- You have trouble keeping your blood glucose in your goal range.
- Your blood glucose level is higher than 240 mg/dL (13.3 mmol/L) for 2 days in a row.
- You have swelling in your hands, ankles, or feet.
- You feel weak, tired, or dizzy.
- You have muscle tightening that you cannot control (spasms).
- You have nausea or vomiting.
- You feel tired all the time.
Get help right away if:
- You are very sleepy.
- You faint.
- You
have:
- A seizure.
- Severe, painful muscle spasms.
- Shortness of breath.
- Chest pain.
Summary
- Keep your blood glucose in your target range as directed by your health care provider.
- Work with your health care provider to manage your blood pressure.
- Keep all follow-up visits and routine visits as told by your health care provider. This is important. Make sure to get screening tests as directed.
