Diabetic Nephropathy

Diabetic nephropathy is a complication of diabetes that is caused by high concentrations of glucose in the blood. Hyperglycemia disturbs the function of the filtering unit of the kidney (nephrons). Over time, this can lead to kidney failure.

 

Prevent or slow kidney failure is the most important step in managing the disease. Maintaining blood glucose and blood pressure within normal limits and a healthy diet may reduce the risk of developing the disease or progress to kidney failure.

Symptoms:

– foot edema initially and then the whole body can be affected

– An increase in blood pressure

– Loss of large amounts of protein in urine (macroalbuminuria, a sure sign of diabetic nephropathy)

– Increasing levels of cholesterol and triglycerides

Treatment:

Diabetic nephropathy is treated with medication that lowers blood pressure and protects the kidneys. Renal lesions may be reversible with treatment, and this should begin immediately after any amount is found in urine protein (microalbuminuria).

American Diabetes Association recommends maintaining blood pressure below 130/80 mmHg. Level recommended by other organizations may vary.

Limit intake of salt in the diet is helpful in maintaining normal blood pressure.

Patients with diabetes have 2-4 times greater risk of dying by heart disease or blood vessels than those without diabetes. Low-dose aspirin therapy and a diet low in fat may help prevent heart attacks, stroke and other diseases of large blood vessels (macrovascular disease).

Medications used to treat diabetic nephropathy are also used in controlling blood pressure. If there is a small amount of protein in urine, kidney damage may be reversible under treatment. If blood pressure is high, it will take two or more drugs to lower blood pressure level at which kidneys will be protected. Medications are added one by one as needed.Maintaining blood glucose within normal limits is important to prevent damage to small blood vessels in the kidneys. American Diabetes Association recommends maintaining blood glucose levels:

– 80 mg / dL to 120 mg / dl before meals and 100 mg / dL to 140 mg / dL at bedtime when used for venous blood testing

– 90 mg / dL to 130 mg / dl before meals and 110 mg / dL to 150 mg / dL at bedtime when using blood from the fingertip (arterial blood)

– Less than 180 mg / dL at 1-2 hours after eating.

As diabetic nephropathy progresses, blood pressure usually increases, making it necessary to add a medication to control blood. Your doctor may recommend one of these drugs is sometimes necessary to administer a combination of drugs to better control your blood pressure:

– An association of converting enzyme inhibitors and angiotensin II receptor blockers, it is more useful in controlling blood pressure than each drug separately

– Calcium channel blockers, such as amlodipine (Norvasc), diltiazem (cardizem SR, Dilacor XR and Tiazac), nifedipine (procardia adalat or XL) and verapamil (Calan and Isoptin SR)

– Diuretics – drugs such as bumetanide, chlorthalidone and hydrochlorothiazide help lower blood pressure by removing sodium and water in the body.

Progression of renal vascular lesion leading to renal failure. Once this occurs, it is probably necessary to establish dialysis (artificial blood filtration method which is purified of substances that are normally eliminated in the urine) or renal transplant patient to survive.

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