Diabetic Nephropathy Kidney Disease
Diabetic Nephropathy Kidney Disease
Each day, your kidneys filter waste out of your blood and help balance your body’s fluids and electrolytes. Over time, when diabetes damages your kidneys, you can’t get rid of all that waste and it builds up in your blood to dangerous levels. This is called uremia and can cause confusion, coma or death. Kidney damage from diabetes is the leading cause of end-stage renal disease (ESRD).
Diabetic nephropathy can be hard to diagnose because it doesn’t usually cause symptoms until the late stages of the condition. But it can be detected with a simple urine test. The test looks for a protein called albumin, which healthy kidneys don’t excrete. If it is present in urine, it’s a sign of early kidney damage. Another test measures the ratio of albumin to creatinine in a urine sample. A normal value is less than 30.
If you have diabetes, you should test your urine for microalbuminuria at least twice a year, or more often if your doctor recommends it. The results can help determine the severity of your kidney damage and how well you are controlling your diabetes.
Early diagnosis and treatment of kidney damage from diabetes can slow progression to ESRD. The best way to treat nephropathy is to control your diabetes, lower your blood pressure, and limit the amount of sodium, phosphorus, and potassium you eat. You should also avoid high-protein diets and exercise regularly.
Research shows that some diabetes medicines can help prevent the progression of nephropathy. These include SGLT2 inhibitors, which reduce the amount of protein excreted in urine, and GLP-1 receptor agonists, which increase the production of insulin and decrease the amount of glucose absorbed by the kidneys. Cholesterol-lowering medicines, such as statins, can also protect the kidneys. And a medicine called finerenone (Kerendia) may reduce the amount of kidney scarring in people with diabetic nephropathy.
Although no one knows exactly what causes kidney damage from diabetes, it seems to involve a combination of factors. High glycemic load and increased vascular resistance probably lead to renal vasodilation and increased intraglomerular capillary pressure, which accelerate renal injury. Obesity accelerates the progression of diabetic nephropathy by increasing renal tubular reabsorption of sodium and by causing a hypertensive shift in renal-pressure natriuresis.
In addition to glycemic control, treating vascular resistance with ACE inhibitors and angiotensin-receptor blockers is effective in slowing the progression of diabetic nephropathy. In the later stages of diabetic nephropathy, peritoneal dialysis or a kidney transplant may be needed.
Diabetes-related nephropathy can affect people with both types of diabetes, but it is more common in those with type 2 diabetes. It is also more common in blacks, Mexican Americans, and Pima Indians with type 2 diabetes than in whites. This is likely due to differences in genetic makeup and environmental factors, such as obesity and poor food choices.
