Diabetic nephropathy appears due to the negative impact on the functioning of the kidneys of diabetes. By this definition we mean 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 the occurrence of diabetic nephropathy. Despite the fact that kidney problems are not directly related to glucose levels, the vast majority of patients with diabetes who are in the queue for kidney transplantation. In some cases, diabetes does not develop nephropathy. But, nevertheless, several theories of the occurrence of this disease are highlighted:
- The influence of genetics. People who have a genetic predisposition under the influence of hemodynamic and metabolic disorders, which are characteristic for diabetes, can develop kidney pathologies.
- The influence of metabolic theory. High blood sugar provokes a biochemical disturbance in the capillaries. This leads to irreversible processes, against which the kidney tissue is damaged.
- The influence of hemodynamic theory. Against the background of diabetes mellitus, blood flow is disturbed in the kidneys of people, which leads to the development of intracranial hypertension. At an early stage, the process of hyperfiltration is formed, that is, increased urine formation. However, this condition is very quickly replaced by dysfunction due to the fact that the passages are blocked by connective tissues.
It is extremely difficult to establish a reliable cause of this disease. The development of such a pathology as diabetic nephropathy is more conducive to prolonged hyperglycemia, along with the uncontrolled use of medications, smoking and other bad habits. All kinds of nutritional errors, combined with overweight and inflammatory processes in nearby organs, such as various infections of the genitourinary system, can also have an effect.
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? About it further.
Main stages
This disease is characterized by slow progression. Very rarely, this pathology can progress in a few months. Most often, its development takes years, during which the symptoms grow very slowly. As a rule, patients do not even immediately notice the discomfort that has appeared. To know exactly at what stage of development the disease is, it is necessary to undergo a blood and urine test. In medicine, the following several stages of the development of this disease are distinguished:
- At the asymptomatic stage, the patient completely does not have 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 keeps within the previous limits, but irreversible changes in 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.
- The prenephrotic stage develops in patients within approximately five years. At this time, no signs are bothering the person, except perhaps a slight increase in pressure after physical exertion. The only method for determining the disease at this stage is urinalysis, which can demonstrate an increase in albuminuria in the region from 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 also blood fragments are periodically present in it. In addition, hypertension becomes regular, edema with anemia may occur. In the blood counts at this time, an increase in ESR, globulins, lipoproteins and cholesterol is recorded. Periodically, in such patients at this stage, the urea and creatinine levels 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, there is protein, blood, and, in addition, cylinders, 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 timely necessary measures are taken to support the kidneys, then critical conditions can be avoided. Diagnosis with the 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 for the most part by chance. In this regard, in the presence of diabetes, it is necessary to regularly monitor the urine count and pass 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 the development of this pathology and other factors increase. As part of managing patients with diabetes, doctors definitely recommend monitoring the general condition of the genitourinary system, and, in addition, regularly undergo examinations by such specialists as, for example, a nephrologist and a urologist. Factors contributing to the development of diabetic nephropathy include the following prerequisites:
- Presence of uncontrolled and constantly high blood sugar.
- The development of anemia, even if it does not lead to additional problems.
- The presence of high blood pressure along with hypertensive seizures.
- The presence of high cholesterol in the blood.
- The presence of high triglycerides.
- Bad habits in the form of smoking and alcohol abuse, and, in addition, narcotic substances.
Old age also serves as a certain risk factor, since the aging process is inevitably reflected in the general condition of all internal organs. A healthy lifestyle will certainly help to reduce the negative impact, along with diet, and, in addition, supportive therapy aimed at normalizing blood sugar.
What are the symptoms of diabetic nephropathy (ICD-10 code N08.3)?
Symptoms of the disease
Definition of the disease at its early stage will certainly help to safely carry out treatment, but, as already noted, there is a problem consisting in the asymptomatic beginning of this pathology. In addition, some indicators indicate other health 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 diagnosis is required for an accurate diagnosis. So, the following are the main symptoms of diabetic nephropathy:
- The presence of constantly elevated blood pressure, i.e. hypertension.
- The presence of discomfort and pain in the lower back.
- The development of anemia of varying degrees, which can sometimes occur in a latent form.
- The appearance of digestive disorders. Nausea combined with loss of appetite is not ruled out.
- A feeling of loss of strength along with drowsiness and general weakness.
- The appearance of swelling of the limbs and face, especially towards the end of the day.
- According to many patients, complaints of dry skin, the appearance of 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 this regard, patients often do not pay any attention to it. It should be emphasized that diabetics require periodic screening showing the presence of protein and blood in the urine. Such indicators serve as a characteristic sign of the development of renal dysfunctions, which helps to determine diabetic nephropathy as early as possible.
Diagnostics
Diagnosis of diabetic nephropathy should be comprehensive.
To detect this disease at its early stage helps, above all, timely contact a nephrologist. In addition to laboratory studies that help determine urine parameters 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. Typically, a disease such as diabetic nephropathy can help identify the following research options:
- Ultrasound examination of the kidneys. This diagnostic method is a 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 patency and detect pathologies of the kidneys and various inflammatory processes in them.
