What Is Diabetic Nephropathy?
People with diabetes and kidney disease do worse overall than people with kidney disease alone. This is because people with diabetes tend to have other long-standing medical conditions, like high blood pressure, high cholesterol, and blood vessel disease (atherosclerosis). People with diabetes also are more likely to have other kidney-related problems, such as bladder infections and nerve damage to the bladder.
Kidney disease in type 1 diabetes is slightly different than in type 2 diabetes. In type 1 diabetes, kidney disease rarely begins in the first 10 years after diagnosis of diabetes. In type 2 diabetes, some patients already have kidney disease by the time they are diagnosed with diabetes.
What Are the Symptoms of Diabetic Nephropathy?
There are often no symptoms with early diabetic nephropathy. As the kidney function worsens, symptoms may include:
- Swelling of the hands, feet, and face
- Trouble sleeping or concentrating
- Poor appetite
- Itching (end-stage kidney disease) and extremely dry skin
- Drowsiness (end-stage kidney disease)
- Abnormalities in the hearts' regular rhythm, because of increased potassium in the blood
- Muscle twitching
As kidney damage progresses, your kidneys cannot remove the waste from your blood. The waste then builds up in your body and can reach poisonous levels, a condition known as uremia. People with uremia are often confused and occasionally become comatose.
How Is Diabetic Nephropathy Diagnosed?
Certain blood tests that look for specific blood chemistry can be used to diagnose kidney damage. It also can be detected early by finding protein in the urine. Treatments are available that can help slow progression to kidney failure. That's why you should have your urine tested every year if you have diabetes.
How Is Diabetic Nephropathy Treated?
Lowering blood pressure and maintaining blood sugar control are absolutely necessary to slow the progression of diabetic nephropathy. There are medications available which have been found to slow down the progression of kidney damage. They include:
- SGLT2 inhibitors including bexagliflozin (Brenzavvy), dapagliflozin (Farxiga), empagliflozin (Jardiance), and ertugliflozin (Steglatro), which help control high blood sugar.
- Angiotensin converting enzyme (ACE) inhibitors can help slow down the progression of kidney damage. Although ACE inhibitors -- including ramipril (Altace), quinapril (Accupril), and lisinopril (Prinivil, Zestril) -- are usually used to treat high blood pressure and other medical problems, they are often given to people with diabetes to prevent complications, even if their blood pressure is normal.
- Angiotensin receptor blockers (ARBs) can often be given instead if you have side effects from taking ACE inhibitors
If not treated, the kidneys will continue to fail and larger amounts of proteins can be detected in the urine. Advanced kidney failure requires treatment with dialysis or a kidney transplant.