Diabetic Nephropathy: Symptoms, Treatment and PrognosisDiabetic nephropathy is a complication that can occur in both type I and type II diabetics. It is a progressive disease of the kidneys that may cause death within two to three years of the initial lesion. It is seen in about 15% of all patients with diabetes and is seen more in men than in women. The syndrome is typically seen in patients that have been living with diabetes for 15 years or more. Generally, this means that patients are older, between 50 and 70 years of age. It is the most common cause of kidney failure and end-stage kidney disease in the US. The greatest risk factor is poor management of blood glucose levels. High cholesterol levels also play a role. Once diabetic nephropathy develops uncontrolled blood sugar and cholesterol levels hasten the progression of the disease. Medical testing for plasma protein in the urine can allow for early detection, sometimes 5-10 years before other symptoms develop. The earlier the condition is detected, the better the prognosis. In other words, if it is caught early enough, it may not progress to full-blown kidney failure.
SymptomologyThroughout its early course, diabetic nephropathy has no outward symptoms. During the late stages, many symptoms develop. These include edema or swelling, usually around the eyes in the morning. Swelling of the legs and other parts of the body is noticed as time goes by. The extra fluid causes weight gain, which complicates the problem. Patients have poor appetite. They may be nauseous and vomiting is not uncommon. Fatigue, headache and itching are other common symptoms. The first diagnosis is made when high levels of protein are seen in the urine, but a biopsy is typically recommended to confirm the diagnosis.
Diabetic nephropathy is often accompanied by Retinopathy , which can be confirmed through an examination of the eyes. Retinopathy is the leading cause of blindness among diabetics. It occurs when blood vessels in the back of the eye leak, causing large dark spots to float in a patient’s visual field. It is important for anyone with diabetes to have regular visual check-ups. Even people with advanced retinopathy have a 90% chance of keeping their vision with the treatments that are available today. TreatmentsAvailable treatments for nephropathy are not as effective. The goal of treatment is to slow the progression of kidney damage, controlling blood sugar levels with dietary changes and possibly increased medications, such as insulin. ACE inhibitors are typically prescribed when urine tests show high plasma protein levels. ACE inhibitors serve several purposes. One of the most important is to protect the kidneys from further damage. In some cases, hypertension or high blood pressure accompanies the condition. ACE inhibitors reduce blood pressure, but are also effective for dilating the blood vessels in the kidneys of non-hypertensive patients. Other drugs may be prescribed and blood glucose levels must be closely monitored. If it is possible to get the blood sugar levels under control, kidney transplantation may be recommended.
When a person with type I diabetes develops diabetic nephropathy, a combination kidney and pancreas transplant may be recommended. In all cases, early detection and following your doctor’s orders are the keys to survival.
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