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Diabetic Nephropathy

Diabetes (diabetes mellitus) and accompanying high blood pressure (hypertension) can lead to kidney damage and cause the development of diabetic nephropathy. Diabetic nephropathy is a serious complication of diabetes that can significantly impact a person's quality of life. If not properly monitored and treated, it can lead to kidney failure and ultimately, even death.

Regular monitoring is of vital importance in diabetic nephropathy, as high blood sugar levels, genetic predisposition, obesity, and hypertension are the risk factors involved. Eliminating or controlling these risk factors constitutes a crucial stage of treatment.

The Nephrology Department experts of Uniqacare Clinic provided information about diabetic nephropathy.

What is diabetic nephropathy?


Diabetic nephropathy is one of the most important and commonly encountered complications of diabetes, which also significantly impacts the quality of life. This condition, also known as diabetic kidney disease, requires regular monitoring and appropriate treatment, as it holds vital importance.


What are the symptoms of diabetic nephropathy?


The symptoms of diabetic nephropathy may not be noticed in the early stages of the disease. However, as it progresses, symptoms such as hypertension, edema (swelling) in the feet, ankles or hands due to the level of protein (albumin) in the urine, weight gain, frequent urination, confusion, difficulty concentrating, shortness of breath, loss of appetite, nausea, and vomiting may appear. Hypertension (high blood pressure) is twice as common in diabetics compared to non-diabetics.


What are the causes of diabetic nephropathy?


Diabetic nephropathy, which is a complication of diabetes frequently observed in society, occurs when untreated or poorly controlled diabetes damages the clusters of blood vessels that filter waste in the kidneys. This condition leads to kidney damage and can also cause high blood pressure. The resulting hypertension, in turn, increases the pressure on the kidney's filtration system, leading to further damage to the kidneys. It is believed that hypertension is both a cause and a consequence of diabetic nephropathy. Uncontrolled high blood pressure can accelerate the progression of diabetic nephropathy.


How is diabetic nephropathy diagnosed?


Diabetic nephropathy (diabetic kidney disease) is detected during tests related to diabetes. For individuals with type 1 diabetes, screening for diabetic nephropathy is recommended five years after the diagnosis of diabetes, whereas for those diagnosed with type 2 diabetes, these screenings start immediately. The routine screening tests for diagnosis are as follows:

  1. Urine albumin test: This test is used to detect albumin, a protein found in blood, in the urine. If the test shows an excessive amount of protein in the urine (urinary albumin > 300 mg in a 24-hour urine collection), it indicates inadequate kidney function.

  2. Albumin/creatinine ratio test: Creatinine is a waste product that healthy kidneys filter from the blood. The albumin/creatinine ratio (albumin/creatinine ≥30 mg/g in urine) provides information about kidney function.

  3. Glomerular filtration rate (GFR): The measurement of creatinine in a blood sample can be used to estimate how quickly the kidneys are filtering the blood. A low filtration rate indicates poor kidney function.

If two or more of these tests show continuous albuminuria (urinary albumin > 300 mg in a 24-hour urine collection or albumin/creatinine ≥30 mg/g in a spot urine test) within a three-month period, the diagnosis is made.

In addition to laboratory tests, the specialist physician may also use imaging devices such as X-rays, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) to assess the condition of the kidneys.


How is diabetic nephropathy treated?


In the treatment of diabetic nephropathy, the most crucial approach is to achieve effective blood sugar control. Similarly, maintaining blood pressure (hypertension) at desired levels reduces the risk of diabetic nephropathy and slows its progression. Restricting salt intake in the diet not only facilitates blood pressure control but also reduces the risk of cardiovascular disease.

If the albumin/creatinine ratio remains consistently high, even in the absence of hypertension, medications from the ACE inhibitor/ARB group of antihypertensive drugs are used to delay chronic kidney disease.


For advanced-stage diabetic nephropathy, which is kidney failure, treatment options include dialysis, kidney transplantation, or symptom management.


Note: It is essential to follow the advice and treatment prescribed by a healthcare professional for managing diabetic nephropathy or any other medical condition.


FREQUENTLY ASKED QUESTIONS ABOUT DIABETIC NEPHROPATHY?

How often should diabetic nephropathy screening be done in diabetic patients?


For adults with type 1 diabetes, screening for diabetic nephropathy should begin five years after the onset of diabetes and then be done annually. For individuals with type 2 diabetes, screening should start at the time of diagnosis, and then annually, by measuring eGFR (estimated glomerular filtration rate) and urine albumin/creatinine ratio, or by assessing the level of albuminuria (presence of protein leakage) in a 24-hour urine collection to screen for diabetic nephropathy.


What are the risk factors for diabetic nephropathy?


The risk factors for diabetic nephropathy include the duration and severity of hyperglycemia (high blood sugar levels), genetic predisposition, ethnic background, obesity, hypertension (high blood pressure), dyslipidemia (abnormal cholesterol levels), smoking, and a family history of diabetes and kidney disease.


Who is most commonly affected by diabetic nephropathy?


Diabetic nephropathy typically occurs in individuals with type 1 diabetes, manifesting around 5 years after the initial diagnosis. For those with type 2 diabetes, it can be seen from the time of diagnosis. Additionally, the frequency of occurrence increases in diabetic patients whose blood sugar and blood pressure are not well controlled.


