Diabetic Nephropathy

Kidney diseases do not produce symptoms until most of the kidney function is lost. Also, the symptoms that eventually appear are non-specific. Fluid build-up is the first sign of nephropathy. Other symptoms include:

• Loss of sleep
• Stomach upset
• Poor appetite
• Weakness
• Imbalance in blood pressure
• Protein in urine
• Confusion or difficulty in concentrating
• Persistent itching
• Increased urination
• Nausea and vomiting

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Kidneys contain numerous capillaries which filter waste products from the blood. These capillaries have tiny holes (filters), through which, waste products are excreted in the form of urine. Blood cells and protein are bigger than these holes and hence are not passed into the urine.

Increased blood sugar level causes damage to these pores, making them bigger. As a result, blood can also pass through. This causes damage to the glomeruli, filters of the kidney. With time, these filters start to leak and small amounts of essential proteins start to be expelled with urine (microalbuminuria). If left untreated, this condition causes an increase in microalbumin loss which is followed by end-stage-renal-disease (ESRD).

Later, this stress on the kidneys causes loss of filtering capacity. Waste products then accumulate in the blood, and finally, kidney failure occurs.

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Your doctor will conduct a physical examination and take your medical history. You may then be advised a few tests including:

• Blood tests to check the condition of the kidneys and assess its functioning
• Urine tests to check the protein content in the urine. High level of a protein called microalbumin in the urine indicates an early stage of nephropathy
• X-ray, MRI and CT scan to check the blood flow to the kidneys
• Renal function test to check the filtering capacity
• Kidney biopsy

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 Medications are used in early stages of nephropathy:

• To control high blood pressure
• To manage high blood sugar level
• To lower blood cholesterol level
• To control protein levels in urine

In later stages, kidney transplant and dialysis may be advised.

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