Nephropathy
Also called Kimmelstiel-Wilson disease; Diabetic glomerulosclerosis or Diabetic kidney disease.
Our kidneys are basically filters. They are made up of millions of units. Each of these units, called nephrons, has a collection of blood vessels called a glomerulus. The blood that enters the glomerulus is 'cleaned' of waste products, which filter through the capillary walls.
These waste products pass via collecting ducts to the urethra and are voided in the urine, while the clean blood, with it's compliment of red cells and proteins etc, which are too large to pass through the walls, continues on it's merry way around the body. A very useful and extremely efficient system - when it works!
When something goes wrong and the kidney is no longer able to function properly nephropathy develops, but this is a slow and insidious process and can go un-noticed for years.
High blood sugars can cause the kidneys to overwork. They have to filter too much out of the blood and get tired and weak.
The glomerulus, sort of like old over-stretched elastic bands, become porous and begin to leak. The larger proteins pass through the walls and appear in the urine.
At first the amount of protein is small and the term for this stage is microalbuminuria. It requires sensitive tests for albumin to pick up the problem at this stage.
For this early stage of kidney disease there are a number of treatments.
For instance Angiotensin Converting Enzyme (ACE) Inhibitors can be taken. These have been shown to reduces protein levels in the urine and slows the progression of diabetic nephropathy.
Angiotensin receptor blockers (ARBs) seem to work in a similar way and sometimes a combination of the two is prescribed.
ACE Inhibitors have the added benefit of lowering blood pressure and this is an important factor as high blood pressure speeds up the progress of nephropathy.
Blood sugars need to be carefully controlled and as always diet and exercise are important.
Untreated microalbuminuria could progress to macroalbuminuria. A larger number of glomerulus are destroyed and the protein in the urine has increased to the point where it can be detected by simple urinalysis tests.
At this point Nephrotic Syndrome may develop. What this means is that so much protein leaks into the urine that the protein levels in the blood fall.
Gradually the kidneys function less and less well. They loose their ability to excrete wastes or concentrate urine and electrolytic conservation is compromised.
This can be a slow process with few symptoms, barring the protein in the urine. This then progresses to what is termed end-stage renal disease" (ESRD).
Symptoms that appear in late stage nephropathy:-
1. Swelling. This manifests first as a swelling around the eyes when you get up but can spread to the legs and then to overall swelling of the body.
2. Urine appears very frothy.
3. Weight gain despite loss of appetite, caused from retained fluid.
4. Fatigue.
5. Nausea and vomiting.
6. Hiccuping a lot.
7. Itching.
8. Frequent urinary tract infections.
9. No or decreased urine output.
10. Skin pigmentation changes - looks yellow or brown.
11. Mental confusion.
12. Loss of sensation in extremities.
End-stage renal disease requires continual treatment with dialysis to remove the toxins, or fluids and waste products will accumulate in the body and death will result.
As a last resort there is the option of a kidney transplant.
Type 1 diabetes patients may need to consider a combined kidney-pancreas transplant.
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