Is diabetic nephropathy a preventable disease?


Yes, diabetic nephropathy can be prevented or its progression delayed by taking certain measures. For both type 1 and type 2 diabetic patients, quitting smoking, maintaining a healthy body weight (achieving an ideal weight), achieving optimal blood sugar control, and, if necessary, undergoing intensive diabetes treatment are necessary steps. Additionally, some antidiabetic medications introduced in recent years have shown positive effects on kidney function beyond controlling blood sugar levels in diabetic patients.

Furthermore, ensuring regular and strict control of blood pressure and cholesterol is essential in reducing the risk of diabetic nephropathy and slowing its progression. Implementing these measures can reduce the risk of developing diabetic nephropathy or prevent its progression. However, it is important to consult a healthcare professional to determine an appropriate treatment plan, taking into account the individual's health status and other factors.


What are the stages of diabetic nephropathy?


The stages of diabetic nephropathy are as follows:

  1. Hyperfiltration stage (increased glomerular filtration rate)

  2. Microalbuminuria

  3. Macroalbuminuria: Overt proteinuria

  4. Development of chronic kidney disease


How is the diet for diabetic nephropathy implemented?


The diet for diabetic nephropathy should be implemented as follows:

  1. Reduce daily protein intake to 0.8 g/kg/day for individuals with diabetic kidney disease. Lowering protein intake can help manage the condition.

  2. Restrict salt intake in the diet. Limiting salt consumption is effective in controlling blood pressure and reducing cardiovascular (heart and vascular system) risks.


What happens if diabetic nephropathy is left untreated?


If diabetic nephropathy is not treated and managed, it can lead to the progression of kidney damage and eventually result in chronic kidney failure, necessitating dialysis over time.


Does diabetic nephropathy cause death?


Diabetic nephropathy generally carries a risk of death due to accompanying heart and vascular issues. Additionally, in cases of chronic kidney failure resulting from diabetic nephropathy and requiring dialysis treatment, the risk of death increases due to dialysis-related complications.


How is diabetic nephropathy monitored?


Diabetic nephropathy is monitored as follows:

For adults with type 1 diabetes, screening for proteinuria (presence of protein in urine) and glomerular filtration rate should begin five years after the onset of diabetes and then be done annually.

For individuals with type 2 diabetes, screening for proteinuria and glomerular filtration rate should start at the time of diabetes diagnosis and then be done annually.

During this monitoring process, if there is progressive decline in kidney function, if proteinuria is detected (>300 mg/day), or if uncontrolled hypertension is present, patients should be referred to a nephrology specialist. Regular follow-up and appropriate medical care are crucial in managing diabetic nephropathy effectively.


What should diabetic nephropathy patients pay attention to?


Diabetic nephropathy patients should pay attention to the following:

  1. They should undergo the recommended tests at the scheduled follow-up times.

  2. They should adhere to the prescribed diet.

  3. They should follow the recommended target levels for blood sugar and blood pressure control.

  4. They should take their medications as prescribed, on time, and without skipping doses.


When should you see a doctor?


In cases where there are any signs or symptoms of kidney disease, it is essential to consult a specialist physician. Diabetic patients should visit their doctors annually or as recommended for tests that assess kidney function.


How can diabetic nephropathy be diagnosed early?


To diagnose diabetic nephropathy early, it is necessary to check for the presence of a protein called "Albumin" in the urine. Normally, there should be no albumin in the urine. Therefore, regular and recommended intervals of urine tests should be performed. Early diagnosis allows for the condition to be treated and its progression to be prevented.


What should diabetic nephropathy patients pay attention to?


Diabetic nephropathy patients need to be mindful of their lifestyle and social life to manage their condition effectively. Diet, exercise, and self-management are essential for controlling blood sugar levels and high blood pressure.

Points to be careful for individuals at risk of diabetic nephropathy or those already diagnosed with it are as follows:

  • Blood sugar levels should be regularly monitored. The best way to prevent or slow down kidney damage is to maintain good control of blood sugar. This is usually achieved through diet, exercise, and, if necessary, insulin or oral hypoglycemic medications.

  • High blood pressure should be kept under control. High blood pressure increases the risk of kidney failure. Seeking support from a healthcare professional to maintain blood pressure at a normal level is crucial.

  • A daily exercise routine should be established to stay active.

  • A healthy eating plan should be developed, including plenty of fruits, non-starchy vegetables, whole grains, and legumes rich in fiber. Also, it is important to limit saturated fats, processed meats, sweets, and sodium.

  • Protein intake should be controlled. Individuals with diabetes and kidney disease should consume enough protein for their health but avoid excessive consumption.

  • Any difficulties in urination should be reported to the relevant healthcare professional promptly, as early treatment is essential in urinary tract infections.

  • Smoking should be completely stopped.

  • Maintaining a healthy weight is important. If weight loss is necessary, consulting with a qualified dietitian is recommended.

  • Medications that may harm the kidneys, such as NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen and naproxen, should not be used. Before taking any herbal supplements, consulting with a doctor is essential, as some herbal products and supplements can harm the kidneys.

  • Diabetic nephropathy patients should provide information about their medical history when visiting healthcare facilities.


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