Diabetic Nephropathy

May 25, 2008

All that we eat, inhale and take within the body by other ways is utilized in form of energy by the body.  However, the body machine transforms the matter into energy by various metabolic processes which give rise to wastes.  These wastes are mainly driven out of the body by the kidney in form of urine. The waste substances are in the blood and are cleared off the body through the filter organ (kidney) which lets the waste out of the body and retains the vital salts. Hence the kidney performs vital excretory functions of the body and if the kidney malfunctions, the entire body balance would go helter skelter. The wastes and water would then be retained in the body and this would give rise to many abnormalities.

Kidney disease is growing in Europe and U.S and the biggest among them is diabetic nephropathy. Read on to know more about the aetiology, pathology and management of diabetic nephropathy but before this we need to understand what the normal kidney is composed off to understand what happens in a nephrotic kidney.
The kidney

The bean shaped pair of kidney in the lower abdomen each comprise of a glomerus, bowmans capsule and renal tubules which are distinguished as ascending and descending limbs. The glomerulus is a network of capillaries which are situated above the bowmans capsule. The glomerulus filters the macro substances in the impure blood along with the red blood cells, proteins and others which are important for the functioning o fthe normal human body. The filtrate then passes through the bowmans capsule and reaches the renal tubule where the ascending and descending limbs reabsorb the vital nutrients which were smaller in size and hence could not be filtered out by  the glomerulus. Ions in forms of salts are one of them. Hence the filtering process by the glomerulus is very critical in the functioning of the kidney.

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What is diabetic nephropathy?

In diabetes, there is a thickening of the blood vessels and capillaries in response to the abnormal metabolism of the body. This is observed in the glomerulus as well. The glomerulus which is a delicate mesh of capillaries reacts to the thickening in form of pores and discontinuities on the membrane. On account of this, the waste blood when passed through the glomerulus is filtered incompletely and proteins along with other vital cells are not retained on the glomerulus. Also the permeability of the capillaries is lowered. Moreover the action of acetyl co enzyme A in a diabetic produces more ketone bodies giving rise to a higher concentration of ketone urea and other proteinaceous substances. This further increases the load on the glomerulus further deteriorating the quality of filtration. This is diabetic nephropathy.

What are the symptoms of Diabetic Nephropathy ?

When proteins are seen in the urine, the nephropathy is confirmed.

Progression of disease

Initially only small particles of proteins are seen in the urine. But on account of the changes in the permeability of the capillaries and the increase of waste load in a diabetic patient, the condition progresses to end stage renal disease when the patient is unable to distinguish between what are nutrients and what are the wastes.

Are all diabetics prone to diabetic nephropathy?

Around 10% of type 2 diabetics and 30% of type 1 diabetes patients run the risk of contracting diabetic nephropathy. The following further increase the risk of developing the complication.

  • Poor blood sugar control
  • High blood pressure
  • Smoking
  • Early onset diabetes

Management of Diabetic Nephropathy

1.    Control blood sugar.
2.    Avoid fast foods and junk food .
3.    Reduce fat intake. Do not take bad (VLDL) cholesterol at all.
4.    Stop alcohol intake and smoking


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