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'''For the WikiDoc page for this topic, click [[Diabetic nephropathy|here]]'''
'''For the WikiDoc page for this topic, click [[Diabetic nephropathy|here]]'''
{{SI}}
{{Diabetic nephropathy (patient information)}}


{{CMG}};  '''Associate Editor(s)-In-Chief:''' Jinhui Wu
{{CMG}};  {{AE}} Jinhui Wu, M.D. [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]


==Overview==
==Overview==
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* Unintentional [[weight gain]] (from fluid buildup)
* Unintentional [[weight gain]] (from fluid buildup)


==What are the causes of Diabetic nephropathy?==
==What causes Diabetic nephropathy?==
The exact cause of diabetic nephropathy is unknown, but it is believed that uncontrolled high blood sugar leads to the development of kidney damage, especially when [[hypertension]] is also present. In some cases, your genes or family history may also play a role. Not all persons with [[diabetes]] develop this condition.
The exact cause of diabetic nephropathy is unknown, but it is believed that uncontrolled high blood sugar leads to the development of kidney damage, especially when [[hypertension]] is also present. In some cases, your genes or family history may also play a role. Not all persons with [[diabetes]] develop this condition.
Each [[kidney]] is made of hundreds of thousands of filtering units called [[nephron]]s. Each nephron has a cluster of tiny blood vessels called a [[glomerulus]]. Together these structures help remove waste from the body. Too much blood sugar can damage these structures, causing them to thicken and become scarred. Slowly, over time, more and more blood vessels are destroyed. The kidney structures begin to leak and [[protein]] (albumin) begins to pass into the [[urine]].
Each [[kidney]] is made of hundreds of thousands of filtering units called [[nephron]]s. Each nephron has a cluster of tiny blood vessels called a [[glomerulus]]. Together these structures help remove waste from the body. Too much blood sugar can damage these structures, causing them to thicken and become scarred. Slowly, over time, more and more blood vessels are destroyed. The kidney structures begin to leak and [[protein]] (albumin) begins to pass into the [[urine]].
Diabetic nephropathy generally goes along with other diabetes [[complication]]s including [[hypertension]], [[retinopathy]], and [[blood vessel]] changes.
Diabetic nephropathy generally goes along with other diabetes [[complication]]s including [[hypertension]], [[retinopathy]], and [[blood vessel]] changes.


==Who is at risk for Diabetic nephropathy?==
==Who is at highest risk?==
Persons with diabetes who have the following risk factors are more likely to develop this condition:
Persons with diabetes who have the following risk factors are more likely to develop this condition:
* African American, Hispanic, or American Indian origin
* African American, Hispanic, or American Indian origin
* Family history of kidney disease or high blood pressure
* Family history of kidney disease or high blood pressure
* Poor control of [[blood pressure]]
* Poor control of [[blood pressure]]
* Poor control of [[blood sugar]]s
* Poor control of [[blood sugar]]
* [[Type 1 diabetes]] before age 20
* [[Type 1 diabetes]] before age 20
* [[Smoking]]
* [[Smoking]]


==How to know you have Diabetic nephropathy?==
==When to seek urgent medical care?==
Call your health care provider if you have diabetes and a routine urinalysis shows protein. Call your health care provider if you develop symptoms of diabetic nephropathy, or if new symptoms develop, including little or no urine output.
 
==Diagnosis==
The main sign of diabetic nephropathy is persistent protein in the urine. ([[Protein]] may appear in the urine for 5 to 10 years before other symptoms develop.) If your doctor thinks you might have this condition, a [[microalbuminuria]] test will be done. A positive test often means you have at least some damage to the kidney from diabetes. Damage at this stage may be reversible. The test results can be high for other reasons, so it needs to be repeated for confirmation.
The main sign of diabetic nephropathy is persistent protein in the urine. ([[Protein]] may appear in the urine for 5 to 10 years before other symptoms develop.) If your doctor thinks you might have this condition, a [[microalbuminuria]] test will be done. A positive test often means you have at least some damage to the kidney from diabetes. Damage at this stage may be reversible. The test results can be high for other reasons, so it needs to be repeated for confirmation.
[[Hypertension]] often goes along with diabetic nephropathy. You may have [[hypertension]] that develops rapidly or is difficult to control.
[[Hypertension]] often goes along with diabetic nephropathy. You may have [[hypertension]] that develops rapidly or is difficult to control.
Laboratory tests that may be done include:
Laboratory tests that may be done include:
* BUN
* BUN(blood urea nitrogen}
* Serum [[creatinine]]
* Serum [[creatinine]]
The levels of these tests will increase as kidney damage gets worse. Other laboratory tests that may be done include:
The levels of these tests will increase as kidney damage gets worse. Other laboratory tests that may be done include:
* 24-hour [[urine protein]]
* 24-hour [[urine protein]]
* Blood levels of [[phosphorus]], [[calcium]], bicarbonate, PTH, and [[potassium]]
* Blood levels of [[phosphorus]], [[calcium]], bicarbonate, parathyroid harmone, and [[potassium]]
* [[Hemoglobin]]
* [[Hemoglobin]]
* [Hematocrit]]
* [Hematocrit]]
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*3. No other kidney or renal tract disease
*3. No other kidney or renal tract disease
A biopsy may be done, however, if there is any doubt in the diagnosis.
A biopsy may be done, however, if there is any doubt in the diagnosis.
==When to seek urgent medical care==
Call your health care provider if you have diabetes and a routine urinalysis shows protein. Call your health care provider if you develop symptoms of diabetic nephropathy, or if new symptoms develop, including little or no urine output.


