Diabetic nephropathy

Alternative Names

Kimmelstiel-Wilson disease; Diabetic glomerulosclerosis; Nephropathy - diabetic

Treatment

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:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin receptor blockers (ARBs)

These drugs help reduce the amount of protein in the urine. Many studies have suggested that a combination of these two types of drugs may be best.

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. See also: Diet for people with diabetes

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 renal disease develops. At this stage, a kidney transplant must be considered. Another option for patients with type 1 diabetes is a combined kidney-pancreas transplant.

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.

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.

Possible Complications

Possible complications include:

• Anemia
• Chronic kidney failure (rapidly gets worse)
• Dialysis complications
• End-stage kidney disease
• Hyperkalemia
• Severe hypertension
• Hypoglycemia
• Infections
• Kidney transplant complications
• Peritonitis (if peritoneal dialysis used)

When to Contact a Medical Professional

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.

References

American Diabetes Association (ADA). Standards of Medical Care in Diabetes - 2008. Diabetes Care. 31:S12-54S.

Inzucchi SE, Sherwin RS. Diabetes Mellitus. In: Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 248.

American Diabetes Association (2004). Nephropathy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care. 27(Suppl 1): S79–S83.

Parving H, Mauer M, Ritz E. Diabetic Nephropathy. In: Brenner BM. Brenner and Rector's The Kidney. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 36.