The deterioration of kidney functions is referred to by the term nephropathy. Higher risk of nephropathy is found in the people with diabetes. According to the reports of Centers of Disease Control and Prevention (CDC) almost 1 in 3 adult patients of diabetes have the early signs of kidney disease present in them. The complications of diabetes can be responsible for  enhancing the cardiovascular disease and high blood pressure, which are common in the diabetes patients and if these complications remain untreated then they may ultimately result in the failure of calamitous organ failure. It is very important for the Diabetic patients to maintain and monitor the health of their kidneys. 

What does Diabetic kidney disease mean? 

Diabetic kidney disease is the kidney disease which is caused due to the build up of high glucose levels over the time.

The chance of developing kidney disease  in the patients of diabetes depends upon which type of diabetes they have,there are two types of diabetes disease which are type 1 diabetes (T1D) and type 2 diabetes T2D). People with type 2 diabetes (T2D) have the higher chances of kidney disease development in them which is appropriately 40 percent. People with type 1 diabetes (T1D) have less chances  of kidney disease development in them as compared with the people of type 2 diabetes (T2D). It is seen that the middle- aged Native Americans, Hispanics and African American are at the higher risk of kidney disease development in comparison to the general population of diabetic patients. 

Kidneys help our body in performing many types of complex functions such as filtering blood and removing the waste substances from it in the form Inn urine, regulating the amount of salts and minerals in our body, producing specific hormones which maintains blood pressure, makes red blood cells, and keeping our bones healthy and strong. 

The increased levels of glucose can damage our kidneys blood vessels over time and make our kidney function slow and weak. After reaching a specific level the damage leads to kidney disease. 

If this damage to the kidney remains untreated for a long time then it may result in kidney failure, in which the kidney gets completely unable to perform its functions. In this case the functions of the kidney will be performed with the help of regular dialysis sessions or a kidney transplantation will be required for performing the necessary functions in the body. 

Lastly at the worst situation nephropathy can result in end stage renal disease (ESRD),  an ultimate calamitous organ failure.

Lab tests for diagnosing diabetic kidney disease

There are no clear symptoms that are visible in the early stage of nephropathy. 

Some symptoms of nephropathy which might be visible includes:

• Upset stomach 
• Appetite loss 
• Fluid retention 

The symptoms which are mentioned above are not completely accurate for proving any kidney issue in your body. 

For monitoring kidney health and diagnosing diabetes related health issues and kidney disease a dual urine and blood test is performed. 

Microalbuminuria and urine samples 

The amount of proteins in your urine is checked through taking a sample of the  urine. 

Albumin is one from those proteins, which is produced by the liver and is present in your blood plasma. Albuminuria is a term which denotes the presence of albumin protein in the urine and it is the signal of kidney damage or disease. Microalbuminuria can be defined as the excretion of 30- 300 milligrams or 20-200 milligrams per day, it is also the early sign of vascular damage. 

Higher risk of cardiovascular vascular disease and early kidney disease is present in microalbuminuria. If your doctor feels that you are at high risk of kidney damage or disease they may suggest a microalbuminuria test. 

eGFR measurement of kidney function

Estimated glomerular filtration rate (eGFR) in you is calculated with the help of your blood sample. 

Creatinine, which is one of the waste substances from muscle use, is measured on the basis of creatinine levels of blood, age, gender and the size of body, for determining person’s (eGFR) a calculation is performed. One measure of the kidney function is provided by the estimated glomerular filtration rate (eGFR). It also helps the people who are suffering from any type of kidney issue to identify which stage kidney disease they have. 

Some controversies are there about estimated glomerular filtration rate (eGFR). 

The process of measuring creatinine is doubted about its authenticity on African Americans. There are certain readings which are established for the African American people because they usually have higher muscle mass than other people taking this test- unless the person’s actual body build. 

According to the National Institutes of Health (NIH), National Kidney foundation and American society of nephrology a change is required in the process of estimated glomerular filtration rate (eGFR) calculation, for eliminating inherent  racial partiality.

