NephropathyTuesday, June 30, 2009
What Is Nephropathy?
Nephropathy, or kidney disease, can result as a complication of diabetes. Diabetes is the most common cause of kidney failure. It occurs when the kidneys do not function properly and cannot rid the body of waste.
Kidneys work on many levels. They clean our blood by removing waste and protein, along with excess fluids and minerals. They also make hormones that target bones and blood cells, keeping each strong and healthy. When the kidneys do not work properly, blood pressure can rise, causing poor waste management in our body and diminishing our ability to create red blood cells.
What Causes Nephropathy?
High blood pressure can significantly contribute to the development of kidney disease. And, kidney disease itself can create high blood pressure, thus creating a cyclical effect. Factors that lead to diabetic nephropathy include heredity, diet and other medical conditions such as high blood pressure.
High blood sugar levels, another cause of nephropathy, can cause the kidneys to filter too much blood. Over time, this overworks the kidneys and might cause protein and waste to leak into the urine.
A small amount of protein in the urine (called microalbuminuria) signals the beginning of kidney disease. At this stage, early diagnosis can lead to treatment that can help prevent the disease from worsening.
If the disease goes unnoticed until large amounts of protein leak into the urine (called macroalbuminuria), end stage renal disease (ESRD) often follows. Treatment of ESRD requires a kidney transplant or kidney dialysis.
How Do You Know If You Have Nephropathy?
Kidney disease usually produces no symptoms until damage has already occurred. However, a check of protein levels in your urine or of waste products in your blood can alert your doctor if kidney problems exist.
The first symptom of kidney disease is often fluid build-up.
Other symptoms of kidney disease might include:
- Difficulty sleeping
- Poor appetite or upset stomach
- Nausea and vomiting
- Difficulty concentrating
- Swelling, most often around the eyes when you wake up, but later, the legs or entire body may swell
- Weight gain from fluid build-up
- Extra frothy urine
- Frequent hiccups
How Do You Treat Nephropathy?
The goals of treatment are to slow the progression of kidney damage and control related complications. Even a slight rise in blood pressure can make kidney disease worsen, so it is important to keep your blood pressure under control. To help do this, exercise regularly, lose weight, eat less salt, and eliminate the use of alcohol and/or tobacco. If your doctor prescribed blood pressure medication, take it regularly as directed.
Several major studies indicate that ACE inhibitors, such as enalapril or captopril, help slow down kidney disease while lowering blood pressure. Other important studies suggest that diuretics can help. A low-protein diet might also help, but talk with your doctor before you begin.
If nephropathy damaged your kidneys so badly that they no longer function, you will require kidney dialysis or a kidney transplant.
If you choose hemodialysis, you will first need surgery to create a place (often in your forearm) from which an artificial kidney (called a dialyzer) can take blood from the body. During hemodialysis, blood goes to the dialyzer to clean out waste, after which the machine returns healthy blood back into the body. You will need hemodialysis two or three times per week (usually performed at a clinic), with each session lasting three to five hours.
Another type of dialysis, called peritoneal dialysis, enables you to do the procedure yourself at home after you have been trained. This allows some greater flexibility, but also requires the ability to see well and follow procedures accurately.
Unless kidney transplantation is an option, once you begin dialysis, you might need it for lifelong therapy.
No matter what course of treatment you and your doctor choose, it is still important to follow your meal plan and diabetes treatment. Also, remember to keep your blood sugar levels as close to normal as possible.
How Can You Prevent Nephropathy?
Keep your blood pressure under control, and take care of your diabetes.
Keeping your blood sugar levels under control can reduce your risk of developing microalbuminuria. If your urine already contains some protein, keeping your blood sugar under control can reduce your risk of developing macroalbuminuria.
Reviewed by Clara Schneider MS, RD, RN, CDE, LDN - 05/13