==Treatment options==
==Treatment options==
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Urinary tract and other [[infection]]s are common and can be treated with appropriate [[antibiotics]].
Urinary tract and other [[infection]]s are common and can be treated with appropriate [[antibiotics]].
[[Dialysis]] may be necessary once end-stage kidney disease develops. At this stage, a kidney [[transplant]] may be considered. Another option for patients with type 1 diabetes is a combined kidney-pancreas transplant.
[[Dialysis]] may be necessary once end-stage kidney disease develops. At this stage, a kidney [[transplant]] may be considered. Another option for patients with type 1 diabetes is a combined kidney-pancreas transplant.
 
===Prevention of Diabetic nephropathy===
==Where to find medical care for Diabetic nephropathy==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|yourdisease}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating Diabetic nephropathy]
 
==Prevention of Diabetic nephropathy==
All persons with [[diabetes]] should have a yearly checkup with their doctor to have their blood and urine tested for signs of possible kidney problems.
All persons with [[diabetes]] should have a yearly checkup with their doctor to have their blood and urine tested for signs of possible kidney problems.
Persons with kidney disease should avoid contrast dyes that contain [[iodine]], if possible. These dyes are removed through the kidneys and can worsen kidney function. Certain imaging tests use these types of dyes. If they must be used, fluids should be given through a vein for several hours before the test. This allows for rapid removal of the dyes from the body.
Persons with kidney disease should avoid contrast dyes that contain [[iodine]], if possible. These dyes are removed through the kidneys and can worsen kidney function. Certain imaging tests use these types of dyes. If they must be used, fluids should be given through a vein for several hours before the test. This allows for rapid removal of the dyes from the body.
Commonly used [[nonsteroidal anti-inflammatory drugs]] (NSAIDs), including [[ibuprofen]], [[naproxen]], and prescription [[COX-2 inhibitor]]s such as [[celecoxib]] (Celebrex), may injure the weakened kidney. You should always talk to your health care provider before using any drugs
Commonly used [[nonsteroidal anti-inflammatory drugs]] (NSAIDs), including [[ibuprofen]], [[naproxen]], and prescription [[COX-2 inhibitor]]s such as [[celecoxib]] (Celebrex), may injure the weakened kidney. You should always talk to your health care provider before using any drugs


==What to expect (Outlook/Prognosis)==
 
==Where to find medical care for Diabetic nephropathy?==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|yourdisease}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating Diabetic nephropathy]
 
==What to expect (Outlook/Prognosis)?==
Nephropathy is a major cause of sickness and death in persons with diabetes. It is the leading cause of long-term kidney failure and end-stage kidney disease in the United States, and often leads to the need for [[dialysis]] or [[kidney transplantation]].
Nephropathy is a major cause of sickness and death in persons with diabetes. It is the leading cause of long-term kidney failure and end-stage kidney disease in the United States, and often leads to the need for [[dialysis]] or [[kidney transplantation]].
The condition slowly continues to get worse once large amounts of protein begin to appear in the urine or levels of creatinine in the blood begin to rise. Complications due to [[chronic kidney failure]] are more likely to occur earlier, and get worse more rapidly, when it is caused by diabetes than other causes. Even after dialysis or transplantation, persons with diabetes tend to do worse than those without diabetes.
The condition slowly continues to get worse once large amounts of protein begin to appear in the urine or levels of creatinine in the blood begin to rise. Complications due to [[chronic kidney failure]] are more likely to occur earlier, and get worse more rapidly, when it is caused by diabetes than other causes. Even after dialysis or transplantation, persons with diabetes tend to do worse than those without diabetes.


===Possible Complications===
==Possible complications==
 
Possible complications include:
* [[Anemia]]
* [[Anemia]]
* [[Chronic kidney failure]] (rapidly gets worse)
* [[Chronic kidney failure]] (rapidly gets worse)
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[[Category:Patient Information]]
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[[Category:Medical emergencies]]
 
[[Category:Disease state]]
[[Category:Patient information]]
[[Category:Medicine]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Kidney diseases]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Mature chapter]]
[[Category:Nephrology]]
[[Category:Nephrology]]
[[Category:Diabetes]]
[[Category:Endocrinology patient information]]
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Latest revision as of 13:33, 26 July 2018

For the WikiDoc page for this topic, click here

Diabetic nephropathy

Overview

What are the symptoms?

What are the causes?

Who is at highest risk?

When to seek urgent medical care?

Diagnosis

Treatment options

Where to find medical care for Diabetic nephropathy?

What to expect (Outlook/Prognosis)?

