Diabetic Nephropathy, nephropatia diabetica also called as Kimmelstiel-Wilson syndrome is a kidney disease. Angiopathy of capillaries in the kidney glomeruli causes this disease.
Symptoms
At the early stage of this type, there are no symptoms. However, in later stages, the high amount of protein secretion in urine or renal failure can be sign and symptoms of this disease. Protein is not found in urine except in high fever, strenuous exercise, pregnancy, or infection. In type 1 diabetes, it can find at the test, the disease has developed for 05 to 10 years, and in type 2, it may find small amount of protein in urine, as because patients in this category are suffering for several years. Increased blood pressure, fluid retention in the body, and reduced plasma (oncotic pressure) are causes edema. Perhaps the other complications are arteriosclerosis of the renal artery and proteinuria.
Therefore, the common symptoms can be edema including swelling around the eyes in the morning, in the legs and later through out the body. Foamy appearance or excessive frothing of the urine due to proteinura, unintentional weight gain, poor appetite, nausea and vomiting, malaise, fatigue, headache, frequent hiccups and itching develop all at later stage.
The first abnormality is a positive Microalbuminuria test. Diagnosis of a routine urinalysis of a diabetic shows much protein in Urine. The urinalysis perhaps shows glucose in urine, when blood glucose is controlled without care. Serum creatinine and bun help kidney damage develop.
Treatment
Being proteinuria stable, the ACE inhibitor drug reduces proteinuria levels and shows the development of diabetic nephropathy. The side effect of ACEI is dry cough. Based on different studies, the related drugs, angiotensin receptor blockers (ARBs) have a similar benefit. ONTRAGE study reveals that combination therapy is appears to be worst major renal outcomes, including increased level of serum creatinine and declined glomerular filtration rate, eGFR.
Blood glucose level can be closely monitored and controlled. It may slow the progression of the disorder at early stage. Medications for managing diabetes can be oral hypoglycemic agents and insulin injections. Less insulin is to control glucose level.
Diet modification is required to control blood sugar level. Modification of protein intake can be effective for hemodynamic and non-hemodynamic injury.
High blood pressure can aggressively be treated with antihypertensive medications; it is treated because of reducing the risks of kidney, eye and blood vessel damage in the body. It is important to control lipid levels, maintaining a healthy weight and engaging in regular exercise.
The patients suffering from diabetic nephropathy have to avoid taking some drugs. These are contrast agents containing iodine, non-steroidal anti-inflammatory drugs, NSAIDs including ibuprofen, and naproxen or COX-2 inhibitor including celecoxib. These drugs perhaps injure the weakened kidney. A combined kidney pancreas transplant can be an option for Type 1 diabetes patients.
Patients suffering from diabetic nephropathy can hope for a bi-product of insulin, C-peptide.
Several compounds are developing for kidney disease including bardoxolone methyl, olmesartan medoxomil, sulodexide, and avosentan.
