Overview
Diabetic nephropathy, also known as diabetic kidney disease, is a serious complication that affects both type 1 and type 2 diabetes patients. It is the leading cause of kidney disease in individuals starting renal replacement therapy. The condition is characterized by increased urinary albumin excretion (UAE) in the absence of other renal diseases.
Types of Diabetic Nephropathy
- Microalbuminuria: UAE >20 μg/min and ≤199 μg/min.
- Macroalbuminuria: UAE ≥200 μg/min.
Causes of Diabetic Nephropathy
The development of diabetic nephropathy is influenced by several factors:
- Hyperglycemia: Prolonged high blood sugar levels contribute significantly.
- Hypertension: Elevated blood pressure is a major risk factor.
- Genetic Predisposition: Some individuals are more susceptible.
- Elevated Serum Lipids: Abnormal lipid levels play a role.
- Smoking Habits: Smoking increases the risk.
- Dietary Protein: The amount and origin of dietary protein matter.
Risk Factors of Diabetic Nephropathy
- Metabolic Control: Maintain A1c levels below 7%.
- Blood Pressure Management: Target <130/80 mmHg (or <125/75 mmHg if proteinuria >1.0 g/24 h and increased serum creatinine).
- Renin-Angiotensin-Aldosterone System Blockade: Use drugs with this effect.
- Dyslipidemia Treatment: Aim for LDL cholesterol <100 mg/dl.
Symptoms of Diabetic Nephropathy
1. Albuminuria: Increased urinary albumin excretion.
2. Edema: Swelling, especially in the legs.
3. Hypertension: Elevated blood pressure.
4. Fatigue: Generalized weakness.
5. Anemia: Reduced red blood cell production.
Preventions of Diabetic Nephropathy
- Early Screening: Start yearly screening 5 years after type 1 diabetes diagnosis (earlier if puberty or poor metabolic control). Type 2 diabetes patients should be screened at diagnosis and yearly thereafter.
- Comorbidity Evaluation: Assess for retinopathy and macrovascular disease.
- Lifestyle Modifications: Encourage a healthy diet, exercise, and smoking cessation.
Diagnosis of Diabetic Nephropathy
- Microalbuminuria: Regular screening using UAE measurement.
- Comorbid Associations: Assess for retinopathy and macrovascular disease.
Treatment for Diabetic Nephropathy
- Metabolic Control: Optimize glycemic control (A1c <7%).
- Blood Pressure Management: Treat hypertension effectively.
- Renin-Angiotensin-Aldosterone System Blockade: Use ACE inhibitors or ARBs.
- Dyslipidemia Treatment: Lower LDL cholesterol.
- Anemia Management: Address if present.
- Nutritional Counseling: Monitor protein intake.
- Regular Follow-Up: Monitor kidney function and adjust treatment as needed.
When to seek medical attention ?
If you have diabetes and experience symptoms like albuminuria, edema, or uncontrolled blood pressure, seek medical attention promptly.
