Diabetic nephropathy appears due to the negative impact on the functioning of the kidneys of diabetes. This definition refers to the general classification of renal failure. Such a diagnosis is considered one of the most unfavorable diabetic complications, which determines the further prognosis for such patients.
Causes of pathology
Medicine cannot yet name the exact causes of diabetic nephropathy. Despite the fact that kidney problems are not directly related to glucose levels, diabetic patients who are on the waiting list for a kidney transplant are in the vast majority. In some cases, diabetes nephropathy does not develop. But, nevertheless, several theories of the occurrence of this disease stand out:
- Influence of genetics. In people who have a genetic predisposition under the influence of hemodynamic and metabolic disorders that are characteristic ofdiabetes, kidney pathology may develop.
- Influence of metabolic theory. Elevated blood sugar provokes a biochemical disturbance in the capillaries. This leads to irreversible processes, against which the kidney tissue is damaged.
- Influence of hemodynamic theory. Against the background of diabetes mellitus in people, blood flow is disturbed in the kidneys, which leads to the development of intraglomerular hypertension. At an early stage, the process of hyperfiltration is formed, that is, increased urine production. However, this condition is very quickly replaced by dysfunction due to the fact that the passages are clogged with connective tissues.
It is extremely difficult to establish a reliable cause of this disease. The development of such a pathology as diabetic nephropathy is largely facilitated by prolonged hyperglycemia along with uncontrolled medication, smoking and other bad habits. All kinds of errors in nutrition, combined with overweight and inflammatory processes in nearby organs, for example, various infections of the genitourinary system, can also have an impact.
It is also known that men are more prone to this pathology than women. This is due to the anatomical structure of the genitourinary system.
What manifestations are characteristic of the preclinical stage of diabetic nephropathy? More on that later.
Main Stages
This disease is characterized by slow development. Very rarely, this pathology can progress over several months. Most often, its development takes years, during whichsymptoms develop very slowly. As a rule, patients do not even immediately notice the discomfort that has appeared. To find out exactly at what stage of development the disease is, it is necessary to undergo a blood and urine test. In medicine, several of the following stages in the development of this disease are distinguished:
- At the asymptomatic stage, the patient is completely absent of any pathological signs of the disease. The only sign is an increase in renal filtration. At this stage, the level of microalbuminuria does not exceed 30 milligrams per day.
- During the initial stage of diabetic nephropathy, microalbuminuria remains within the same limits, but irreversible changes in the organs begin to appear. For example, the walls of the capillaries thicken, and, in addition, the connecting duct of the kidneys, which is responsible for the blood supply to the organ, expands.
- Prenephrotic stage develops in patients for approximately five years. At this time, a person is not disturbed by absolutely any signs, except that a slight increase in pressure after physical exertion is possible. The only method of determining the disease at this stage is a urinalysis, which can demonstrate an increase in albuminuria in the region of 20 to 200 milligrams per milliliter in a portion of morning urine.
- The nephrotic stage of the disease also develops slowly. What are the signs of diabetic nephropathy at this stage? Proteinuria (protein in the urine) can be observed constantly, and blood fragments are also occasionally present in it. ExceptIn addition, hypertension becomes regular, edema with anemia can be observed. In blood parameters at this time, an increase in ESR, globulins, lipoproteins and cholesterol is recorded. Periodically, in such patients, at this stage, the level of urea and creatinine may increase.
- The terminal stage is characterized by the development of chronic kidney failure. At the same time, the filtration and concentration functions of the kidneys are noticeably reduced, which causes a pathological change in the organ. In the urine, protein, blood, and, in addition, cylinders are observed, indicating dysfunctions of the excretory system. This is the classification of diabetic nephropathy.
As a rule, the progression of the disease to the terminal stage takes from five to twenty years. In the event that the necessary measures are taken in a timely manner to support the kidneys, then critical conditions can be avoided. Diagnosis with treatment of the disease is very difficult due to the asymptomatic onset of the pathology. It is worth noting that at an early stage, diabetic nephropathy is determined mostly by chance. In this regard, in the presence of diabetes, it is necessary to regularly monitor the urine index and take all the required tests.
