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Our kidneys regulate the salts and fluid levels in our body, which is vital for controlling blood pressure and protecting our cardiovascular health. Diabetic nephropathy is a chronic kidney disease precipitated by extremely high blood glucose levels among both Type 1 and Type 2 diabetics, which damage their kidney function.

It’s one of the most potent causes of long-term kidney disease and end-stage renal disease (ESRD), which in turn, could lead to renal failure. Nearly one-third of people with diabetes later develop diabetic nephropathy.

While in Type 1 diabetes patients, diabetic nephropathy rarely develops during the first decade following diagnosis, some Type 2 diabetics can already have kidney disease when they are diagnosed with diabetes.

What are the common symptoms of diabetic nephropathy?

In the early stages, a patient may not feel any symptoms. As the disease progresses, some of these symptoms could manifest:

• Swollen ankles, hands and feet, sometimes face
• Difficulty sleeping, flagging concentration levels
• Lack of appetite, nausea, metallic taste
• Blood in the urine
• Fatigue and drowsiness
• Dry skin and itching (in end-stage renal disease)
• Irregular heart rhythm due to raised potassium levels in blood
• Twitching of muscles
• Shortness of breath

With progression of the disease, waste gathers in the body in dangerous levels, often leading to uremia, which can cause extreme confusion in the patient, sometimes even coma.

How do doctors diagnose diabetic nephropathy?

• Blood tests: Certain blood tests can throw up specific blood chemistry pointing towards kidney damage
• Urine tests: The disease can be detected early if traces of protein called albumin is found in the urine sample

How is diabetic nephropathy treated?

Whittling down blood pressure levels and controlling blood glucose are the keys to treating diabetic nephropathy. To slow down progress of the disease, doctors often use medications like:

• Blood sugar-controlling medicines like SGLT2 inhibitors (like dapagliflozin)
• ACE inhibitors like ramipril and quinapril to treat hypertension and diabetic complications
• For those showing side-effects with ACE inhibitors, sometimes ARBs or angiotensin reception blockers are used

For late-stage patients:

• Dialysis for ESRD patients to cleanse the blood regularly
• Kidney transplant for some patients in the final stages if a suitable donor is found

Are there allied risk factors for developing diabetic nephropathy?

Yes, there are known risk factors besides diabetes like:

• Smoking: Smokers have been seen to be more prone to hypertension, diabetes and kidney disease
• Age: People above 65 years of age are more vulnerable to kidney disease than those younger
• Sex: Men are more prone to this condition compared to women
• Allied health issues: Obesity, high BP and cholesterol count, insulin resistance or chronic inflammation can raise the risk

What can I do to reduce the risk of diabetic nephropathy?

Managing your glycemic levels is the key. Diabetics can cut the risk of diabetic nephropathy by:

• Regular monitoring of blood glucose levels
• Sticking to a healthy diet low in sugar and salt
• Getting into a regular exercising regimen
• Following the treatment plan to a T, having meds, taking insulin on time
• Watching their weight
• Avoiding heavy drinking
• Not smoking
• Controlling stress better

What is the outlook for patients with diabetic nephropathy?

The outlook is totally dependent on how well blood sugar levels and hypertension are controlled and also at what stage the disease was detected. Earlier the diagnosis, better the outlook… Timely treatment can delay the progress of the disease and hence lessen complications. Hence, it is of utmost importance for diabetics to go for periodic kidney screening.

Medica Siliguri’s Department of Kidney Diseases offers comprehensive facilities for treatment of diabetic nephropathy. Our specialists adopt a multi-disciplinary approach to ensure regular monitoring and long-term care