Nephropathy – Part 3

When kidney damage is caught in its early stages, it can be slowed with treatment. Once larger amounts of protein appear in the urine, kidney damage will slowly get worse. Follow your doctor's advice to keep your condition from getting worse. The following are excellent steps to prevent as much damage as possible. Some of these steps should be started as soon as you have been diagnosed with diabetes.

Control your blood pressure - Keeping your blood pressure under control (below 130/80) is one of the best ways to slow kidney damage.

1. Your doctor may prescribe medicines to lower your blood pressure and protect your kidneys from more damage.
2. Taking these medicines, even when your blood pressure is in a healthy range, helps slow kidney damage.

Control your blood glucose level - You can also slow kidney damage by controlling your blood glucose level, which you can do by:

1. Eating healthy foods
2. Getting regular exercise
3. Taking medicine or insulin as instructed by your doctor

Checking your blood glucose level as often as instructed and keeping a record of your blood glucose numbers so that you know how meals and activities affect your level.

Other ways to protect your kidneys -

1. Before having an MRI, CT scan, or other imaging test in which you receive a contrast dye, tell the health care provider who is ordering the test that you have diabetes. Contrast dye can cause more damage to your kidneys.
2. Before taking an NSAID pain medicine, such as ibuprofen or naproxen, ask your health care provider if there is another kind of medicine that you can take instead. NSAIDs can damage the kidneys, especially when you use them often.
3. Know the signs of urinary tract infections and get them treated right away.
   
   Many resources can help you understand more about diabetes. You can also learn ways to manage your kidney disease. Education is a key to keeping your kidneys healthy. The links following are a few of the sources:

1. American Diabetes Association: http://www.diabetes.org
2. National Diabetes Information Clearinghouse: http://www.diabetes.niddk.nih.gov
3. National Kidney Foundation: http://www.kidney.org
   
   

Your doctor may need to stop some of your medicines because they can harm your kidneys if diabetic nephropathy is getting worse. Diabetic kidney disease is a major cause of sickness and death in people with diabetes. It can lead to the need for dialysis or a kidney transplant.

Talk to your doctor if you have diabetes and you have not had a urine test to check for protein. If necessary, ask for a referral to an urologist or even a specialist in kidney diseases – a nephrologist.

Some of the other names for this include - Diabetic nephropathy; Nephropathy - diabetic; Diabetic glomerulosclerosis; Kimmelstiel-Wilson disease.

When kidney disease is diagnosed early, during microalbuminuria, several treatments may keep kidney disease from getting worse. Having larger amounts of protein in the urine is called macroalbuminuria. When kidney disease is caught later during macroalbuminuria, end-stage renal disease, or ESRD, usually follows.

In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. This failure, ESRD, is very serious. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis).

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.

Nephropathy – Part 1

The definition of kidney disease varies some depending on the type and cause. Diabetic nephropathy is this topic, but I would be remiss if I do not include more. According to several sources, several causes must be considered in any definition.

IgA nephropathy - is the most common glomerulonephritis throughout the world.

Acute glomerulonephritis is an inflammatory disease of both kidneys predominantly affecting children from ages two to 12. Chronic glomerulonephritis can develop over a period of 10-20 years and is most often associated with other systemic disease, including diabetes, malaria, hepatitis, or systemic lupus erythematosus.

Acute glomerulonephritis is an inflammation of the glomeruli, bundles of tiny vessels inside the kidneys. The damaged glomeruli cannot effectively filter waste products and excess water from the bloodstream to make urine. The kidneys appear enlarged, fatty, and congested. Diabetic nephropathy will be the discussion in the next blog, based on this definition.

For more information, please enter the word 'glomerulonephritis' into the Search box of this medical dictionary. You may wish to use the medical dictionary for other terms below, as some are dependent on a correct meaning. You may wish to bookmark the dictionary as in future blogs, you may wish to use it again.

Analgesics - One cause of nephropathy is the long-term usage of analgesics. The pain medicines which can cause kidney problems include aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs, or NSAIDs. This form of nephropathy is "chronic analgesic nephritis," a chronic inflammatory change characterized by loss and atrophy of tubules and interstitial fibrosis and inflammation. Specifically, long-term use of the analgesic phenacetin has been linked to renal papillary necrosis (necrotizing papillitis).

Iodinated contrast media - Kidney disease induced by iodinated contrast media (ICM) is called CIN (= contrast induced nephropathy) or contrast-indueced AKI (= acute kidney injury). Currently, the underlying mechanisms are unclear. But there is a body of evidence that several factors including apoptosis-induction seem to play a role.

Xanthine oxidase deficiency - Another possible cause of Kidney disease is due to decreased function of xanthine oxidase in the purine degradation pathway. Xanthine oxidase will degrade hypoxanthine to xanthine and then to uric acid. Xanthine is not very soluble in water; therefore, an increase in xanthine forms crystals (which can lead to kidney stones) and result in damage of the kidney. Xanthine oxidase inhibitors, like allopurinol, can cause nephropathy.

Polycystic Disease of the Kidneys - Additional possible cause of nephropathy is due to the formation of cysts or pockets containing fluid within the kidneys. These cysts get enlarged with the progression of aging causing renal failure. Cysts may also form in other organs including the liver, brain, and ovaries. Polycystic Kidney Disease is a genetic disease caused by mutations in the PKD1, PKD2, and PKHD1 genes. This disease affects about half a million people in the US. Polycystic kidneys are susceptible to infections and cancer.

Toxicity of Chemotherapy Agents - Nephropathy can be associated with some therapies used to treat cancer. The most common form of kidney disease in cancer patients is Acute Kidney Injury (AKI) which can usually be due to volume depletion from vomiting and diarrhea that occur following chemotherapy or occasionally due to kidney toxicities of chemotherapeutic agents. Kidney failure from break down of cancer cells, usually after chemotherapy, is unique to onconephrology. Several chemotherapeutic agents, for example Cisplatin, are associated with acute and chronic kidney injuries.[3] Newer agents such as anti Vascular Endothelial Growth Factor (anti VEGF) are also associated with similar injuries, as well as proteinuria, hypertension and thrombotic microangiopathy.