Diabetic Nephropathy (kidney disease)

most frequent cause is a badly adjusted blood sugar level

develops over a long period of time

30 – 40% of all people with diabetes develop during their life a diabetic nephropathy – one of the most important late complications of diabetes. The most common reason for nephropathy is poorly controlled diabetes – the situation is the same for people with type 1 and type 2 diabetes. Diabetic nephropathy develops over a long time of latency – in average it takes 10 – 15 years from the first diagnose of diabetes until manifestation of the kidney disease.

Urine-Check as prevention for dialysis
As a first marker of a kidney disease microalbuminurea (small protein particles in urine) can be proven. High blood glucose levels cause calcification of big blood vessels in the kidney but damage to small blood vessels as well. Therefore the body eliminates more protein in the urine – this can be found out during urine examination.

Early diagnosis and setup of treatment help to stopp progression of the disease and will increase life expectancy.

Urine check and limits
Spontaneous urine, night urine or 24-hours urine (best) is used for the check. Sometimes the relation between albumine and creatinine is used to measure microalbuminurea.

• A result below 20mg/l (milligram per litre) albumine is normal
• A result between 20 and 200 mg/l shown beginning kidney disease (microalbuminurea)
• Results above 200 mg/l are a proof for advanced kidney disease (macroalbuminurea)

Microalbuminurea is proven if there are two positive results within 2 – 4 weeks. False positive results can be caused by e.g. diseases with fever, infections of the urinary tract, strong hyperglycemia, heart insufficiency or after intensive training.

Once a year!
Regular screening for microalbuminurea and possible therapeutic consequences are important for people with type 1 and type 2 diabetes. Microalbuminurea plays furthermore an important role for people with type 2 diabetes as a risk factor for atherosclerotic complications (heart attacks).

Note: Not every protein elimination of people with diabetes is caused by diabetic nephropathy – a kidney check for more parameters ensures the diagnosis.

Control HbA1c
Early diagnosis of a diabetic nephropathy at the stage of microalbuminurea is important because at this time progression of the disease can be prohibited through appropriate therapy.

A reduction of other risk factors like hypertension, high blood fats or smoking also decreases the risk of developing cardiovascular diseases which are one of the most common causes of death.

Big clinical trials (DCCT, UKPDS) could proof that an intensified diabetes therapy together with lowering of HbA1c can dramatically reduce microvascular complications and therefore prohibit manifestation or progression of a diabetic nephropathy. A HbA1c of 7.0 – 7.5% should be the target. HbA1c above 8.0% will dramatically increase the rate of complications.

Lower hypertension
The second important therapeutic „column“ in the prevention of nephropathy is the optimization of the blood pressure. Guidelines recommend for people with diabetes an arterial blood pressure below 130/80mmHg and with existing macroalbuminurea even below 125/75mmHg. Some pharmaceuticals (ACE-Inhibitors, AT1-Receptor-Inhibitors) provide the blood pressure lowering effect as well a protective effect for the kidneys. Sometimes it is required to take a combination of different medications to reach the optimal blood pressure.

People with diabetes with advanced kidney insufficience have to undergo dialysis at an early stage to avoid more complications through arteriosclerotic diseases of the blood vessels and infections. Combined kidney-pancreas-transplantation can be useful for some people with diabetes.

How to prevent?

• Optimization of blood sugar
• Therapy of hypertension and blood fats
• No nicotine
• Existent nephropathy: regular checks and controls; low intake of proteins with the food (below 10% of the total energy)

Conclusions
Prevention and early diagnosis of a kidney damage and an optimal therapy increase quality of life and life expectancy.

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