Nephropathy alone is damage or disease of the kidney; however, diabetic nephropathy is kidney disease that is associated with long-term diabetes also referred to as Kimmelstiel-Wilson disease or intercapillary glomerulonephritis.

This disease affects the tiny blood vessels found in the glomerulus, which is the main structure in the capillary blood vessels of the kidneys. This structure is vital for the blood to be filtered. Clinically the signs of nephropathy are the excess filtration of protein in the urine, impaired kidney function, and high blood pressure. When diabetic nephropathy becomes severe it can lead to kidney failure, end stage renal disease and the need for dialysis or even a kidney transplant is necessary. An individual with type 1 – insulin-dependent or type 2 – non-insulin-dependent can suffer from nephropathy.

In Type 1 diabetes individuals it is believed that 25% to 45% of patients will at some time develop nephropathy. The common time frame for nephropathy to show signs is between ten and fifteen years after the beginning of diabetes. (1)

In Type 2 diabetes individuals the disease is not as aggressive but is noted in Pima Indians more often with 50% developing nephropathy after twenty years of suffering from diabetes. (1)

Symptoms

There are no early warning symptoms of nephropathy. The progression of the disease is slow and will not be discovered when the kidneys ability to function properly begins to have problems. The symptoms most commonly associated with nephropathy include tiredness, feeling under the weather, frequent hiccups, foamy urine, headache, itching, nausea, vomiting, swelling of the legs, morning swelling around the eyes, weight gain due to retaining fluid, and poor appetite.

Risk Factors

Risk factors for developing Nephropathy include individuals with long standing Type 1 Diabetes or Type 2 Diabetes.

Diabetic nephropathy is responsible for 35% of End Stage Renal Disease also known as stage 5 kidney disease in the United States with estimated at $50,000 per patient per year. Type 1 diabetes patients have a higher risk of developing nephropathy; however, those with type 2 diabetes can also develop nephropathy. Recent research has shown that the number of type 1 diabetes patients developing nephropathy is decreasing. This could be due to an increase in better preventive measures.  A recent study, San Antonio Heart Study did show that more Mexican Americans with type 2 diabetes were now developing nephropathy. The report showed that during the 7 to 8 study that an increase from 5.7 percent in 1979 was 15.7 percent in 1988. The study confirmed that individuals with various end stage renal disease was higher among those with type 2 diabetes due to the fact that more individuals have this type of diabetes.  (2)

Risk Factors that cannot be controlled

The main risk factors that cannot be controlled includes a family history of high blood pressure, family history of kidney disease, and your origin with more individuals being of American Indian, Hispanic, or African American descent.

The main reason a person develops nephropathy is associated with glomerular hypertrophy and an increase in the renal size. The reason this occurs is not actually known however, it is believed to be due to high blood pressure.

Risk factors you can control

The good news is that most of the risk factors associated with nephropathy are controllable. Blood pressure is a major factor. Those with high blood pressure have a higher risk of developing nephropathy along with poor glucose control which is the blood sugar level are both contributing factors. For patients with high blood pressure and uncontrolled blood sugar levels the risk of developing nephropathy increases within twenty years. For patients that are controlling their blood sugar and keep it below 8.1% the risk is much lower, however for those that have a concentration above 11% the risk of developing nephropathy is higher. (3)

The sad news is that in most patients at the time of a diagnosis of diabetes, around 80 percent have abnormal blood pressure.

Smoking has shown an increased risk of developing or increasing the progression of nephropathy. A study in 1983 with patients diagnosed with type 1 diabetes of 192 men and 109 women all classified as smokers, concluded cigarette smoking contributes to the development of nephropathy. (4)

Treatment

Treatment of nephropathy is to prevent complications and to keep the disease from becoming worse. The best treatment is to control the blood pressure to help slow kidney damage. The medications often used in treating high blood pressure include angiotensin receptor blockers or antiotensin-converting enzyme. These medications are often prescribed to individuals with high blood pressure that are showing sings of kidney disease.

Along with this blood sugar levels should be checked often and a diabetic diet followed closely. During the early stages of nephropathy, this is a very important factor for slowing the disease. Your physician can also prescribe medications that can help control the blood sugar levels. The most common medications in the treatment of diabetes include melformin, sulfonylureas, thiazolidinediones, meglitinides, alpha-glucosidase inhibitors, and dipeptidyl peptidase-4 inhibitors.

Infections are a common issue with patients suffering from nephropathy such as urinary tract infection, which is treated with antibiotics.

In the final stages of nephropathy, the treatment is usually dialysis or kidney transplant.

Sources:
1) Ari Kostadaras, M.D. – Nephrology Hemodialysis Hypertension Clinic, New York
2) American Diabetes Association
3) Ari Kostadaras, M.D. – Nephrology Hemodialysis Hypertension Clinic, New York
4) American Diabetes Association

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