Annual kidney screening for people with diabetes 

It is recommended by the American d

Diabetes Association’s 2022 standards of care state that people with T2D should attend kidney screening tests annually and people with T1D should attend kidney screening tests beginning 5 years after diagnosis. 

A patient of kidney disease may require to attend screening tests more frequently for tracking their kidney’s overall health and progression of their kidney disease. 

How to stop kidney diabetic disease

If the treatment of nephropathy begins in the early stage of its progression can be slowed or stopped, in some cases it can even be reversed. 

A number of factors are present in which the effectiveness of the treatment depends such as early detection of symptoms and sedulous health care management. 

Some ways for actively managing kidney health are mentioned below: 

• Reduce alcohol intakes 
• Avoid smoking 
•  Manage stress 
• Maintain a decent blood pressure. 
• Lead a healthy life 
• Reduce the amount of protein, potassium and sodium that should be taken in diet. 
•  Maintain a decent glucose level. 
• Avoid specific medications

One of the most appropriate ways for maintaining good kidney health is to balance the amount of glucose in blood and maintain blood pressure. Balancing the amount of glucose in blood and maintaining blood pressure will help you keep your kidney healthy and reduce the chances of diabetes and hypertension progression.  

Some types of medications which helps in the management of kidney health and functions includes: 

• Finerenone: It is the type of nonsteroidal mineralocorticoid receptors antagonists, which is helpful for stopping the progression in patients who are unable to consume SGLT2 or in patients who have higher chances of kidney disease or cardiovascular issues. 
• SGLT2 inhibitors and GLP1 receptors agonists: It is the type of medication in which the kidney is protected while levels of glucose are down in the body.
• Diuretics: These are the medications which help our body in the removal of extra fluids from it.
• Cholesterol lowering medications: These are the medications which support cardiovascular health. 
• Angiotensin- converting enzymes (ACE) inhibitors or angiotensin receptor blockers (ARBs): These medications are used for reducing the blood pressure in the body. 

How to treat diabetic nephropathy 

Stages of diabetic kidney diseases 

There are five stages of diabetes related kidney diseases.  Each of these stages is classified on the basis of eGFR level. Generally higher eGFR levels are better  than lower eGFR levels. 

Stage 1: In this stage no symptoms appear and the stage in the levels of  eGFR is (90+). 

Stage 2: In this stage no specific symptoms are present and only a mild decrease in  the condition of the kidney can be noticed. In this stage the eGFR levels are between 60 to 89. 

Stage 3:  In this stage some symptoms such as brown urine, puffiness and water retention might appear and moderate decrease in the kidney condition can be noticed. In this stage eGFR levels are between 30 to 39. 

Stage 4: In this stage symptoms are clearly visible and severe decrease in kidney condition can be noticed. In this stage eGFR levels are from 15 to 29.

Stage 5:  In this stage the kidney completely stops performing its functions and eGFR are below 15 which results in kidney failure.  At this stage kidney transplant or dialysis will be required. 

From stage 1 to 4, a proper management of kidney health and sedulous medications may result in some positive effects. 

However at stage 5, the kidney will completely stop performing its tasks then after more complex treatment will be required. 

Kidney dialysis for nephropathy 

The treatment of dialysis requires a minimum of 4 hours or even more than that distinct days a week. 

Generally dialysis treatment is performed at a treatment center and needs the patient to sit quietly while connected with the dialysis machine in order to filter the blood. 

Kidney transplant for diabetes related complications

Major surgery is needed in kidney transplant with expansive pre-operative and post-operative care. It can be very much difficult and expensive to find a compatible organ donor. The average kidney transplantation costs around 6 lakhs to 10 lakh rupees in India. 

Take away 

One of the most serious potentially life threatening complications of diabetes is nephropathy. However, diabetes related kidney disease cannot be the cause of death if kidney health will be managed with the association of healthy apparel, medications and monitoring.