Overview

Diabetic nephropathy is a serious kidney-related complication of type 1 diabetes and type 2 diabetes. It is also called diabetic kidney disease. Up to 40 percent of people with diabetes eventually develop kidney disease.

Diabetic nephropathy affects the ability of your kidneys to do their usual work of removing waste products and extra fluid from your body. The best way to prevent or delay diabetic nephropathy is by maintaining a healthy lifestyle and treating your diabetes and high blood pressure.

Over many years, the condition slowly damages your kidneys' delicate filtering system. Early treatment may prevent or slow disease progression and reduce the chance of complications.

Your kidney disease may progress to kidney failure, also called end-stage kidney disease. Kidney failure is a life-threatening condition. At this stage your treatment options are dialysis or a kidney transplant.

Diabetic nephropathy care at Mayo Clinic

Source: http://www.mayoclinic.com

Symptoms

In the early stages of diabetic nephropathy, you may not notice any signs or symptoms. In later stages, the signs and symptoms include:

• Worsening blood pressure control
• Protein in the urine
• Swelling of feet, ankles, hands or eyes
• Increased need to urinate
• Less need for insulin or diabetes medicine
• Confusion or difficulty concentrating
• Loss of appetite
• Nausea and vomiting
• Persistent itching
• Fatigue

When to see a doctor

Make an appointment with your doctor if you have any signs or symptoms of kidney disease.

If you have diabetes, visit your doctor yearly for a urine test that detects protein. This helps determine how well the kidneys are functioning.

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Causes

Diabetic nephropathy results when diabetes damages blood vessels and other cells in your kidneys.

How the kidneys work

Your kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Severe damage to these blood vessels can lead to diabetic nephropathy, decreased kidney function and kidney failure.

Diabetic nephropathy causes

Diabetic nephropathy is a common complication of diabetes, types 1 and 2.

Over time the high blood sugar associated with untreated diabetes causes high blood pressure. This in turn damages the kidneys by increasing the pressure in the delicate filtering system of the kidneys.

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Diagnosis

Your doctor will ask you about your signs and symptoms, conduct a physical exam, and ask about your medical history. He or she may refer you to a kidney specialist (nephrologist) or a diabetes specialist (endocrinologist).

To determine whether you have diabetic kidney disease, you may need certain tests and procedures, such as:

• Blood tests. If you have diabetes, you will need blood tests to monitor your condition and determine how well your kidneys are working.
• Urine tests. Urine samples provide information about your kidney function and whether you have too much protein in the urine. High levels of a protein called microalbumin may indicate your kidneys are being affected by disease.
• Imaging tests. Your doctor may use X-rays and ultrasound to assess your kidneys' structure and size. You may also undergo CT scanning and magnetic resonance imaging (MRI) to determine how well blood is circulating within your kidneys. Other imaging tests may be used in some cases.
• Renal function testing. Your doctor can assess your kidneys' filtering capacity using renal analysis testing.
• Kidney biopsy. Your doctor may recommend a kidney biopsy to remove a sample of kidney tissue. You will be given a local anesthetic. Then your doctor will use a thin needle to extract small pieces of kidney tissue for examination under a microscope.

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Complications

Complications of diabetic nephropathy may develop gradually over months or years. They may include:

• Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema)
• A sudden rise in potassium levels in your blood (hyperkalemia)
• Heart and blood vessel disease (cardiovascular disease), possibly leading to stroke
• Damage to the blood vessels of the retina (diabetic retinopathy)
• Anemia
• Foot sores, erectile dysfunction, diarrhea and other problems related to damaged nerves and blood vessels
• Pregnancy complications that carry risks for the mother and the developing fetus
• Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival

Source: http://www.mayoclinic.com

Prevention

To reduce your risk of developing diabetic kidney disease:

• Treat your diabetes. With effective treatment of diabetes, you may prevent or delay diabetic kidney disease.
• Manage high blood pressure or other medical conditions. If you have high blood pressure or other conditions that increase your risk of kidney disease, work with your doctor to control them. Ask your doctor about tests to look for signs of kidney damage.
• Follow instructions on over-the-counter medications. When using nonprescription pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others), follow the instructions on the package. For people with diabetic kidney disease, taking these types of pain relievers can lead to kidney damage.
• Maintain a healthy weight. If you're at a healthy weight, work to maintain it by being physically active most days of the week. If you need to lose weight, talk with your doctor about strategies for weight loss. Often this involves increasing daily physical activity and reducing calories.
• Don't smoke. Cigarette smoking can damage your kidneys and make existing kidney damage worse. If you're a smoker, talk to your doctor about strategies for quitting smoking. Support groups, counseling and medications can all help you to stop.

Lifestyle and home remedies

Lifestyle behaviors can support your treatment goals. Depending on your situation, kidney function and overall health, these actions may include:

• Being active most days of the week. With your doctor's advice, aim for at least 30 minutes of physical activity most days of the week.
• Adjusting your diet. Talk with a dietitian about limiting intake of sodium, choosing lower potassium foods and limiting the amount of protein you eat.
• Quitting smoking. If you're a smoker, talk with your doctor about strategies for quitting smoking.
• Maintaining a healthy weight. If you need to lose weight, talk with your doctor about strategies for weight loss. Often this involves increasing daily physical activity and reducing calories.
• Taking a daily aspirin. Talk with your doctor about whether a daily low-dose aspirin is right for you.

• Being vigilant. Alert doctors unfamiliar with your medical history that you have diabetic nephropathy. They can take steps to protect your kidneys from further damage due to medical tests that use contrast dye (such as angiogram and computerized tomography scan).

  Also be able to recognize when you have a urinary tract infection and seek treatment promptly.

Source: http://www.mayoclinic.com

Coping and support

If you have diabetic nephropathy, here are some steps that may help you cope:

• Connect with other people who have diabetes and kidney disease. Ask your doctor about support groups in your area. Or contact organizations such as the American Association of Kidney Patients, the National Kidney Foundation or the American Kidney Fund for groups in your area.
• Maintain your normal routine, when possible. Try to maintain a normal routine, doing the activities you enjoy and continuing to work, if your condition allows. This may help you cope with feelings of sadness or loss that you may experience after your diagnosis.
• Talk with someone you trust. Living with diabetic kidney disease can be stressful, and it may help to talk about your feelings. You may have a friend or family member who is a good listener. Or you may find it helpful to talk with a faith leader or someone else you trust. Consider asking your doctor for a referral to a social worker or counselor.

Source: http://www.mayoclinic.com

Risk factors

Several factors may increase your risk of diabetic nephropathy, including:

• Diabetes, type 1 or 2
• High blood sugar (hyperglycemia) that's difficult to control
• High blood pressure (hypertension) that's difficult to control
• Being a smoker and having diabetes
• High blood cholesterol and having diabetes
• A family history of diabetes and kidney disease

Source: http://www.mayoclinic.com