Diabetic nephropathy; Description, Causes and Risk Factors:Abbreviation: DN.Alternative Names: Diabetic glomerulosclerosis, Kimmelstiel-Wilson disease, and Nephropathy - diabetic.ICD-9-CM: 583.81.Diabetic nephropathy is typically defined by macroalbuminuria i.e., a urinary albumin excretion of more than 300 mg in a 24-hour collection or macroalbuminuria and abnormal renal function as represented by an abnormality in serum creatinine, calculated creatinine clearance, or glomerular filtration rate (GFR). Clinically, diabetic nephropathy is characterized by a progressive increase in proteinuria and decline in GFR, hypertension, and a high risk of cardiovascular morbidity and mortality.The exact cause of diabetic nephropathy is unknown, but it is believed that uncontrolled high blood sugar leads to the development of kidney damage, especially when high blood pressure is also present. In some cases, your genes or family history may also play a role. Not all persons with diabetes develop this condition.Each kidney is made of hundreds of thousands of filtering units called nephrons. Each nephron has a cluster of tiny blood vessels called a glomerulus. Together these structures help remove waste from the body. Too much blood sugar can damage these structures, causing them to thicken and become scarred. Slowly, over time, more and more blood vessels are destroyed. The kidney structures begin to leak and protein (albumin) begins to pass into the urine.Diabetic nephropathy is a major cause of morbidity and mortality in people with diabetes mellitus (DM). People with diabetes make up the largest number (greater than 25%) of those who start renal dialysis for end-stage renal disease (ESRD) each year in the U.S. The incidence of ESRD approaches 40% in people who have had type 1 DM for 20 years.Hypertension, or high blood pressure, is a complication of diabetes that is believed to contribute most directly to diabetic nephropathy. Hypertension is believed to be both the cause of diabetic nephropathy, as well as the result of damage that is created by the disease. As kidney disease progresses, physical changes in the kidneys often lead to increased blood pressure.Uncontrolled hypertension can make the progress toward stage five diabetic nephropathy occur more rapidly.The risk of diabetic nephropathy is higher in males, blacks, Hispanics, and Native Americans.Symptoms:Symptoms develop late in the disease and may include:
General ill feeling.
Nausea and vomiting.
Foamy appearance or excessive frothing of the urine.
Swelling, usually around the eyes in the mornings; general body swelling may occur with late-stage disease.
Diagnosis:The problem is diagnosed using simple tests that check for a protein called albumin in the urine. Urine does not usually contain protein. But in the early stages of kidney damage-before you have any symptoms-some protein may be found in your urine, because your kidneys aren't able to filter it out the way they should.Finding kidney damage early can keep it from getting worse. So it's important for people with diabetes to have regular testing.Laboratory tests that may be done include:
Other laboratory tests that may be done include:
24-hour urine protein.
Blood levels of phosphorus, calcium, bicarbonate, PTH, and potassium.
Protein electrophoresis - urine.
Early screening for microalbuminuria is essential for all patients with diabetes. Aggressive intervention can delay and possibly stop progression through the stages of diabetic nephropathy. Patients often seek medical attention only after having progressed to stage 3 or 4. Those who have reached stage 3 should be referred to a nephrologist. The nephrologist monitors ongoing management and conducts further diagnostic studies to exclude nondiabetic causes for protein in the urine (proteinuria).Treatment Options:The goals of treatment are to keep the kidney disease from getting worse and prevent complications. This involves keeping your blood pressure under control. Controlling high blood pressure is the most effective way of slowing kidney damage from diabetic nephropathy.Your doctor may prescribe the following medicines to lower your blood pressure and protect your kidneys from damage. Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin receptor blockers (ARBs). These drugs are recommended as the first choice for treating high blood pressure in persons with diabetes and for those with signs of kidney disease.It is also very important to control lipid levels, maintain a healthy weight, and engage in regular physical activity. You should closely monitor your blood sugar levels. Doing so may help slow down kidney damage, especially in the very early stages of the disease. Your can change your diet to help control your blood sugarDialysis may be necessary once end-stage kidney disease develops. At this stage, a kidney transplant may be considered. Another option for patients with type 1 diabetes is a combined kidney-pancreas transplant.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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