Dr Aidin Rawshani

Nephropathy (kidney disease) and impaired renal function

Contents

Diabetes and kidney disease (nephropathy)

Nephropathy affects both people with type 1 diabetes and type 2 diabetes

The kidneys are the purification plant of the body. They purify the blood from excess substances and waste products, which are allowed to leave the body through the urine. Also, medicines leave the body through the kidneys. In addition, the kidneys regulate fluid balance, salts, minerals, blood pressure, blood acidity, bone metabolism and hematopoiesis. In each kidney there are about 1 million small units called nephrons. These devices contain special blood vessels that filter the blood. The nephrons work around the clock and their capacity to purify blood is higher than what is actually needed, which allows one to cope even when kidney function decreases.

Diabetes unfortunately leads to a deterioration in the functioning of the kidneys over the years. Nephropathy means kidney disease and in fact diabetes is the most common cause of nephropathy worldwide. The term diabetic nephropathy is often used to describe this type of kidney disease. Nephropathy is a disease that worsens over time and eventually you can suffer from kidney failure. In case of renal failure, the kidneys no longer cope with their duties. Renal failure is a very serious condition that affects all aspects of life. Both people with type 1 diabetes and type 2 diabetes may suffer from nephropathy and eventually renal failure.

How to detect nephropathy?

Nephropathy can be detected by measuring the concentration of a particular egg white substance (protein) in the urine. This egg white substance is called albumin. If you have too much albumin in your urine, it’s a sign of nephropathy. The more albumin one secretes, the more pronounced the nephropathine is.

In medical language, the term albuminuria is used to say that albumin is present in the urine. It distinguishes microalbuminuria and macroalbuminuria:

Microalbuminuria means that the concentration of albumin in the urine is between 30 and 299 mg/day. This means that you have “little albuminuria” .Macroalbuminuria involves the excretion of 300 mg or more albumin per day. This means that one has “a lot of albuminuria”.

Everyone who has diabetes annually undergoes a check of albuminuria. It is important that you ensure that such a check is carried out every year.

What does albuminuria mean (albumin in urine)?

If you have too much albumin in your urine, it means you have nephropathy. The kidneys should not normally “leak” albumin. When they do, you have kidney complications as a result of diabetes. Albuminurine itself indicates two things:

Kidney damage (nephropathy) exists — Albuminuria is evidence of kidney damage due to diabetes disease.Increased risk of cardiovascular disease — Research strongly suggests that people with nephropathy have a significantly increased risk of other cardiovascular diseases, such as heart attack, stroke and heart failure.

Scientists do not know for sure why nephropathy is related to the increased risk of cardiovascular disease. However, we know for sure that the risk of renal failure and cardiovascular disease increases as the concentration of albumin in the urine rises.

How common is nephropathy and albuminuria?

About a third of people who receive type 1 diabetes develop microalbuminuria within 20 years.

Approximately 40% of people with microalbuminuria receive macroalbuminuria within 10 years.

However, it should be mentioned that some people with microalbuminuria never develop macroalbuminuria. The nature of the course varies greatly from individual to individual.

How to prevent nephropathy or reduce the risk of its aggravation?

The main measures to reduce the risk of kidney damage, as well as to prevent them from getting worse, are as follows:

Good blood glucose control (glycaemic control). Likely, high blood sugar is the main reason for the onset of nephropathy. Careful control of blood pressure. High blood pressure is very harmful to the kidneys and it must be treated to reduce damage. Today, there are very effective drugs for treating hypertension.Possibly, even statins (drugs that lower blood fats, cholesterol) can be favorable.8

Research shows that careful blood sugar control reduces the risk of developing microalbuminuria by 30%. The risk of microalbuminuria transition to macroalbuminuria may be reduced by 50% by close blood glucose control.

What symptoms cause nephropathy and kidney failure?

Nephropathy does not cause any symptoms until the renal failure is very pronounced and then the situation is usually serious. In addition, the symptoms arising from renal failure are difficult to recognise. The most common symptom is the accumulation of fluid in the body. You can also get poor appetite, upset stomach, weakness and difficulty in concentrating.

How can I prevent nephropathy?

Self-care

Check your blood sugar regularly and do your utmost to stay within the range recommended by the doctor/nurse. Higher blood sugar means an increased risk of nephropathy. (However, one should take into account the risk of low blood sugar, which can become dangerous) .Check your blood pressure regularly. High blood pressure always exacerbates nephropathy. To lower your blood pressure, you can (1) lose weight, (2) eat less salt, (3) avoid alcohol and tobacco, (3) exercise regularly.

Medicines

Most often, medicines are used to lower blood pressure. In diabetes, it makes sense to use antihypertensive drugs of the type of ACE inhibitors or ARB, as these proved to be beneficial for renal function.ACE inhibitors and ARBs are recommended to people with diabetes and hypertension or albuminuria. These drugs protect the kidneys and lower blood pressure.

Diet

Some doctors recommend eating less protein if you have macroalbuminuria. The purpose of this is to reduce the burden on the kidneys. Protein appears to increase the effort on the kidneys. Talk to your caregiver about this before changing your diet.

What does renal failure mean?

As nephropathy worsens, nephron’s ability becomes worse. This means that the nephron can no longer filter the blood and then waste products begin to accumulate in the body. This leads to disturbances in fluid balance, salt balance, high blood pressure, etc. Renal failure is a very serious condition with high morbidity and mortality. In severe renal failure, you must either obtain a new kidney (transplant) or filter the blood via a machine called dialyzer (the treatment is called dialysis).

You can actually measure the ability of the kidneys to filter blood. This is most often done by measuring the concentration of creatinine in the blood. Creatinine concentration rises in the blood as the function of the kidneys is impaired. By measuring creatinine, we can estimate kidney function.

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