- Biopsy of kidney tissue. Such a procedure is performed under local anesthesia.
- Urinalysis This indicator is studied throughout the entire period of not only diagnosis, but also treatment.
Mandatory determine the glomerular filtration rate. As a rule, at the beginning of the disease, this indicator is increased. Among other things, the indicator of albuminuria is being investigated. Many pharmacies today sell home tests to determine urine counts. Despite the fact that their effectiveness is not very high, this analysis still helps to identify possible problems, after which the patient should undergo a full professional laboratory examination.
Diabetic Nephropathy Treatment
The main therapeutic measures for this disease are aimed at normalizing blood sugar, and, in addition, to general support of the body. Many metabolic processes in the presence of diabetes mellitus proceed differently, which leads to visual impairment, vascular damage and other problems. In the early stages of the disease, there is a real chance of rectifying the situation through dietary nutrition.
In the event of the appearance of characteristic symptoms, preventive measures alone are not enough; in this connection, it is mandatory to consult your doctor about suitable drugs for treatment. It is very important to monitor urine, and, in addition, blood as part of a test of treatment effectiveness. Conducting drug treatment, as a rule, includes the following drugs:
- Angiotensin-converting enzyme inhibitors . These include drugs in the form of Enalapril, Ramipril, and Thrandolapril.
- Treatment with special angiotensin receptor antagonists. Among the most popular, it is worth mentioning Irbesartan along with Valsartan and Losartan.
- As part of supporting the work of the heart and blood vessels, agents are used that normalize the lipid composition of the blood.
- Against the background of severe kidney damage, doctors recommend the use of detoxifying drugs, sorbents, and, in addition, anti-azotemic drugs.
- In order to raise hemoglobin, special drugs are used in combination with some alternative methods. It is important that the use of this or that prescription is necessarily agreed with the attending physician.
- As part of the fight against puffiness, diuretic drugs help along with reducing the amount of fluid used.
All of these drugs normalize systemic hypertension, reducing pressure and slowing the progression of the disease. In the event that medical treatment is not enough, a decision is made on the use of cardinal methods of kidney support.
How is late diabetic nephropathy treated?
Late Treatment
The characteristic symptoms of incipient renal failure are not only poor laboratory tests, but also the general condition of the patient. At the late stage of diabetic nephropathy, renal function is extremely weakened, in this regard, additional options for treating the patient must be considered. The following treatment methods are considered cardinal methods:
- The use of hemodialysis or "artificial kidney" apparatus. This helps to remove decay products from the body. This procedure is repeated after about a day. This is a supportive therapy and it helps patients live with this diagnosis for quite some time.
- Peritoneal dialysis. There is a slightly different principle compared to hardware hemodialysis. This procedure is carried out a little less often (approximately once every five days) and it does not require the use of sophisticated equipment.
- The implementation of kidney transplantation. As part of this method of treatment, a donor organ is transplanted to a patient. This is a fairly effective operation, but in our country it is still not very common.
Clinical guidelines for diabetic nephropathy should be strictly followed. At a late stage of the disease, a decrease in insulin requirements is observed in patients. 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 transferred to appropriate therapy.
Folk remedies for diabetic nephropathy can also be effective:
- With such a violation, the collection, based on yarrow, motherwort, oregano, horsetail and calamus rhizomes (in equal shares), 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 glass 3 times a day for about 30 minutes before a meal.
- Known in the fight against hypertension with nephropathy is marsh cinnamon. 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.
- Also used in folk treatment are birch buds. 2 tbsp. l brew 300 ml of boiling water. Heat in a water bath, insist. Take 50 ml for 2 weeks before meals three times a day.
Diet
In order to reduce the symptoms and improve the clinical picture, it is imperative to follow a diet for diabetic nephropathy. As a rule, low-carbohydrate, as well as low-protein (in the last stage of the disease) is effective.
Food should be varied. The daily diet includes cereals, meat or fish, vegetables, fruits and berries. Juices from fruits and berries, even with a low glycemic index, are prohibited for dietary nutrition. In this case, fiber is lost, which ensures a uniform flow of glucose into the blood. Fruits and berries are better to eat in the morning, no more than 150-200 g.
What is the prevention of diabetic nephropathy?
Prophylaxis
The following recommendations are among the measures to prevent the occurrence of diabetic nephropathy:
- The implementation of stabilization of blood pressure.
- Sugar control.
- Emphasis on salt-free, and, moreover, on diet.
- Normalization of cholesterol in the blood.
- A complete rejection of certain bad habits.
- Occupation of feasible physical activity.
- Absolute rejection of drugs that adversely affect the functioning of the kidneys.
- A prophylactic visit to a nephrologist along with appropriate tests.
Forecast
Despite effective methods of treatment, most patients face severe consequences of this ailment. In many cases, the only option to save a life 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 disease from moving to an advanced stage.
Usually, the prognosis for patients who suffer from diabetic nephropathy is quite favorable, the main thing is that it is detected at an early stage. , . , .