Diabetes can lead to renal failure

Diabetic nephropathy (diabetic kidney disease) is one of the chronic vascular complications of diabetes, which tends to develop after several years of diabetes and results in progressive loss of kidney function.

Diabetes can lead to renal failure 300x199 Diabetes can lead to renal failureThe overall risk of developing diabetic nephropathy varies between 10 per cent of Type 2 diabetic individuals to about 30 per cent of Type 1 diabetic individuals. The final stage of nephropathy is called end-stage renal disease (ESRD). Diabetes is the most common cause of ESRD, accounting for 30 to 40 per cent of all such cases.

Diabetic nephropathy usually progresses slowly through several stages. While in stage 1, there is elevation in the glomerular filtration rate, in stage 2, it progresses to Microalbuminuria. By the time a patient reaches stage 3, there is fluid retention and loss of large amounts of protein. In stage 4, the kidneys become less able to remove poisons from the blood resulting in a build-up of chemicals such as urea and creatinine. This is known as chronic renal failure. By stage 5 ESRD sets in decreasing urine output and renal replacement therapy is required.

Microalbuminuria in the range of 30-299 mg/24 hour has been shown to be the earliest detectable and treatable stage of diabetic nephropathy and is also a significant marker for cardiovascular diseases in both diabetic and non-diabetic individuals.

However, not everyone with diabetes gets nephropathy. In fact, over 50 per cent of diabetic patients will never develop kidney disease even if their blood sugars are poorly controlled. Some of the modifiable risk factors for diabetic nephropathy depend upon the quality of health care.

Although there are no symptoms in the early stages they may manifest when the kidney disease has progressed.

* Edema of the body
* Weight gain due to fluid retention
* Tiredness
* Poor appetite
* Nausea
* Itching
* Increase in blood pressure
* Troubled sleep

The keystone in the prevention of diabetic nephropathy is good blood glucose control. It can prevent its development and progression as well as prevent other complications.

Blood pressure control is the most important factor to reduce the rate of progression of renal disease. Both systolic and diastolic hypertension markedly accelerates the progression of diabetic nephropathy.

When end-stage kidney failure is reached, dialysis and transplantation are the only treatment options. Early detection and treatment can slow the rate of kidney damage and significantly lengthen the time required to reach the stage of dialysis or renal transplant. Today, because of better control of diabetes and improved rates of survival, physicians don’t hesitate to offer dialysis and kidney transplantation to people with diabetes.

* Optimise glucose and blood pressure control.
* Angiotension-converting enzyme therapy.
* Controlling blood lipids and cholesterol.
* Diet modification.
* Cessation of smoking.

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