Untreated diabetes leads to serious kidney disease. What is nephropathy?

Complications affecting the kidneys appear as a consequence of metabolic incompetence of diabetes – especially with the existence of such a condition for many years, which leads to changes throughout the body – writes Prof. dr hab. n. med. Dorota Zozulińska-Ziółkiewicz, president of the Polish Diabetes Society.

1. Every 6 seconds a person dies in the world from diabetes and its complications, and one in two is under 60
2. The most serious complications of diabetes are those that cause a diabetic patient to die prematurely; a dies mainly of cardiovascular disease
3. However, it is important to be aware that all complications of diabetes are causal, leading to disability and premature death.
4. More information can be found on the Onet homepage

Diabetes complications are always dangerous

We divide the complications of diabetes into acute and chronic. Acute complications of diabetes are a direct life-threatening condition and are therefore dangerous. These include hypoglycemia and acute hyperglycemic states, i.e. diabetic ketoacidosis and hyperglycemic-hypermolar states. The risk of hypoglycaemia is mainly increased in patients treated with insulin. Diabetic ketoacidosis is a consequence of absolute insulin deficiency and most often affects people with type 1 diabetes.

1. Also check: «Silent epidemic». A child with diabetes is already in every school in Poland

Chronic complications of diabetes mellitus can be defined as diabetes-specific neurovascular complications because they involve the nervous system and the vessels. The earliest organ manifestation of neurovascular complications is observed at the fundus (diabetic retinopathy). Through the stages of advancement, the disease leads to blindness.

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Another serious neurovascular complication is diabetic kidney disease, which is defined by increased urinary albumin excretion and a decrease in glomerular filtration. This ultimately results in kidney failure. Another chronic complication of diabetes is neuropathy, most often in the form of sensorimotor polyneuropathy or neuropathy of the autonomic system. The clinical manifestation of multiple diseases is the diabetic foot syndrome. Patients with diabetic foot syndrome often have comorbid retinopathy, diabetic kidney disease, neuropathy, atherosclerotic cardiovascular disease, and periodontal disease. Chronic complications of diabetes are therefore multiorgan, but due to various individual conditions their clinical manifestation is also different.

Diabetic nephropathy – complication almost unknown

As a rule, patients are aware of such consequences as diabetic foot, diabetic retinopathy, but we observe a lack of awareness about diabetic nephropathy. This is partly because kidney failure may not be symptomatic for many years. And if diagnostic tests are not performed, the person with diabetes may not know that the complications of diabetes also manifest in the kidneys. Hence the lack of widespread awareness of the existence of diabetic nephropathy.

The mechanism of development of diabetic kidney disease is complex, and the spectrum of clinical symptoms of diabetic kidney disease is wide – from no symptoms to symptoms associated with high protein loss in the urine (generalized swelling, foaming urine) and symptoms characteristic of severe kidney failure (mood changes, weakness, lack of appetite, disgust in the mouth, nausea and vomiting, skin changes, anemia).

Diabetic nephropathy can and must be prevented

We can prevent the development and progression of diabetic kidney disease as well as other complications of diabetes. The key to success is: educating the patient and motivating him to follow medical recommendations – from the moment of diagnosis. The patient should strive for a very good metabolic control, i.e. should take care to maintain normoglycaemia (normal blood glucose levels), normolipemia (normal blood lipids levels) and normotension (normal blood pressure) and a healthy body weight. He should undertake systematic physical exertion, do not smoke cigarettes and use drugs recommended by a doctor that have a proven protective effect on the kidneys. Phosphines and GLP-1 analogues have proven nephroprotective effects among antihyperglycemic drugs.

It is worth knowing that genetic conditions, long duration of diabetes mellitus, persistently high blood glucose levels above the renal threshold, large daily glucose fluctuations, insulin resistance, hypertension, and smoking are factors of an increased risk of developing and progressing diabetic kidney disease.

Early diagnosis of diabetic kidney disease – the key to longer life

An early diagnosis of diabetic kidney disease is crucial for successful therapy. Detecting, thanks to screening tests, the increased excretion of albumin in the urine in the amount formerly referred to as microalbuminuria and the implementation of corrective mechanisms eliminating risk factors give a chance for the changes to regress. For this reason, tests for diabetic kidney disease should be performed in a person with type 1 diabetes no later than five years after diagnosis, and then performed annually. However, in patients with type 2 diabetes – performed annually after the diagnosis of the disease.

Glomerular filtration (eGFR) and urinary albumin excretion (ACR) are assessed for the diagnosis of diabetic kidney disease. It is necessary to carry out both studies, because one does not eliminate the value of the other – they are complementary studies. It should also be emphasized that both albuminuria and eGFR are independent cardiovascular and renal risk factors in diabetic patients. The size of the eGFR determines the stages of chronic kidney injury. Importantly, in a diabetic patient, the CKD-EPI formula ( Chronic Kidney Disease Epidemiology Collaboration), taking into account gender and serum creatinine concentration.

I would like to emphasize that the systematic performance of tests that define diabetic kidney disease is very important as it allows to determine the effects of therapeutic measures to protect the kidneys and increase the safety of antihyperglycemic therapy.

The article comes from the educational campaign “Diabetes under control” prepared by Warsaw Press. All materials can be found on http://www.warsawpress.com/

Also read:

1. Five signs that you should have your blood sugar checked
2. He saved the lives of millions of people. Previously, diabetes was a death sentence
3. Earliest Diabetes Symptoms. If you miss it, run for a checkup
4. Unusual Diabetes Symptoms You Need to Know

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