Diabetic nephropathy is damage to the supplying kidney vessels as a result of high blood glucose levels, which can lead to pronounced impairment of kidney function. Diabetic nephropathy is the most common reason for requiring dialysis in Germany.
What is diabetic nephropathy?
Diabetic nephropathy is the term used to describe damage to the glomerular (tangle-shaped) capillaries of the kidney, which can often be observed in connection with long-standing diabetes mellitus (types I and II), particularly poorly controlled diabetes that has been present for more than ten to 15 years. In many cases, the symptoms of diabetic nephropathy manifest themselves only after years of advanced progression. These include headaches, poor performance, anemia, edema in the legs (swelling due to water retention), weight gain, itching, and milk–coffee-colored skin changes. Nephropathy is accompanied by retinopathy diabetica in about one third of those affected by diabetes mellitus. In the advanced stages of diabetic nephropathy, dialysis and kidney transplantation may be required due to the extensive kidney damage. More than 30 percent of people requiring dialysis in Germany are affected by diabetic nephropathy, making the disease the most common reason for requiring dialysis.
Causes
Diabetic nephropathy is due to elevated blood glucose levels over a prolonged period of time. The elevated blood glucose level causes deposits in the large blood vessels supplying the kidneys, leading to disruption of blood flow (arteriosclerosis) and subsequently additional impairment of the smaller, glomerular vessels. As a result, kidney functions, especially the filtering capacity and detoxification capacity of the organ, are severely impaired, so that increased amounts of proteins (albumin) are excreted in the urine, especially the so-called albumin, which cannot be detected in the urine of a healthy person. In addition, various factors such as hypertension (high blood pressure), elevated blood lipid levels, poor blood glucose control, nicotine consumption, excessive dietary protein intake, and a genetic disposition (predisposition) increase the risk of diabetic nephropathy.
Symptoms, complaints, and signs
- Itching
- Yellowish-brownish skin
- General weakness and low resilience
- Water retention
- Headache
- Anemia (anemia), iron deficiency anemia.
- Weight gain
Diagnosis and course
Diabetic nephropathy is diagnosed by the concentration of albumin in the urine. For example, since urinary protein levels are also elevated in urinary tract infections or febrile illnesses, at least two out of three urine samples (morning urine) must show an elevated albumin value for a confirmed diagnosis. The concentration level can provide information about the stage of diabetic nephropathy. Whereas a value of 20 to 200 mg/l can be assumed to indicate the onset of kidney disease, kidney damage can already be classified as advanced at a value of over 200 mg/l. In addition, elevated creatinine, uric acid and urea levels in the blood provide information about impaired kidney function and whether chronic kidney failure is already present. If diagnosed and treated early, the progression of diabetic nephropathy can be slowed down and, if necessary, halted. In the long term, untreated diabetic nephropathy leads to severe impairment of kidney function, including the need for dialysis.
Complications
Diabetic nephropathy results from impaired sugar balance, as is the case with diabetes mellitus, which can have a wide variety of complications. The increased sugar in the blood can lead to a blockage of smaller vessels in the body during the course of the disease and thus to a lack of supply of blood and oxygen to the individual organs, causing them to die. On the one hand, the kidneys (diabetic nephropathy) are particularly affected. In the course of the disease, there is an increased flow of urine, which becomes less and less in the further stages. A failure of the kidneys announces itself.This increases the risk of edema, but also of cardiac arrhythmias, because less potassium is excreted due to kidney failure, which increases the concentration in the blood (hyperkalemia). Poisoning of the blood or uremia is also conceivable, because toxins are no longer sufficiently excreted. Furthermore, diabetes can also lead to blockage of the vessels in the retina (diabetic retinopathy). This can lead to a severe impairment of vision, which can even result in blindness. Nerves are also affected by diabetes (diabetic neuropathy), which can lead to sensory disturbances, as well as motor disorders.
When should you see a doctor?
In this condition, a doctor must be consulted in any case, because there is no self-healing and the kidneys can be completely and, above all, irreversibly damaged as a result. As a rule, a doctor must be consulted if the affected person already suffers from diabetes. This results in itching of the skin and the skin itself turns yellowish or brownish. If these complaints also occur together with water retention or with fatigue and general weakness, a visit to the doctor is definitely necessary. An iron deficiency and an increase in weight can also be indicative of this disease. Furthermore, many patients also suffer from headaches. As a rule, the disease can be diagnosed by a general practitioner or by an internist. However, further treatment depends on the progress of this disease and is then carried out by different specialists. The affected person may then be dependent on a kidney transplant.
