Overview

Diabetic nephropathy is a complication of diabetes characterized by increased protein levels in urine. It is caused by the destruction of glomeruli, those small clusters of blood vessels in the kidney that filter blood and form urine. Diabetic nephropathy is the most common cause of chronic kidney disease in the US.

Early stage diabetic nephropathy has no symptoms. Protein may appear in the urine for 5-10 years before other symptoms develop, namely: fatigue, swelling of both lower legs, and swelling around the eyes, foamy urine, among others. Most often, the diagnosis is suspected when a routine urinalysis shows abnormally increased levels of protein.

The goal of treatment is to slow down the progression of kidney damage. This is achieved by controlling blood glucose levels and blood pressure by means of a healthy diet, exercise, hypoglycemic pills, and anti-hypertensive drugs. When end-stage renal disease develops, dialysis and kidney transplant are now a consideration.

Impact On Life Expectancy

Diabetic nephropathy has no symptoms, and protein may appear for 5-10 yrs prior to the appearance of an abnormally high protein and other symptoms. However, when high blood pressure appears and large amounts of protein are excreted, the kidneys’ ability to function starts to decline, leading to chronic kidney failure, which in turn may progress to end-stage renal disease (ESRD) within 2-6 years after the appearance of high protein in urine. Even with dialysis, people with diabetes and ESRD have a worse prognosis than those without. About 23% of diabetics with ESRD die every year, with 5, 10 and 20-year survival rates at 87, 82 and 78%, respectively. Despite the advent of dialysis, most patients with advanced kidney failure die within 5-10 years.

Care Needs

When kidneys fail, the goal of treatment is to be able to do the work of “cleaning” the blood by removing excess fluids, minerals and wastes. A patient may die when toxic wastes accumulate and are not removed from the body. This is achieved by dialysis, an artificial way of removing waste from the blood, which also helps prolong life in ESRD. Current efforts focus on home dialysis and an alternate day dialysis schedule, to make it easier for patients.

A kidney transplant is usually a better option because it provides a better quality of life. However, finding a compatible donor is difficult and the wait can last for many years and the operation can be quite expensive. But once a new kidney is in place, as long as rejection does not occur, the patient is given a new lease on life.