Diabetic Nephropathy

Diabetic nephropathy is a type of kidney disease caused by diabetes. This disease can occur in people with type 1 or type 2 diabetes. The longer a person has diabetes or if there are other risk factors, such as hypertension, the greater the risk of diabetic nephropathy. high.

Symptoms of diabetic nephropathy

In the early stages of development, diabetic nephropathy often has no symptoms. However, if kidney damage continues, a number of symptoms will appear on their own, such as:

• The frequency of urination increases or vice versa.
• itchy
• Loss of appetite.
• Insomnia.
• transmission
• Eyes swollen.
• Nausea and vomiting.
• Swelling of the arms and legs.
• Difficult to concentrate.
• There is protein in the urine and foamy urine.

Causes of diabetic nephropathy
Diabetic nephropathy occurs when diabetes causes damage and scar tissue forms in the nephron. Nephron is the part of the kidney that filters blood waste and removes excess fluid from the body. Besides disrupting its function, the damage causes a protein called albumin to be wasted in the urine and not reabsorbed.

It is not yet known why the above conditions occur in people with diabetes, but are thought to be related to high blood sugar levels and high blood pressure, both of which can interfere with kidney function.

In addition to uncontrolled hyperglycemia (hyperglycemia) and high blood pressure (hypertension), other factors that can increase the risk of diabetic nephropathy include:

• Smoke.
• Type 1 diabetes before the age of 20 years.
• Suffer from hypercholesterolemia.
• Overweight
• Have a family history of diabetes and kidney disease.
• Suffer from other diabetes complications, such as diabetic neuropathy.

Diagnosis of diabetic nephropathy

Doctors can suspect patients with diabetic nephropathy if diabetics have a number of symptoms described above. But certainly, doctors can do additional tests to check kidney function, such as:

• BUN (blood urea nitrogen) or urea test. This test aims to measure the level of urea nitrogen in the blood. BUN is metabolic waste that is usually filtered by the kidneys and excreted in the urine. Normal BUN levels depend on age and sex, namely 8-24 mg / dL in adult men, 6-21 mg / dL in adult women, and 7-20 mg / dL in children. 1 to 17 years.
• Creatinine test. This test is done to measure creatinine levels in the blood. Like urea nitrogen, creatinine is also a metabolic waste that is usually removed by urine. In general, normal creatinine in people aged 18 to 60 ranges from 0.9 to 1.3 mg / dL for men and 0.6 to 1.1 mg / dL for women.
• LFG test (glomerular filtration rate). LFG test is a type of blood test that is done to measure kidney function. The lower the LFG value, the worse the kidney's function in filtering waste, as explained below:

• • Stage 1 (LFG 90 and above): The kidneys are functioning properly.
  • Stage 2 (LFG 60-89): slight changes in kidney function.
  • Stage 3 (LFG 30-59): Impaired kidney function in the intermediate stage.
  • Stage 4 (LFG 15-29): severe impairment of kidney function.
  • Stage 5 (LFG 15 and below): kidney failure.
  
  Microalbuminuria urine test. Patients may be suspected of suffering from diabetic nephropathy if the urine contains a protein called albumin. The test can be done by taking a random sample of the patient's urine in the morning or for 24 hours. The level of albumin in the urine is still quite normal if it is less than 30 mg. Although albumin levels between 30 and 300 mg (microalbuminuria) indicate a state of early kidney failure. If more than 300 mg (macroalbuminuria), the condition indicates that kidney disease has become more severe.
  Imaging test. The doctor can do an ultrasound of the kidneys or X-rays to determine the structure and size of the patient's kidney. CT and MRI can also be used to assess the state of blood flow in the kidneys.
  Kidney biopsy. If necessary, the doctor can take a small sample of tissue taken from the patient's kidney. Samples will be taken with a thin needle and examined using a microscope.
  
  Treatment of diabetic nephropathy
  
  Diabetic nephropathy cannot be treated, but its development can be prevented from getting worse. This treatment aims to control blood sugar and high blood pressure. Treatment methods include administering drugs, such as:
  
  
  • Angiotensin-converting enzyme (ACE inhibitor) or angiotensin II receptor blocker (ARB) to reduce high blood pressure while preventing albumin leakage in the body. urine
  • Hypocholesterolemia drugs, such as statins, to treat high cholesterol, one of the risk factors for diabetic nephropathy.
  • Insulin, to reduce blood sugar levels.
  
  In addition to providing medicine, the doctor will also encourage patients to adopt a more restrictive diet. Among them, limiting protein intake, reducing sodium or salt intake to less than 1500-2000 mg / dL, limiting consumption of potassium-rich foods, such as bananas and avocados, and limiting consumption of phosphorus-rich foods, such as yogurt, milk, and processed meat.
  
  If a patient with diabetic nephropathy has advanced renal insufficiency, the doctor may advise him to undergo kidney replacement therapy. This procedure aims to cleanse the blood of metabolic waste. Kidney replacement therapy can be in the form of machine dialysis (hemodialysis) 2 to 3 times a week, dialysis by the stomach or peritoneal dialysis (CAPD), or kidney transplantation.
  Prevention of diabetic nephropathy
  
  Diabetic nephropathy can be prevented by improving lifestyle through simple steps, such as:
  
  
  • Treat diabetes well. Good diabetes management can delay or even prevent diabetic nephropathy.
  • Maintain blood pressure and general health. People with risk factors for diabetic nephropathy are advised to consult a doctor regularly to find out signs of kidney disease.
  • Follow the instructions for using the medicine. Use medication properly, especially if diabetic nephropathic patients take painkillers in the class of nonsteroidal anti-inflammatory drugs. The use of drugs that do not comply with the instructions can cause kidney damage.
  • Maintain ideal body weight. Exercise regularly several days a week to maintain ideal body weight. For obese people, ask your doctor to find out how to lose weight properly.
  • Quit smoking. Cigarettes can damage the kidneys and worsen the condition of the damaged kidney. 
  Complications of diabetic nephropathy
  
  Diabetes nephropathy is the most common cause of end-stage renal failure or chronic kidney failure in Indonesia and throughout the world. In Indonesia alone, 52% of dialysis patients experience diabetic nephropathy.
  
  Other complications of diabetic nephropathy, which can develop progressively over several months or years, include:
  
  
  • Open wound in the leg.
  • Anemia or lack of red blood cells.
  • A sudden increase in blood potassium (hyperkalemia).
  • Fluid retention can cause swelling of the hands, feet or lungs (pulmonary edema).

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