Diabetic nephropathy, which occurs after several years of diabetes, causes a deficiency in filtration of the kidneys. To prevent and treat this disease, it is essential to strictly control the blood sugar and blood pressure of the patient. 

Nephropathy includes all diseases of the kidneys. Diabetic nephropathy occurs after years of diabetes attacking the filtration part of the kidneys.

Raised blood sugar levels, or “hyperglycaemia,” affect how small blood vessels work and how well the kidney works.

The prevalence of kidney failure is about 40% in patients with type 1 diabetes mellitus. In type 2 diabetes mellitus, the prevalence of kidney failure is usually estimated at 20 to 30%. Diabetic nephropathy is the most common cause of end-stage kidney disease in the United States, accounting for up to 80% of cases.

Kidney failure is particularly common in certain ethnic groups, such as African Americans, Mexican Americans, Polynesians, and Pima Indians.

Male sex, smoking, age are risk factors. Obesity, sedentary lifestyle, high cholesterol are cardiovascular risk factors that can also worsen the situation.

The diagnosis is made on urine tests which show high proteinuria and high cholesterol and triglycerides.

Except very late in the disease, when blood pressure can become high, nephropathy does not show clinical signs. This is why it is important to have regular screening (every year) in people with diabetes.

During screening tests, we look for the presence of albumin in the urine (microalbuminuria) which makes it possible to demonstrate a dysfunction of the kidneys. 

In advanced stages, signs of renal failure appear (nausea, vomiting, anorexia, etc.).

To fight against diabetic nephropatie it is essential to protect the kidneys. Several recommendations for this:

• Strict blood sugar control. Indeed a bad balance of diabetes favors the appearance or the evolution of nephropathy.
• Blood pressure control. Indeed, arterial hypertension appears as soon as albuminuria rises and will constitute a factor of aggravation of nephropathy and acceleration towards chronic renal failure.
• “Nephroprotective” treatments will limit and delay the progression of the disease.
• Hepatitis B vaccination
• A reduction in the protein intake
• Diabetic nephropathy can lead to end stage renal disease, requiring dialysis or kidney transplantation.

Annual screening is essential for people with diabetes in order to detect kidney dysfunction as quickly as possible. 

The development of nephropathy is directly linked to blood glycemic balance, close control of blood glucose limits the risk of nephropathy.

Tobacco should be stopped because of its toxicity to the kidney. It is also necessary to fight against cardiovascular risk factors such as obesity or sedentary lifestyle.