Risk factors
Despite the fact that the main causes of this disease must, first of all, be sought in the functioning of internal systems, the risks of developing this pathology and other factors increase. As part of the management of patients with diabetes, doctors definitely recommend monitoring the general condition of the genitourinary system, and, in addition, regularly undergo examinations in such patients.narrow specialists such as nephrologist and urologist. Factors contributing to the development of diabetic nephropathy include the following:
- Having uncontrolled and persistently high blood sugar levels.
- The development of anemia, even if it does not lead to additional problems.
- Presence of high blood pressure along with hypertensive attacks.
- The presence of high cholesterol in the blood.
- High triglycerides.
- Bad habits in the form of smoking and alcohol abuse, as well as drugs.
Old age also serves as a certain risk factor, since the aging process is inevitably displayed on the general condition of all internal organs. A he althy lifestyle, along with dietary nutrition, and, in addition, supportive therapy aimed at normalizing blood sugar will certainly help to reduce the negative impact.
What are the symptoms of diabetic nephropathy (ICD-10 code N08.3)?
Symptoms of disease
Identification of the disease at its early stage will certainly help to carry out the treatment safely, but, as already noted, there is a problem that the asymptomatic onset of this pathology. In addition, some indicators indicate other he alth problems. In particular, the symptoms of diabetic nephropathy very often resemble diseases in the form of chronic pyelonephritis, glomerulonephritis or kidney tuberculosis. All these diseases are classified as renal pathologies, therefore, a comprehensive examination is required for an accurate diagnosis. So, the main symptoms of diabetic nephropathy include the following:
- The presence of persistently elevated blood pressure, i.e. hypertension.
- The presence of discomfort and pain in the lumbar region.
- The development of anemia of varying degrees, which can sometimes take place in a latent form.
- The appearance of digestive disorders. Nausea combined with loss of appetite is not ruled out.
- Feeling low energy along with drowsiness and general weakness.
- Appearance of swelling of the limbs and face, especially towards the end of the day.
- According to many patients, complaints of dry skin, itching and rashes on the face and body are recorded.
In some cases, the symptoms of diabetic nephropathy (ICD-10 code N08.3) may be similar to the manifestations of diabetes, in connection with this, patients very often do not pay any attention to it. It should be emphasized that diabetics are required to periodically take screenings that demonstrate the presence of protein and blood in the urine. Such indicators serve as a characteristic sign of the development of renal dysfunction, which helps to identify diabetic nephropathy as early as possible.
Diagnostics
Diagnosis of diabetic nephropathy should be complex.
First of all, a timely visit to a nephrologist helps to detect this disease at its early stage. In addition to laboratory studies that help determineurine indicators in patients, special microscopic and instrumental studies of the tissue of the affected organ are widely used. In order to confirm the diagnosis, the patient will probably have to undergo several special procedures, the nature and appropriateness of which is determined by the doctor. As a rule, a disease such as diabetic nephropathy helps to identify the following research options:
- Ultrasound examination of the kidneys. This diagnostic method is painless and very informative type of examination. Ultrasound demonstrates possible pathologies of the organ along with a change in its size, shape and condition of the ducts.
- Dopplerography of the vessels of the kidneys. This study is carried out to determine the patency and detection of kidney pathologies and various inflammatory processes in them.
- Taking a biopsy of kidney tissue. This procedure is carried out under local anesthesia.
- Urine analysis. This indicator is studied throughout the entire period of not only diagnosis, but also treatment.
The rate of glomerular filtration is determined without fail. As a rule, at the beginning of the disease, this indicator is increased. Among other things, the indicator of albuminuria is being studied. Many pharmacies now sell home tests to determine urine values. Despite the fact that their effectiveness is not very high, this analysis still helps to detect possible problems, after which the patient should undergo a full professionallaboratory examination.
Treatment of diabetic nephropathy
The main therapeutic measures for this disease are aimed at normalizing blood sugar, and, in addition, at the general support of the body. Many metabolic processes in the presence of diabetes proceed differently, which leads to visual impairment, vascular damage and other problems. At an early stage of the disease, there is a real chance of correcting the situation through dietary nutrition.
If characteristic symptoms appear, preventive measures alone are not enough, therefore it is imperative to consult your doctor about suitable drugs for treatment. It is very important to monitor the urine, and, in addition, blood as part of the verification of the effectiveness of treatment. Medical treatment usually includes the following drugs:
- Angiotensin-converting enzyme inhibitors. These include drugs in the form of Enalapril, Ramipril and Trandolapril.
