Nephropathy – Part 2

Kidney disease or kidney damage that occurs in people with diabetes is called diabetic nephropathy. This condition is a complication of diabetes. Each kidney is made of hundreds of thousands of small units called nephrons. These structures filter your blood, help remove waste from the body, and control fluid balance. In people with diabetes, the nephrons slowly thicken and become scarred over time. The kidneys begin to leak and protein (albumin) passes into the urine. This damage can happen years before any symptoms begin.

Kidney damage is more likely if you:

1. Have uncontrolled blood sugar
2. Have high blood pressure
3. Have type 1 diabetes that began before you were 20 years old
4. Have family members who also have diabetes and kidney problems
5. Smoke
6. Are African American, Mexican American, or Native American

Looking at the list above, two things should stand out because of their importance. First, you must manage your blood glucose levels. Second, you must manage your blood pressure.

Often, there are no symptoms as the kidney damage starts and slowly gets worse. Kidney damage can begin 5 to 10 years before symptoms start. People who have more severe and long-term (chronic) kidney disease may have symptoms such as:

1. Fatigue most of the time
2. General ill feeling
3. Headache
4. Nausea and vomiting
5. Poor appetite
6. Swelling of the legs
7. Itchy skin

Other symptoms and signs of nephropathy when kidney function is impaired include:

• Cola- or tea-colored urine (caused by red blood cells in the urine)
• Repeated episodes of cola- or tea-colored urine, sometimes even visible blood in your urine, usually during or after an upper respiratory or other type of infection
• Pain in the side(s) of your back below your ribs (flank)
• Foam in the toilet water from protein in your urine
• Swelling (edema) in your hands and feet
• High blood pressure

Your health care provider will order tests to detect signs of kidney problems. A urine test looks for a protein called albumin leaking into the urine.

• Too much albumin in the urine is often a sign of kidney damage.
• This test is also called a microalbuminuria test because it measures small amounts of albumin.

Your doctor will also check your blood pressure. This is because if you have diabetic nephropathy, you likely also have high blood pressure. A kidney biopsy may be ordered to confirm the diagnosis or look for other causes of kidney damage. If you have diabetes, your doctor will also check your kidneys by using the following blood tests at least annually:

• BUN - Blood urea nitrogen test is used to evaluate kidney function, to help diagnose kidney disease, and to monitor acute or chronic kidney dysfunction or failure.
• Serum creatinine - This test measures how effectively the kidneys are filtering small molecules like creatinine out of the blood.

If you have diabetes, make sure that your doctor does these tests described above, because you want the doctor to catch these signs early and this will allow you and your doctor to take precautionary steps to prevent further damage. It may be necessary to get a referral to an urologist to obtain the best care.

Treatment and other preventive steps will be discussed in the next blog.