How can Diabetes cause Nephropathy? 

Diabetes, if not controlled, may lead to a slew of issues affecting practically every organ in the body. Diabetic Nephropathy is one among them.

Diabetic Nephropathy is a severe consequence of type 1 and type 2 Diabetes. It is often mentioned as Diabetic renal disease.

Diabetic Nephropathy impairs the kidney’s capacity to perform its normal function of eliminating waste products and excess fluid from the body. Maintaining a healthy lifestyle and properly treating your Diabetes and high blood pressure are the most significant ways to avoid or postpone Diabetic Nephropathy. The decrease of kidney function is referred to as Nephropathy.

The last stage of Nephropathy is kidney failure, often named End-Stage Renal Disease (ESRD). The onset and progression of Diabetic Nephropathy can be reduced by proper management of Diabetes and related symptoms, including blood pressure medicines.

What are the stages of Diabetic Nephropathy? 

The stages of kidney disease are usually determined by the Glomerular Filtration Rate (GFR), which represents the percentage of effective kidney function.

Loss of function ranging from mild to severe levels

Stages	Glomerular filtration rate (GFR)	Effects
Stage 1	90% or above	Kidney damage is present but kidney functions normally
Stage 2	60–89%	Kidney damage accompanied by some impaired functions
Stage 3	30–59%	Loss of function ranging from mild to severe levels
Stage 4	15–29%	loss of function is severe
Stage 5	under 15%	Renal failure

How can Diabetic Nephropathy be detected? 

If you have Diabetes, you should have a urine test done once a year to check for Diabetic Nephropathy or kidney damage. A baseline creatinine blood test should be performed to evaluate your kidney function. If you have high blood pressure, heart illness or a family history of renal failure, you may need a frequent health check-up.

A sample of your urine will be checked for albumin in the diagnostics, a blood protein that might show up in your urine if your kidneys are damaged.

They will also take a blood sample to determine your Glomerular Filtration Rate (GFR), which measures how successfully your kidneys filter waste from your blood.

Your doctor will also monitor your blood pressure regularly because controlling high blood pressure is critical in reducing the progression of renal disease. Your blood pressure should be lower than 130/80 mmHg.

What factors contribute to Diabetic Nephropathy? 

Waste products are produced during the protein-digesting process. Millions of small blood channels – capillaries, with even tinier holes serve as filters in the kidneys. Small molecules, such as waste particles squeeze through the gaps in the blood arteries when blood passes through them. These waste products get eliminated in the urine.

Protein and red blood cells are too large to pass through the pores in the filter and remain in the blood.

High blood sugar levels cause the kidneys to filter excessive blood. After a considerable period, they begin to leak, resulting in the loss of valuable protein in the urine. Microalbuminuria is the presence of tiny quantities of protein in the urine.

When kidney disease is detected early, numerous treatments may be used to prevent severe conditions during microalbuminuria. The presence of more protein in the urine is referred to as Macroalbuminuria. End-stage renal disease (ESRD) frequently occurs when kidney damage is discovered later during Macroalbuminuria. Over time due to such reasons kidney loses its filtering capacity. This makes the waste products pile up in the blood. Eventually, the kidneys fail.

Severe ESRD needs to have a kidney transplant or is expected to undergo dialysis.

Let us understand the factors involved in the occurrence and progression of Diabetic Nephropathy.

• Hyperglycemia
• Hypertension
• Hyperlipidemia
• Genetic factors

Reversible or curable factors such as Hypertension, Hyperlipidemia and Hyperglycemia are important in clinical patient care. At the moment, genetic variables are only relevant for theoretical debate, but with the fast-growing science of gene therapy, it may be possible to adjust the risk factors for Diabetic Nephropathy favourably by gene therapy.

What are the symptoms experienced in Nephropathy by a Diabetic person?

Diabetic Nephropathy at early stages may not reveal any symptoms. In later stages, the symptoms include:

• Swelling of the hands, ankles, feet and face
• Trouble sleeping or concentrating
• Poor appetite
• Protein in the urine
• Nausea
• Shortness of breath
• Weakness
• Persistent itching (end-stage kidney disease) and extremely dry skin
• Drowsiness (end-stage kidney disease)
• Abnormalities in the heart’s regular rhythm (due to increased potassium in the blood)
• Muscle twitching
• Fatigue

How can you lower the chances of Diabetic Nephropathy? 

Let us get to know the ways of preventing Diabetic Nephropathy,

1. The easiest method to avoid Diabetic Nephropathy is to keep your blood sugar under control and your blood pressure within normal limits. The systolic blood pressure should be continuously less than 130 millimetres of mercury (mmHg).
2. If you are at a healthy weight, work to maintain it by being physically active most days of the week. If you need to lose weight, consult your doctor about weight-loss strategies, such as increasing daily physical activity and consuming fewer calories.
3. Maintain frequent Diabetes management visits. Plan yearly check-ups or more frequent appointments if your health care provider recommends it to assess your Diabetes management and test for Diabetic Nephropathy and other complications.
4. Manage hypertension or other medical disorders. If you have high blood pressure or other factors that put you at risk for kidney disease, discuss with your doctor to get them under control.
5. Reduction of Proteinuria.
6. Cigarette smoking can be avoided, which can damage your kidneys and can worsen the existing kidney damage.
7. Some medications are available that can slow down the progression of kidney damage, namely,

• SGLT2 inhibitors – dapagliflozin (Farxiga) for controlling high blood sugar.
• Angiotensin-converting enzyme (ACE) inhibitors, including ramipril (Altace), quinapril (Accupril), and lisinopril (Prinivil, Zestril) — these drugs are often given to Diabetic people to prevent complications, even if their blood pressure is normal.
• Angiotensin receptor blockers (ARBs)

Summing up! 

Many advances have been achieved in understanding the pathogenetic pathways and risk factors for the development of Diabetic Retinopathy during the last several decades. According to a recent Indian study, the risks defining Diabetic Nephropathy in urban Asians include Diabetes duration, Diabetic management and systolic blood pressure. (Source: Diabetes Care, “Prevalence and risk factors of Diabetic Nephropathy in an urban South Indian population.” 2007;30:2019–24.)

Hence, following a Diabetes treatment plan and getting frequent health checks can help a diabetic person to maintain their blood sugar levels, lower the risk of kidney abnormalities and find out whether they need to take action early.

To control the lifestyle conditions that cause Diabetes, early identification and ongoing supervision are required. You will be able to regulate your sugar levels and live a healthy life if you receive the right medical treatment. However, with increasing medical inflation for comprehensive medical treatments, you may need Diabetes Health Insurance.

Star Health Insurance offers Diabetes Safe Insurance Policy, a unique policy to cover you against all expenses incurred on hospitalisation for the treatment of Type I or Type II Diabetes and its complications.

With Diabetes Safe Insurance Policy, you get two plan options for health Insurance coverage, namely, Plan A and Plan B. Major Diabetes complications like Cardio vascular Diseases, Diabetic Nephropathy, Diabetic Retinopathy & Diabetic Foot ulcers are covered with no waiting periods in Plan A (Mandatory Pre – Insurance Screening) and after 12 months in Plan B (Without Pre insurance Screening). In addition, organ transplant-related surgery and donor expenses are covered in this policy with a waiting period of 24 months.