- Treatment with specific angiotensin receptor antagonists. Among the most popular are Irbesartan along with Valsartan and Losartan.
- As part of the support of the work of the heart and blood vessels, means are used that normalize the lipid composition of the blood.
- Against the background of severe kidney damage, doctors recommend taking detoxifying drugs, sorbents, and, in addition, antiazotemic drugs.
- In order to raise hemoglobin, special preparations are used in combination with some folk methods. It is important that the applicationof this or that prescription was necessarily coordinated with the attending physician.
- Diuretics work well in the fight against swelling, along with a reduction in fluid intake.
All of these drugs normalize systemic hypertension, lowering blood pressure and slowing down the progression of the disease. In the event that drug treatment is not enough, a decision is made to use cardinal methods of kidney support.
How is late diabetic nephropathy treated?
Delayed treatment
Characteristic symptoms of incipient kidney failure are not only poor laboratory results, but also the general condition of the patient. In the late stage of diabetic nephropathy, renal function is extremely weakened, and in this regard, it is necessary to consider additional options for the treatment of the patient. The following treatments are considered cardinal methods:
- Using hemodialysis or artificial kidney machine. It helps to remove decay products from the body. This procedure is repeated about a day later. This is a supportive therapy and helps patients live with this diagnosis for a long time.
- Peritoneal dialysis. There is a slightly different principle here compared to hardware hemodialysis. This procedure is performed slightly less often (about once every five days) and does not require the use of sophisticated equipment.
- Performing a kidney transplant. As part of this method of treatment, a donor organ is transplanted to a patient. This is a fairly effective operation, but it is not yet very common in our country.
Clinical guidelines for diabetic nephropathy must be strictly followed. At a late stage of the disease, patients observe a decrease in the need for insulin. This is a rather alarming sign, indicating the progress of the disease. In this regard, it is very important to maintain normal blood sugar levels in the patient. At this stage, even non-insulin dependent patients are being switched to appropriate therapy.
Folk remedies for diabetic nephropathy can also be effective:
- With such a violation, a collection that is based on yarrow, motherwort, oregano, horsetail and calamus rhizomes (in equal proportions) helps well. All components must be crushed and mixed with each other. 2 tbsp. l. collection brew 300 ml of boiling water. Heat in a water bath for 15 minutes, insist 2 hours. Take a decoction of a third cup 3 times a day about 30 minutes before a meal.
- Known in the fight against hypertension with nephropathy cudweed. Brew 10 g of herbs with boiling water in a volume of 1 cup. Insist 40 minutes, strain. Take 1 tbsp. l. half an hour before meals 3 times a day.
- Birch buds are also used in folk treatment. 2 tbsp. l. brew 300 ml of boiling water. Warm up in a water bath, insist. Take 50 ml for 2 weeks before meals three times a day.
Diet
In order to reduce symptoms and improve the clinical picture, it is imperative to follow a diet for diabetic nephropathy. As a rule, low-carb is effective, as well as low-protein (at the last stage of the disease).
Food should be varied. The daily diet includes cereals, meat or fish, vegetables, fruits and berries. Juices from fruits and berries are forbidden for dietary nutrition, even with a low glycemic index. At the same time, fiber is lost, which ensures a uniform supply of glucose into the blood. Fruits and berries are best eaten in the morning, no more than 150–200 g.
What is the prevention of diabetic nephropathy?
Prophylaxis
Measures to prevent the onset of diabetic nephropathy include the following recommendations:
- Implementation of blood pressure stabilization.
- Controlling sugar levels.
- Emphasis on s alt-free, and, in addition, on diet food.
- Normalization of blood cholesterol.
- Complete rejection of certain bad habits.
- Engaging in feasible physical activity.
- Absolute refusal of drugs that adversely affect the functioning of the kidneys.
- Prophylactic visit to a nephrologist along with appropriate tests.
Forecast
Despite effective treatments, most patients face severe consequences of this disease. In many cases the onlya life-saving option is a kidney transplant. Among other things, the risk of recurrence of nephropathy is very high, in this regard, it is important to prevent the transition of the disease to an advanced stage.
Usually, the prognosis for patients who suffer from diabetic nephropathy is quite favorable, the main thing is that it be detected at an early stage. This disease develops slowly, so it is very important to follow the conditions of medical recommendations and control sugar. In addition, it is important to radically reconsider the way of life.
