Diabetic Nephropathy

The kidney is a vital organ, which is responsible for filtering your blood and removing any waste products through the production of urine. If it becomes damaged, your blood begins to accumulate waste products, which can lead to coma and death. This problem is evident in approximately 30% of patients who are diagnosed under 30 years old, usually causing problems after 20-25 years of diabetes.

The kidney has many different parts, each of which are essential to its function. Damage to the kidney can occur for many different reasons, the main types are:

  • Damage to the filter
  • Damage to the blood supply
  • Infection

Causes of Nephropathy

The kidney has very specialised filters called glomeruli, which allows it to remove very small waste molecules from the blood. The blood is delivered through vessels that progressively get smaller and smaller. Unfortunately if you suffer from diabetes and have particularly poor control of your blood sugar, you are already at a high risk of developing nephropathy. This happens due to the large concentration of glucose within your blood damaging the small vessels, which causes the pressure within the kidney to rise. This raised pressure then damages the glomeruli, preventing they kidney from removing the waste products from your blood.

The second major cause of nephropathy is damage to the blood vessels that supply the kidney. The vessels that supply the glomeruli enlarge in response to the high pressures that occur within the diabetic kidney. As they increase in size, they begin to block blood from flowing to the glomeruli which eventually causes the kidney to fail. This is a very serious complication and requires emergency treatment.

Finally, the last major cause of nephropathy is infection. This is a lot more common in women who suffer from diabetes than men, due to their shorter urinary tracts. This problem occurs when bacteria ascend the urinary system into the kidney leading to infection. This is partly due to damage to the nerves that supply the bladder , as the bacteria are not cleared by frequent urination.  

Diagnosis and screening for diabetic nephropathy is fairly straight forward. It is vital that you have regular urine tests to check for the prescence of protein in your urine, which would suggest kidney damage. This is known as microalbuminuria and does not occur in normal urine. If protein is found in the urine, it is not itself indicative of kidney damage. There are a number of other causes that should be excluded before a definitive diagnosis is made.

Renal Disease

Unfortunately a diagnosis of nephropathy almost certainly indicates a steady progression towards end stage renal disease (ESRD). To help slow this, you will be started on treatment known as anti-hypertensives to bring your blood pressure down. The most common type are ACE inhibitors. It is likely that your sensitivity to insulin will increase, so you will probably need to reduce your insulin dose. There are also many other rules you should follow if you have kidney problems, which will be explained to you by your doctor.  

Kidney Transplant

As nephropathy progresses, you will require more frequent trips to hospital for dialysis to help clear your blood of waste products. If available, you may be eligible for a kidney transplant, which is usually performed with a pancreatic transplant, to try and cure your diabetes.  The symptoms you should be aware of are swollen ankles, headaches, itchy legs and tiredness.

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