Diabetic Nephropathy (kidney disease)

30 – 40% of all diabetics develop during their life a diabetic nephropathy – one of the most important late complications of diabetes. The most common reason for nephropathy is poorly controlled diabetes – the situation is the same for type 1 and type 2 diabetics.
 
Diabetic nephropathy develops over a long time of latency – in average it takes 10 – 15 years from the first diagnose of diabetes until manifestation of the kidney disease.
 
 
Urine-Check as prevention for dialysis
As a first marker of a kidney disease microalbuminurea (small protein particles in urine) can be proven. High blood glucose levels cause calcification of big blood vessels in the kidney but damage to small blood vessels as well. Therefore the body eliminates more protein in the urine – this can be found out during urine examination.
 
Early diagnosis and setup of treatment help to stopp progression of the disease and will increase life expectancy.
 
 
Urine check and limits
Spontaneous urine, night urine or 24-hours urine (best) is used for the check. Sometimes the relation between albumine and creatinine is used to measure microalbuminurea.
 

• A result below 20mg/l (milligram per litre) albumine is normal.
• A result between 20 and 200 mg/l shown beginning kidney disease (microalbuminurea).
• Results above 200 mg/l are a proof for advanced kidney disease (macroalbuminurea).

Microalbuminurea is proven if there are two positive results within 2  – 4 weeks. False positive results can be caused by e.g. diseases with  fever, infections of the urinary tract, strong hyperglycemia, heart  insufficiency or after intensive training.
 
 
Once a year!
Regular screening for microalbuminurea and possible therapeutic  consequences are important for type 1 and type 2 diabetics.  Microalbuminurea plays furthermore an important role for type 2  diabetics as a risk factor for atherosclerotic complications (heart  attacks).
 
Note: Not every protein elimination of diabetics is caused by  diabetic nephropathy – a kidney check for more parameters ensures the  diagnosis.
 
 
Control HbA1c
Early diagnosis of a diabetic nephropathy at the stage of  microalbuminurea is important because at this time progression of the  disease can be prohibited through appropriate therapy.
 
A reduction of other risk factors like hypertension, high blood fats  or smoking also decreases the risk of developing cardiovascular diseases  which are one of the most common causes of death.
 
Big clinical trials (DCCT, UKPDS) could proof that an intensified  diabetes therapy together with lowering of HbA1c can dramatically reduce  microvascular complications and therefore prohibit manifestation or  progression of a diabetic nephropathy. A HbA1c of 7.0 – 7.5% should be  the target. HbA1c above 8.0% will dramatically increase the rate of  complications.
 
 
Lower hypertension
The second important therapeutic „column“ in the prevention of  nephropathy is the optimization of the blood pressure. Guidelines  recommend for diabetics an arterial blood pressure below 130/80mmHg and  with existing macroalbuminurea even below 125/75mmHg. Some  pharmaceuticals (ACE-Inhibitors, AT1-Receptor-Inhibitors) provide the  blood pressure lowering effect as well a protective effect for the  kidneys. Sometimes it is required to take a combination of different  medications to reach the optimal blood pressure.
 
Diabetics with advanced kidney insufficience have to undergo dialysis  at an early stage to avoid more complications through arteriosclerotic  diseases of the blood vessels and infections. Combined  kidney-pancreas-transplantation can be useful for some patients.
 
 
How to prevent?

• Optimization of blood sugar
• Therapy of hypertension and blood fats
• No nicotine
• Existent nephropathy: regular checks and controls; low intake of proteins with the food (below 10% of the total energy)

Conclusions
Prevention and early diagnosis of a kidney damage and an optimal therapy increase quality of life and life expectancy.