Monday, 26 December 2011

Diabetic nephropathy

Causes, incidence, and risk factors

Each kidney is made of hundreds of thousands of small units called nephrons. These structures filter your blood and help remove wastes from your body.
In people with diabetes, the nephrons thicken and slowly become scarred over time. The kidneys begin to leak and protein (albumin) passes into the urine.

The exact cause is unknown. Poor control of blood sugar is thought to lead to kidney damage. If you also have high blood pressure, kidney damage is even more likely.
In some cases, your family history may also play a role. Not everyone with diabetes develops this kidney problem.
People with diabetes who smoke, and those with type 1 diabetes that started before age 20 have a higher risk for kidney problems.

People of African-American, Hispanic, andAmerican Indian origin are also more likely to have kidney damage.




Often, there are no symptoms as the kidney damage starts and slowly gets worse. Kidney damage can begin 5 to 10 years before symptoms start.
People who have more severe kidney disease may have a poor appetite, feel tired most of the time, and have a general ill feeling.
Headache,nausea and vomiting,swelling of the legs, and many other symptoms may also occur.
See also: End stage kidney disease

Signs and tests


Tests your doctor orders can often find signs of kidney problems in the early stages.
Once a year, you should have a urine test. It looks for a protein called albumin. Because the test looks for small amounts of albumin, it is sometimes called a test for microalbuminuria.
When you have diabetes, your doctor will test your urine for too much protein at least once a year. Too much protein is often a sign of kidney damage.

High blood pressure often goes along with diabetic nephropathy. You may have high blood pressure that begins quickly or is hard to control.
Your doctor will also check your kidneys with the following blood tests every yea



The goal of treatment is to keep the kidney disease from getting worse. Keeping your blood pressure under control (under 130/80) is one of the best ways to slow kidney damage.
Your doctor may prescribe medicines to lower your blood pressure and protect your kidneys from more damage. Often, the best types of medicine to use are ACE inhibitors and angiotensin receptor blockers (ARBs).
Eating a low-fat diet, taking drugs to control lipids, and getting regular exercise can also help prevent or slow kidney damage.