Diabetic Nephropathy: Making a Late Entrance

Diabetic Nephropathy refers to a renal pathology that arises as a result of a preexisting diabetic condition. As we understand diabetes more and more, the complications that it can cause has been given increased scrutiny due to the prevalence and severity of said complications. While it is not a given that diabetic nephropathy will occur to any given diabetic patient, it is another ramification of diabetes that needs to be addressed for enhanced prophylaxis and increased preparedness. Also, diabetic nephropathy is currently the main culprit for chronic kidney disease in the United States.

When thinking of diabetes, one must take into account the hemodynamic changes that take place as a result of increased blood glucose levels. The kidneys are supplied blood by microscopic arterioles and capillaries that, when damaged, can dramatically alter the function of the kidney. Due to a hyperglycemic state, glucose molecules begin attaching to glomerular proteins, a process called glycosylation. This leads to a rise in the proliferation of mesangial cells, increased lesions of endothelium vessels and excess fibrosis between nephrotic capillaries (interstitial fibrosis). The damage to these structures mean that the filtration efficacy of the kidney has been compromised. Slowly, as more and more damage occurs and healthy nephrotic cells are replaced by nodes and scarring, the kidney ultimately fails.

For detection of Diabetic Nephropathy, a urine test is performed where albuminuria levels are determined. Normally, a healthy person will have very small trace amounts of protein present in urine but during a nephrotic syndrome, a protein called Albumin increases enough in urine to be considered albuminuria, a strong indication of a nephrotic condition. A reading between 30 and 300 mg/24h confirms albuminuria. The GFR (Glomerular Filtration Rate) also shows signs of waning and at the cardiac and vascular level, high blood pressure ensues. These combinations of symptoms are all typical behavior of Diabetic Nephropathy.

A differential diagnosis still needs to be performed because as mentioned before, diabetes might not be the actual cause of kidney disease. The following signs should lead a physician to discern between one cause and another for an accurate treatment plan:

– Hematuria (presence of blood in urine)

– Urinary Casts

– Renal Hypoplasia (renal shrinkage)

– A lower glomerular filtration rate

– Steep increase of proteinuria

– Absenteeism of Diabetic Retinopathy

As your doctor discards other causes and confirms Diabetic Nephropathy, he will be able to begin an appropriate strategy for treatment. Medications such as ACE inhibitors (Angiotensin-Converting Enzyme) and ARBs (Angiotensin II Receptor Blockers) are used for treatment along with other daily life modifications such as a healthier diet, increased exercise, maintaining blood glucose levels low, smoking cessation and the management of hypertension.

Diabetic Nephropathy shows little to no signs of symptoms early on. Once the aforementioned signs come up, it means the kidneys have been battling for a while now. Because of the prevalence of nephrotic syndromes among diabetic patients, urinalysis should be performed at the frequency recommended by your healthcare practitioner.

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