Possible complications

Diabetic nephropathy On the Web

Ongoing Trials at Clinical Trials.gov

Images of Diabetic nephropathy

Videos on Diabetic nephropathy

FDA on Diabetic nephropathy

CDC on Diabetic nephropathy

Diabetic nephropathy in the news

Blogs on Diabetic nephropathy

Directions to Hospitals Treating Diabetic nephropathy

Risk calculators and risk factors for Diabetic nephropathy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jinhui Wu, M.D. Ujjwal Rastogi, MBBS [2]

Overview

Diabetic nephropathy is kidney disease or damage that results as a complication of diabetes.

What are the symptoms of Diabetic nephropathy?

Early stage diabetic nephropathy has no symptoms. Over time, the kidney's ability to function starts to decline. Symptoms develop late in the disease and may include:

What causes Diabetic nephropathy?

The exact cause of diabetic nephropathy is unknown, but it is believed that uncontrolled high blood sugar leads to the development of kidney damage, especially when hypertension is also present. In some cases, your genes or family history may also play a role. Not all persons with diabetes develop this condition. Each kidney is made of hundreds of thousands of filtering units called nephrons. Each nephron has a cluster of tiny blood vessels called a glomerulus. Together these structures help remove waste from the body. Too much blood sugar can damage these structures, causing them to thicken and become scarred. Slowly, over time, more and more blood vessels are destroyed. The kidney structures begin to leak and protein (albumin) begins to pass into the urine. Diabetic nephropathy generally goes along with other diabetes complications including hypertension, retinopathy, and blood vessel changes.

Who is at highest risk?

Persons with diabetes who have the following risk factors are more likely to develop this condition:

When to seek urgent medical care?

Call your health care provider if you have diabetes and a routine urinalysis shows protein. Call your health care provider if you develop symptoms of diabetic nephropathy, or if new symptoms develop, including little or no urine output.

Diagnosis

The main sign of diabetic nephropathy is persistent protein in the urine. (Protein may appear in the urine for 5 to 10 years before other symptoms develop.) If your doctor thinks you might have this condition, a microalbuminuria test will be done. A positive test often means you have at least some damage to the kidney from diabetes. Damage at this stage may be reversible. The test results can be high for other reasons, so it needs to be repeated for confirmation. Hypertension often goes along with diabetic nephropathy. You may have hypertension that develops rapidly or is difficult to control. Laboratory tests that may be done include:

The levels of these tests will increase as kidney damage gets worse. Other laboratory tests that may be done include:

A kidney biopsy confirms the diagnosis. However, your doctor can diagnose the condition without a biopsy if you meet the following three conditions:

  • 1. Persistent protein in the urine
  • 2. Diabetic retinopathy
  • 3. No other kidney or renal tract disease

A biopsy may be done, however, if there is any doubt in the diagnosis.

Treatment options

The goals of treatment are to keep the kidney disease from getting worse and prevent complications. This involves keeping your blood pressure under control (under 130/80). Controlling high blood pressure is the most effective way of slowing kidney damage from diabetic nephropathy. Your doctor may prescribe the following medicines to lower your blood pressure and protect your kidneys from damage:

These drugs are recommended as the first choice for treating hypertension in persons with diabetes and for those with signs of kidney disease. It is also very important to control lipid levels, maintain a healthy weight, and engage in regular physical activity. You should closely monitor your blood sugar levels. Doing so may help slow down kidney damage, especially in the very early stages of the disease. Your can change your diet to help control your blood sugar. Your doctor may also prescribe medications to help control your blood sugar. Your dosage of medicine may need to be adjusted from time to time. As kidney failure gets worse, your body removes less insulin, so smaller doses may be needed to control glucose levels. Urinary tract and other infections are common and can be treated with appropriate antibiotics. Dialysis may be necessary once end-stage kidney disease develops. At this stage, a kidney transplant may be considered. Another option for patients with type 1 diabetes is a combined kidney-pancreas transplant.

Prevention of Diabetic nephropathy

All persons with diabetes should have a yearly checkup with their doctor to have their blood and urine tested for signs of possible kidney problems. Persons with kidney disease should avoid contrast dyes that contain iodine, if possible. These dyes are removed through the kidneys and can worsen kidney function. Certain imaging tests use these types of dyes. If they must be used, fluids should be given through a vein for several hours before the test. This allows for rapid removal of the dyes from the body. Commonly used nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, naproxen, and prescription COX-2 inhibitors such as celecoxib (Celebrex), may injure the weakened kidney. You should always talk to your health care provider before using any drugs


Where to find medical care for Diabetic nephropathy?

Directions to Hospitals Treating Diabetic nephropathy

What to expect (Outlook/Prognosis)?

Nephropathy is a major cause of sickness and death in persons with diabetes. It is the leading cause of long-term kidney failure and end-stage kidney disease in the United States, and often leads to the need for dialysis or kidney transplantation. The condition slowly continues to get worse once large amounts of protein begin to appear in the urine or levels of creatinine in the blood begin to rise. Complications due to chronic kidney failure are more likely to occur earlier, and get worse more rapidly, when it is caused by diabetes than other causes. Even after dialysis or transplantation, persons with diabetes tend to do worse than those without diabetes.

Possible complications

Sources


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