Kidney Disease: Consequences of Diabetes

Diabetes can cause numerous complications, one of which is kidney damage, which occurs in a significant proportion of patients. Diabetic nephropathy, as this kidney damage is called, develops gradually and involves the disease of the glomeruli of the kidney, which are the capillaries involved in urine filtration. During this process, the connective tissue between the capillaries increases, hindering the normal functioning of the kidney.

Diabetic nephropathy is initially asymptomatic, so many people are unaware that their kidney function has begun to decline. However, as the disease progresses, the structure of the kidneys changes, and the decrease in function becomes increasingly noticeable. Obesity, particularly a high body mass index (BMI), is closely associated with an increased risk of kidney damage. Fortunately, if the problem is recognized in time and appropriate medical treatment, along with lifestyle changes, is implemented, the progression of the disease can be slowed or even halted.

The Stages of Diabetic Kidney Damage

Diabetic nephropathy can be divided into five different stages, with the first two stages showing no clinical symptoms. Therefore, regular screening tests are of utmost importance, as they allow for the early detection of kidney damage.

In the first stage, the kidney enlarges, and the amount of filtered urine increases, but no complaints can be observed yet. In the second stage, the structure of the kidney is already damaged, but the patient still does not notice clinical signs. In the third stage, mild hypertension may occur, and protein appears in the urine, which can be a warning sign.

The fourth stage is characterized by a significant decrease in kidney function. The patient may feel fatigued, report malaise, and weight loss may occur. The structure of the kidney is already severely damaged, and blood pressure can be abnormally high. In the fifth stage, kidney damage is so severe that end-stage kidney disease develops, which can be accompanied by anemia, nausea, and neurological symptoms.

Understanding the different stages of nephropathy can help patients and doctors choose the appropriate treatment and monitor the progression of the disease.

How is Diabetic Nephropathy Diagnosed?

The first sign of diabetic nephropathy is microalbuminuria, which is a small amount of protein appearing in the urine. A laboratory test is required to establish the diagnosis, during which the protein excretion is determined from urine collected over 24 hours. The normal value is below 30 mg/day. If the value is between 30 and 300 mg/day, it is considered abnormal, and further tests are necessary.

Additionally, kidney function should be monitored by determining the glomerular filtration rate (GFR), which indicates the kidney’s detoxification capacity. The normal GFR value is between 90-120 ml/min, and the lower the value, the more severe the kidney damage. Elevated prorenin activity levels in blood tests may also indicate an increased risk of nephropathy.

Regulating blood sugar levels plays a key role in preventing diabetic nephropathy. Measuring HbA1c levels helps doctors monitor the effectiveness of diabetes treatment. Achieving a value of 7% or lower can significantly reduce the risk of nephropathy, which is otherwise 40% among diabetics.

How to Treat Diabetic Nephropathy?

Treating diabetic nephropathy is a complex process that involves strict control of blood sugar levels. The ideal pre-meal blood sugar level is below 6.5 mmol/l, while the post-meal level should not exceed 9 mmol/l. Maintaining an HbA1c level around 7% helps slow the progression of the disease.

During pharmacological treatment, it is important to consider the use of SGLT-2 inhibitors, which not only lower blood sugar levels but also have beneficial effects on weight and blood pressure. Antihypertensive medications, especially ACE inhibitors, can also help reduce protein excretion, while aldosterone antagonist medications may also be effective.

Lipid-lowering treatments, such as HMG-CoA reductase inhibitors, also play an important role in protecting the kidneys, as they prevent the worsening of nephropathy. Additionally, a low-salt diet, regular exercise, and the cessation of smoking and alcohol consumption are essential in managing the disease.

If nephropathy has already developed, patients may have a reduced insulin requirement, and dosages need to be adjusted. During medical care, it is important for both a diabetologist and a nephrologist to be involved in the treatment. In cases of end-stage kidney disease, dialysis or kidney transplantation may become necessary, making early detection and treatment potentially life-saving.