Diabetic nephropathy, or diabetic kidney disease, is a serious complication seen in diabetes that affects the kidneys. It is one of the most common causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD) around the world. This disease develops insidiously over time, and if untreated, can lead to renal failure requiring dialysis or a transplant.

What is Diabetic Nephropathy?
Diabetic nephropathy happens when high blood sugar persists over a long period harming the kidney’s tiny blood vessels called glomeruli. Glomeruli are needed to filter the waste from the blood; when damaged the kidney cannot carry out this role, allowing protein to leak into the urine, and eventually, kidney function declines.

Causes and Risk Factors
The primary cause of diabetic nephropathy is long-standing uncontrolled diabetes, either type 1 or type 2. The other risk factors include:

• High blood pressure (hypertension)

• Family history

• Smoking

• High cholesterol

• High BMI (obesity)

• Poor glycemic control

The risk of developing diabetic nephropathy increases the longer you live with diabetes and you do not have good blood sugar and blood pressure control.

Symptoms of Diabetic Nephropathy
In its early stages, diabetic nephropathy may not cause any significant symptoms. As the nephropathy progresses, you may experience:

Swelling in your feet, ankles, hands, and/or around your eyes

• Increased urination

• Fatigue and weakness

• Nausea or vomiting

• Loss of appetite

• High blood pressure that is difficult to control

• The presence of protein in your urine detected by lab tests

Diagnosis
Early diagnosis is very important. If you have diabetes, regular screening will usually include:

• Urine testing to check for microalbuminuria (small amount of protein in your urine)

• Blood testing to check creatinine and estimate glomerular filtration rate (eGFR)

• Blood pressure readings

• Need for imaging

Management and Treatment
The treatment aims to slow or prevent kidney damage. Important aspects of management include:

1. Blood Sugar

Keeping blood glucose levels in the target range will ultimately slow kidney disease progression significantly.

2. Blood Pressure

No matter how the kidney function is functioning, it is likely that ACE inhibitors or angiotensin receptor blockers (ARBs) will be prescribed. These drugs lower blood pressure and also will help with kidney preservation.

3. Modifications to Lifestyle

• Healthy diet (low sodium, low protein)

• Exercise

• Quit smoking

• Weight loss

4. Medications

In addition to anti hypertensives, it is likely that patients will need medication to manage their cholesterol and blood sugar and anaemia associated with kidney disease.

5. Monitoring and follow-ups
   Any person covering a person with a one time chronic condition, needs to have regular follow-up with a clinician to monitor kidney function and optimize therapy.

Advanced stages and prognosis
If diabetic nephropathy has developed into end-stage renal failure, patients can have:

• Dialysis (hemodialysis or peritoneal dialysis)

• Transplantation of a kidney

With adequate surveillance and quality intervention, most people with diabetic nephropathy will be able to prevent progression to kidney failure.

Conclusion
Diabetic nephropathy is a serious complication of diabetes, but most importantly it is preventable. The best ways to protect the kidneys are controlling blood sugar and blood pressure, adopting a healthy lifestyle, and having regular screening appropriate to the risk. Education and early intervention will help reduce the burden of kidney disease on the individual and healthcare system.