Diabetic nephropathy is a change in the kidneys caused by diabetes that causes the loss of protein in the urine. When diabetes is not controlled, excess sugar in the blood causes progressive damage to the blood vessels of the kidneys, causing them to no longer function properly.
In the initial phase of diabetic nephropathy, it is possible that no symptoms will be noticed, however, as the disease progresses there may be swelling of the hands and feet, nausea, vomiting, excessive tiredness and increased urinary frequency, for example.
Diabetic nephropathy is a progressive disease, and it is important that the diagnosis is made early on so that treatment can be started immediately afterwards and, thus, it is possible to prevent and delay the deterioration of the kidneys.
Main symptoms
The main symptoms of diabetic nephropathy are:
- Swelling of hands, feet and ankles;
- Blood in the urine, in some cases;
- Foamy urine, due to the presence of proteins;
- Excessive tiredness;
- Increased urinary frequency
- Loss of appetite;
- Shortness of breath or difficulty breathing;
- Nausea and vomiting;
- Frequent changes in blood pressure.
In the initial phase of diabetic nephropathy, the person may not present symptoms, and it is important that the doctor is consulted regularly to carry out screening tests, as the initial diagnosis helps to delay the disease.
How the diagnosis is made
The diagnosis of diabetic nephropathy is initially made by a general practitioner, nephrologist, endocrinologist or cardiologist, through routine examinations, and the person may be referred to a nephrologist if changes are noted in the examinations.
Therefore, the doctor may recommend a blood test and a single urine sample, which allows the kidney filtration rate, amount of protein and presence of other substances in the urine to be assessed. The 24-hour urine test can be used to confirm the loss of protein in the urine, but due to the difficulty in collecting it correctly, it is used less and less. See more about the 24-hour urine test.
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A single urine sample, comparing albuminuria to creatinuria, is sufficient to assess the loss of albumin in the urine. Through a 24-hour urine test, it is also possible to identify the amount of albumin in the urine, and it is considered early diabetic nephropathy when 30 to 300 mg is found in the 24-hour urine or in a single sample.
Confirmation of the diagnosis is technically done by kidney biopsy, but as it is an invasive procedure and will not change the conduct initially, it is not performed.
In addition, the doctor may also order other tests that evaluate the kidneys, such as ultrasound, abdominal tomography or kidney biopsy, if necessary. Find out how a kidney biopsy is performed.
Causes of diabetic nephropathy
Diabetic nephropathy is a complication of diabetes that occurs due to the constant increase in blood sugar, causing inflammation and fibrosis, causing damage to the kidneys, mainly the glomeruli, which are the kidney units responsible for filtering the blood and eliminating waste. Thus, due to damage to the kidneys, larger molecules, such as albumin, pass through, which would not happen in the case of a healthy kidney.
Furthermore, uncontrolled diabetes can cause an increase in blood pressure, as the kidneys are responsible for producing aldosterone, a hormone that helps regulate tension. Thus, as a consequence of diabetes, it is possible to have changes in blood pressure, worsening kidney damage. See more diabetes complications.
How the treatment is carried out
Treatment for diabetic nephropathy depends on the severity of the disease. In general, it is recommended by your doctor to control diabetes and blood pressure through the use of specific medications.
Changes in eating habits may also be indicated, and it is important that a nutritionist specialized in diabetes is consulted so that an assessment can be carried out and a nutritional plan adapted to the person’s needs can be indicated.
In cases where the person is in a more advanced stage of diabetic nephropathy, dialysis or kidney transplantation may be indicated.