Treatment and therapy
Therapeutic measures in diabetic nephropathy are aimed first and foremost at optimal adjustment of blood glucose levels, as this can slow the progression and eliminate kidney damage in the early stages. In addition, medications should be reviewed and, if necessary, long-term therapy should be adjusted. For example, people affected by diabetic nephropathy should not take the commonly used antidiabetic drug metformin, as it exacerbates renal insufficiency and is therefore contraindicated (unsuitable). In addition, blood pressure levels should be kept as low as possible in diabetics with kidney disease, as the kidneys can function better at a low level. Antihypertensive agents such as ACE inhibitors and angiotensin II antagonists are used for this purpose, minimizing not only the risk of progression of diabetic nephropathy but also that of heart attacks and strokes. Furthermore, other risk factors such as elevated blood lipid levels must be treated. A change in diet to a low-protein and low-salt diet as well as the reduction of existing excess weight and the renunciation of nicotine consumption is recommended in many cases of diabetic nephropathy. In the advanced stage of diabetic nephropathy, dialysis (blood washing) or kidney transplantation is indicated in most cases, as irreversible (irreversible) damage is already present at this point.
Outlook and prognosis
The prognosis of diabetic nephropathy is considered unfavorable. Because the cause is poorly treated diabetes, several years of improperly adjusted blood glucose levels occurred beforehand. This has an impact on the organic activity of the kidney, among other things, and shortens the patient’s lifespan. With a change in medical care and a healthy lifestyle, the patient can have a positive influence on his well-being. However, the damage caused to the kidney is considered irreparable. The rate of progression of the diabetes can be influenced. Nevertheless, the functioning of the kidney is impaired. In severe cases, diabetic nephropathy leads to organ failure and thus to the patient’s death. In addition to good treatment of the diabetes, the affected person must regularly undergo dialysis. This is an immense burden and can lead to a psychological disorder. Other diseases additionally worsen the prospect of recovery. In favorable cases, a donor kidney is found and the patient is suitable for a kidney transplant. Once this is successful, the patient’s life can be successfully prolonged. Nevertheless, impairments are to be expected.In addition, good medical treatment of diabetes is elementary to avoid triggering renewed symptoms or kidney problems.
Prevention
Diabetic nephropathy can be specifically prevented by regular control examinations (blood pressure and blood fat, protein content in the urine) and good blood sugar control. In addition, a change in diet to a low-salt and low-protein diet is recommended. With early diagnosis and timely initiation of therapy, renal failure due to diabetic nephropathy can be avoided.
Diabetic nephropathy
Because diabetic nephropathy is a common but also dangerous secondary disease of diabetes mellitus, it requires regulated and professional follow-up by an experienced nephrologist. The latter should take blood samples from the patient during the check-ups and check the kidney values in order to detect a possible, already incipient restriction of the kidney function at an early stage. In this way, impending kidney failure can be prevented. If necessary, the nephrologist can perform a biopsy to provide an accurate statement about the stage of kidney damage. Dialysis or, in the worst case, kidney transplantation may be necessary in the course of the disease, and the patient should be informed about this. If diabetic nephropathy occurs in the context of still untreated diabetes mellitus, the patient should be referred to an appropriate specialist, so that the patient is adjusted with appropriate medication and insulin and trained, since taking the medication can be very complex. Likewise, the physician should prescribe regular checks of blood glucose to monitor the setting on the medications and adjust if necessary. In addition to the kidneys, the eyes are also frequently affected, which is why the patient should visit an ophthalmologist annually for a check-up. With the help of a reflection of the back of the eye, this can detect changes early and thus prevent blindness.
What you can do yourself
In case of a diagnosed diabetic nephropathy, the first self-help measure is to adjust the blood sugar optimally and to avoid high blood pressure, since the kidneys are additionally burdened by hypertension. By taking the above measures, people suffering from diabetes can slow down the progression of diabetic nephropathy or even stop it altogether. This is independent of whether it is the more common type 2 or type 1 diabetes. In the early stages, the kidneys can also regenerate completely. The disease is caused by damage to the supplying blood vessels and the glomerular capillary vascular system of the kidneys. The vascular damage can usually be traced to years of suboptimally adjusted blood glucose concentrations. In some cases, certain medications are also causally responsible. This leads to sclerotic deposits in the vessels, so that kidney function is impaired and in the final stage can fail completely, so that only dialysis and a kidney transplant can provide relief. Regardless of optimal blood glucose and blood pressure control, one self-help measure is to recognize typical symptoms of diabetic nephropathy. Typical signs may include frequent itching and a slight yellow-brownish discoloration of the skin. Less specific symptoms include general low exercise tolerance, headaches, and water retention (edema) in the body and resulting weight gain. A general iron deficiency anemia also usually presents.
