Diabetic Nephropathy Disease Treatment in India

Overview of the Condition

What is Diabetic nephropathy?

Diabetic nephropathy, also called diabetic kidney disease, is a serious complication of type 1 diabetes and type 2 diabetes. It occurs when high blood pressure and poorly controlled diabetes damage the kidneys.

Why is it important?

Over time, this reduces the kidneys' ability to filter waste products and excess fluid from the blood, which may lead to kidney failure.

Causes / Why it happens

Underlying causes

Diabetic nephropathy occurs when diabetes damages the blood vessels and other cells in the kidneys. Over time, poorly controlled diabetes can damage the tiny blood vessels that filter waste from the blood, reducing the kidneys' ability to function properly.

High blood pressure can further damage the kidneys by increasing pressure in their filtering system.

Risk factors

The following factors increase the risk of developing diabetic nephropathy in people with diabetes:

Uncontrolled high blood sugar
Uncontrolled high blood pressure
Smoking
High blood cholesterol
Obesity
A family history of diabetes and kidney disease

Signs, symptoms & complications

Common signs & symptoms

High blood pressure that becomes difficult to control
Swelling of the feet, ankles, hands, or around the eyes
Foamy urine
Tiredness and weakness
Loss of appetite
Nausea and vomiting
Itching
Shortness of breath
Confusion or difficulty concentrating
Muscle cramps

Complications

If left untreated, diabetic nephropathy may lead to:

Fluid buildup (edema), including swelling of the arms and legs, high blood pressure, or fluid in the lungs (pulmonary edema)
High potassium levels (hyperkalemia)
Heart and blood vessel disease, which increases the risk of heart attack or stroke
A reduced number of red blood cells
Pregnancy complications
End-stage kidney disease (ESKD), which is permanent kidney failure that may require dialysis or a kidney transplant

When to see a doctor

Consult a healthcare provider if you develop symptoms of kidney disease
If you have diabetes, attend regular medical check-ups and have your kidney function tested as recommended by your healthcare provider

Diagnosis and investigations

Clinical evaluation

Diabetic nephropathy is usually diagnosed during routine diabetes check-ups. People with type 2 diabetes and those who have had type 1 diabetes for more than five years should have regular kidney function tests, as recommended by their healthcare provider.

Tests

Urinary albumin test: Detects the presence of the protein albumin in urine, which may indicate kidney damage
Urine albumin-to-creatinine ratio (ACR): Measures the amount of albumin compared with creatinine in a urine sample to assess kidney function
Blood creatinine and estimated glomerular filtration rate (eGFR): Evaluates how well the kidneys filter waste from the blood

Additional tests, if needed, may include:

Imaging tests: Ultrasound, X-ray, CT scan, or MRI to assess the size, structure, and blood flow of the kidneys
Kidney biopsy: A small sample of kidney tissue is collected using a thin needle under local anaesthesia and examined in a laboratory to evaluate the extent of kidney damage

Treatment options

Medications

In the early stages of diabetic nephropathy, treatment focuses on controlling diabetes and slowing kidney damage. Medicines may include:

Blood pressure medicines
Blood sugar-lowering medicines
Cholesterol-lowering medicines (statins)
Slow the progression of chronic kidney disease and lower the risk of kidney failure and cardiovascular complications in people with type 2 diabetes (Finerenone)

Lifestyle changes

Healthy lifestyle habits can help slow the progression of diabetic nephropathy:

Stop smokin
Exercise for at least 30 minutes on most days (about 150 minutes per week)
Maintain a healthy weight
Limit or avoid alcohol

Non-surgical treatment

Kidney dialysis may be required if the kidneys can no longer remove waste and excess fluid effectively.

Hemodialysis: Blood is filtered through a dialysis machine. Treatment is usually performed at a dialysis centre about three times a week, with each session lasting 3–5 hours, or at home if appropriate
Peritoneal dialysis: Uses the lining of the abdomen (peritoneum) to filter waste products. This treatment is usually performed at home but may not be suitable for everyone

When a procedure or surgery is needed

A kidney transplant or combined kidney-pancreas transplant may be recommended for people with kidney failure. Before transplantation, the healthcare team performs a thorough assessment to determine whether the patient is suitable for surgery.

Follow up

Attend all scheduled follow-up appointments to monitor your kidney function and overall health
Take all prescribed medicines exactly as directed by your healthcare provider
Regular blood and urine tests may be required to assess how well your kidneys are working and to determine whether the kidney disease is stable or progressing

Myths and Facts

Myth

Only people with type 1 diabetes develop diabetic nephropathy.

Fact

Diabetic nephropathy can occur in people with both type 1 and type 2 diabetes.

Myth

If I have diabetes and feel well, my kidneys must be healthy.

Fact

Diabetic nephropathy often develops without noticeable symptoms in its early stages. Regular kidney check-ups can help detect problems early.

Myth

Kidney damage from diabetes happens suddenly.

Fact

Diabetic nephropathy usually develops gradually over many years. Good control of blood sugar and blood pressure can help slow its progression.

Myth

A diagnosis of diabetic nephropathy means I will definitely need dialysis.

Fact

Many people can slow the progression of kidney disease with appropriate treatment, lifestyle changes, and regular follow-up. Not everyone develops kidney failure.