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Alternative namesKimmelstiel-Wilson disease; Diabetic glomerulosclerosis; Diabetic kidney disease
DefinitionDiabetic nephropathy is a complication of diabetes . If you have this condition, your kidney loses its ability to function properly. The condition is characterized by high protein levels in the urine.
Causes, incidence, and risk factors
Each kidney is made of more than a million units called nephrons. Each nephron has a tuft of blood vessels called a glomerulus. The glomerulus filters blood and forms urine, which drains down into collecting ducts to the ureter.
The earliest detectable change in the course of diabetic nephropathy is a thickening in the glomerulus. At this stage, the kidney may start allowing more albumin (protein) than normal in the urine, and this can be detected by sensitive tests for albumin. This stage is called "microabuminuria" (micro refers to the small amounts of albumin).
As diabetic nephropathy progresses, increasing numbers of glomeruli are destroyed. Now the amounts of albumin being excreted in the urine increases, and may be detected by ordinary urinalysis techniques. At this stage, a kidney biopsy clearly shows diabetic nephropathy.
Protein may appear in the urine for 5 to 10 years before other symptoms develop. High blood pressure often accompanies diabetic nephropathy. Over time, the kidney's ability to function starts to decline. Diabetic nephropathy may eventually lead to chronic kidney failure . The disorder continues to progress toward end-stage kidney disease , usually within 2 to 6 years after the appearance of high protein in the urine (proteinuria).
Throughout its early course, diabetic nephropathy has no symptoms. Symptoms develop in late stages and may be a result of excretion of high amounts of protein in the urine or due to renal failure:
Signs and tests
The first laboratory abnormality is a positive microalbuminuria test . This means you are very likely to develop diabetic nephropathy.
Most often, the diagnosis is suspected when a routine urinalysis of a person with diabetes shows too much protein in the urine (proteinuria). The urinalysis may also show glucose in the urine, especially if blood glucose is poorly controlled.
The goals of treatment are to slow the progression of kidney damage and control related complications.
The main treatment, once proteinuria is established, is angiotensin converting enzyme (ACE) inhibitors. This class of drugs reduces urine protein levels and slows the progression of diabetic nephropathy. Many studies have shown that related drugs, angiotensin receptor blockers (ARBs), have a similar benefit. In fact, a combination may be best.
Contrast dyes that contain iodine are excreted through the kidney. They may worsen an already reduced glomerular filtration rate, and should be avoided if possible. If they must be used, fluids should be adequate to allow their rapid excretion.
Commonly used non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, or Cox-2 inhibitors like Celebrax or Vioxx, may injure the weakened kidney. A physician must always be consulted before using any drugs, but especially these.
Diabetic nephropathy continues to get gradually worse. Complications of chronic kidney failure are more likely to occur earlier, and progress more rapidly, when it is caused by diabetes than other causes.
Even after initiation of dialysis or after transplantation, people with diabetes tend to do worse than those without diabetes.
ComplicationsPossible complications include:
Calling your health care provider
Call your health care provider if your health care provider if you have diabetes and a routine urinalysis shows protein.
Call your health care provider if you develop symptoms of diabetic nephropathy, or if new symptoms develop, including little or no urine output .
PreventionBlood glucose levels should be controlled as closely as possible in people with diabetes. Controlling blood pressure, cholesterol, and weight is just as important.
Update Date: 11/1/2003Irfan A. Agha, M.D., Department of Medicine, Renal Division, St. Louis University, St. Louis, MO. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT