Diabetic Nephropathy: Chronic Kidney Disease (CKD)

Dr. Manoj Chaudhary, MD, DNB (Nephrology), Consultant Nephrologist & Transplant Physician

What is Diabetic Nephropathy?

Diabetic nephropathy, also known as diabetic kidney disease, refers to damage to kidneys due to high blood sugar levels.
It can develop in patients with either type I or type II diabetes. Type II diabetes is increasing at alarming proportions and has become the leading cause of Nephropathy, Renal failure in diabetes due to changing lifestyle, obesity, and aging.

What are the Symptoms of Diabetic Nephropathy?

  • Swelling or puffiness most commonly occurs in people’s legs, ankles, and feet, but can also occur around the eyes, abdomen and less often in other parts of the body.
  • Sometimes pain or burning can occur with urination. The urine could also be foamy, bloody or dark.
  • Loss of appetite. Besides, protein version problems, they don’t want to eat meat.
  • Feeling “winded” or out of breath. And, people feel fatigued, being unable to concentrate or tiring easily.
  • Feeling pains, mostly in legs and back, especially around the kidney area.
  • Itching or rashes of the skin.

How is Diabetic Nephropathy Diagnosed?

Proteinuria is the hallmark of diagnosis. The diagnosis could be made by a simple test like a urine routine examination. Of course, the quantification of Proteinuria could be done by 24-hour Urinary protein examination or spot urinary protein examination. The patient also complains of this in form of frothy urine.

What are the risk factors of Diabetic Nephropathy?

The most important risk factor is Blood sugar control: if a patient has hypertension it further predisposes to Nephropathy. Other risk factors are obesity, smoking, abnormal Lipid profile, degree of proteinuria(Amount). Patients whose first-degree relatives have hypertension and cardiovascular disease are like warning signs for the development of nephropathy. Intrauterine exposure to high blood sugar may also risk of development of nephropathy. Inherent susceptibility to Nephropathy can be proved by Genetic susceptibility studies.

Prevention & Treatment of Diabetic Nephropathy

Dietary:

Diet is one of the most important treatments in managing diabetes and kidney disease. If you’ve been diagnosed with kidney disease as a result of diabetes, you’ll need to work with a dietitian to create an eating plan that’s right for you.
– Calories restriction mostly in the obese patient
– Salt restriction  : 2-3 gm/day –
Salt restrictions enhance the anti-protein uric effect of angiotensin converter blocker (ARB).
If a patient has kidney failure serum creatinine is high: potassium containing food likes fruits/ fruit juice / Green leafy vegetables should be restricted. But the above thing shouldn’t be followed blindly. If patient potassium is normal some amount of the above food can be allowed in small quantities. Some are true for salt I.e., all patient are not salt sensitive.

Lifestyle modification:
– Weight loss in obese patient and it also decreases proteinuria.
– Exercise and stoppage smoking also beneficial.

Lipid-Lowering: Dietary restrictions and weight loss also beneficial for lipid control, if not- beneficial the start

Frequently asked questions (FAQs)

What to do if kidney function starts to decrease? 

  1. Diet control
  2. Strict BP Control (130/80 or 120/80)
  3. ACE/ARB – telmisartan, ramipril etc.

How to avoid further Injury? 

  1. Avoid NSAIDS (Pain Killers) and Aminogly Consider (Injection Gentamicin, Amikacin)
  2. Try to avoid contrast for angiography
  3. Avoid Ayurvedic / Homeopathic drugs & other remedies without properly knowing that they can also decrease your Kidney function (Increase serums creatinine)
  4. If you have vomiting, Diarrhea or you are on diuretics then try to avoid ACE/ARB inhibitor temporarily

How to control of Anemia (Low Hb)? 

Best is I/V iron, oral iron satisfactory, erythropoietin.

If kidney damaged, Advance Renal Failure (ACKD Stage-V)?

The best treatment – Kidney Transplantation

Other Acceptable Treatment: Hemodialysis CAPD (Home dialysis)

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