Definition

One of the complications of type 1 and type 2 diabetes is a condition known as diabetic nephropathy. This condition is also referred to as diabetic renal disease. Nephropathy refers to pathological conditions of the kidneys.

Diabetic nephropathy has become more prevalent globally, including in Indonesia, due to the increasing incidence of diabetes over the years. According to the 2018 primary health research data, the prevalence of diabetes mellitus in Indonesia among those aged over 15 years, as diagnosed by doctors, was 2% of the total population. Diabetes is a significant contributor to morbidity and mortality in the global population.

The prevalence of diabetes increased from 171 million in 2000 to 382 million in 2013. Without significant lifestyle modifications, the number of people estimated to have diabetes will increase to 592 million by 2035. Diabetes is the leading cause of renal failure, also known as end-stage renal disease, in several nations, including Malaysia, Mexico, and Singapore.

Diabetic nephropathy leads to impaired renal function, particularly its ability to eliminate waste products and fluids from the body. Inadequate elimination of toxins and fluids may affect the central nervous, circulatory, and hormonal systems.

Diabetes nephropathy, if left untreated, may lead to end-stage renal failure (ESRD), which necessitates regular dialysis treatment and, in the most severe condition, may result in death.

Causes

Diabetic nephropathy is a complication of uncontrolled diabetes. Due to high blood sugar levels, diabetes may damage blood vessels throughout the body, including the kidneys. Renal vasculopathy is a condition characterized by impaired renal function, specifically in the filtration and excretion of chemicals through urination, resulting from abnormalities in the blood vessels within the kidneys.

Risk Factor

The following are factors that may increase the risk of diabetic nephropathy:

• Uncontrolled elevated blood glucose levels (hyperglycemia)
• Unregulated high blood pressure (hypertension)
• Smoking
• High blood cholesterol
• Obesity
• A familial predisposition to diabetes and kidney disease
• Male
• Age above 40 years
• A sedentary lifestyle, primarily lack of physical activity

Symptoms

Generally, diabetic nephropathy is asymptomatic in its early stages. However, if symptoms develop, they may include the following:

• Edema in the hands, feet, and face
• Insomnia and concentration impairment
• Loss of appetite
• Nausea and vomiting
• Fatigue
• Itchy, extremely parched skin
• Hypersomnia
• Cardiac arrhythmias caused by elevated blood potassium levels
• Muscle cramps and twitching

Diagnosis

The doctor might perform a medical interview, a physical examination, and additional examinations to confirm diabetic nephropathy.

Anamnesis

The interview begins with questions regarding the patient's chief complaint, associated symptoms, duration, history of past diseases, specific medications, lifestyle and activities, and familial predisposition.

Physical Examinations

The patient's general health, blood pressure, body temperature, pulse, and respiration rate will be evaluated during the doctor's physical examination. To find any potential signs of diabetic nephropathy, the doctor will also perform a thorough head-to-toe examination.

Additional Examinations

The doctor may also perform a complete blood laboratory examination to see the albumin, creatinine, and renal filtration rate levels. Then, the doctor may also suggest a urinalysis to identify the protein leakage in the urine. Furthermore, the doctor may recommend radiological examinations, such as x-rays or ultrasounds, if necessary, and a kidney biopsy in several severe cases.

Management

Controlling blood sugar levels, both through pharmacological and non-pharmacological treatment, is the primary treatment for diabetic nephropathy.

The doctor might recommend the treatment depending on their specific needs. Several medications will be prescribed to reduce high blood pressure, blood cholesterol, and blood sugar levels, which can be administered through oral or insulin injections. The doctor may also suggest dialysis or, in extreme cases of diabetic nephropathy, a kidney transplant if necessary.

Non-pharmacological treatment

Non-pharmacological treatments include lifestyle modifications such as:

• Weight loss
• Exercising at least three times a week with a minimum duration of 30 minutes
• Consuming a nutritionally balanced diet
• Limiting intake of sugar, salt, and saturated fat
• Drinking less water
• Avoiding stress
• Adequate sleep

Complications

Complications from diabetic nephropathy may develop over months or years, including:

• Fluid retention, or accumulation, causes edema in the shoulders and legs
• Elevated potassium levels in the blood (hyperkalemia)
• Cardiovascular diseases lead to the risk of stroke and obstruction of blood circulation
• Damage of vessels in the retina of the eye (diabetic retinopathy)
• Decreased red blood cell count (anemia)
• Lower leg pain, erectile dysfunction, diarrhea, and other nerve and blood vessel injuries
• Osteodystrophy is a skeletal disorder resulting from impaired renal function, leading to abnormal regulation of calcium and phosphorus levels in the bloodstream
• Maternal and fetal complications during pregnancy
• Irreversible renal failure, a coma state, impaired cognitive function, and death

Prevention

The following may decrease the risk of diabetic nephropathy:

• Visit your doctor regularly
• Maintain normal blood sugar levels by controlling diabetes
• Control blood pressure and other health conditions
• Follow pharmacist guidelines for over-the-counter medications
• Maintain body weight
• Keep active
• Avoid alcohol and smoking
• Avoid sugar, salt, and saturated fat

When to see a doctor?

See your doctor immediately if you experience the following symptoms after being diagnosed with diabetes: 

• Dyspnea
• Urinary retention
• Extreme fatigue
• Headache

You may visit the emergency room or an internist for treatment options.

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