Treatment of Diabetic Nephropathy

What about Hypertension in Diabetic Patients ?

Diabetic patients frequently have hypertension (high blood pressure) also. Uncontrolled blood pressure (BP) worsens diabetic kidney disease faster.

Since the filter is already leaking proteins, creation of additional pressure inside the filter (in the form of high blood pressure), will further make it leakier.

The damage to kidneys is even worse with severe ‘spikes’ of rise in BP needing hospitalization.

What precautions should a patient with diabetic kidney disease take ?

no smokeSmoking should be strictly avoided by everyone, let alone a diabetic with kidney disease. Constituents of the ‘smoke’ damage the inside lining of blood vessels and narrow them. Similar changes occur in the glomerulus and if it is already affected by diabetic changes, the affection gets worse. Diabetic kidney disease progresses rapidly in smokers compared to non-smokers.
Over-the-counter (OTC) medications, pillsespecially pain killers should be avoided by patients with kidney diseases. They have significant allergic potential causing kidney damage. This is, however, reversible if detected early. If taken on long term basis, pain killers can damage the kidneys beyond repair.
Diabetics, especially women, are prone to urinary tract infections (UTI). If the sugar control is optimum and personal hygiene is maintained, incidence of UTI is less.

When manifest, it can be severe enough to need hospitalization and rarely abscesses (pus collections) are detected inside or around the kidneys. Surgery may be needed in such situations.

Who should be screened for diabetic kidney disease ?

screeningEarly detection is of utmost significance. Since loss of proteins in urine is completely asymptomatic till it assumes large proportions, screening of individuals at risk becomes extremely important.

Diabetics, whether type 1 or type 2, are expected to be screened for kidney involvement at the time of diagnosis. This includes a routine urine test to detect loss of proteins in urine and the level of creatinine in blood to determine kidney function.

An eye check will show the status of blood vessels of retina at that stage.

If there is no protein detected in the urine on a routine test, special test for detection of microalbuminuria must be done, especially if eyes show abnormalities in retina.

What is the Treatment ?

Treatment involves a very strict control of sugar levels and blood pressure.

The recommended targets for BP must be actively sought and the need to achieve them can never be overemphasized. Awareness is yet to arrive regarding these BP targets in practice. Most patients are content with achieving readings of 140/90 mmHg and are averse to suggestions in further reductions in BP. This has to be overcome and optimum BP control achieved. target

The target BP in diabetics is 130/80 millimeters of mercury (mmHg) and  it is 125/75 mmHg if the patient has protein loss in urine.
Similarly a ‘comfort zone’ of blood sugar level is often stuck to and the real target sub optimally achieved.

The fasting Sugar level must be between 90 and 110 mg % and definitely never above 120 mg%.

As discussed previously, if these two ‘figures’ (of BP and sugar) are achieved consistently over a long period of time, onset and progression of diabetic kidney disease can be delayed significantly, eventually translating into productive longevity.

Role of Diet

dietDiet restrictions should be adhered to, which contribute to better management of blood sugar levels and BP.

Commonest restrictions involve intake of common salt, protein containing food, fat containing food and of course, sugar.

A situation unique to kidney diseases, is the need to restrict potassium-containing food and largely involves the fruits, artificial flavors and salt substitutes.

Click here for details on diet.

Dialysis or Transplantation

When kidney functions fall below 10% of normal, dialysis needs to be started.

Better still, kidney transplantation should be sought if medically and financially feasible.

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