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Diabetic Nephropathy

What is Diabetic Nephropathy?

What is the Stages of Diabetic Nephropathy?

What are the symptoms of Diabetic Nephropathy (DN)?

What is the diet for Diabetic Nephropathy

What is Diabetic Nephropathy (DN)?

Nephropathy is deterioration of the kidneys. Diabetic Nephropathy is a secondary kidney disease caused by long-term or poor management of Diabetes. It is the leading cause of end-stage kidney failure worldwide.

Both type 1 Diabetes and type 2 Diabetes can cause kidney disease if not well controlled. Having some risk factors, such as high blood pressure, smoking and family history can greatly increase possibilities of kidney disease in people with Diabetes.

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What is the stages of Diabetic Nephropathy?

Diabetic Nephropathy develops through five clinical stages, with early noticeable symptom as protein in urine:

Stage 1, high perfusion and high filtration stage. Kidneys and glomerulis are abnormally enlarged, and glomerular filtration rate (GFR) is higher than normal. The renal hemodynamic changes can not be detected unless tests are done. No symptoms are present in this stage.

Stage 2, asymptomatic stage. Typically patients are at this stage two years after diagnosis of Diabetes. Glomerular basement cells are thickened, usually with proliferation in mesangium. Patients experience intermittent microalbuminuria after exercise, however, this can remit soon after a rest. Glomerular filtration rate is still evidently elevated. By timely treatment the first two stages of Diabetic Nephropathy can be reversed.

Stage 3, microalbuminuria stage. Blood pressure begins to increase, and the output of urine albumin continues to increase. Microalbuminuria test will detect the elevated urine albumin. Anti-hypertension treatment has proven effective in relieving micro albuminuria. Typically patients develop into stage 3 Diabetic Nephropathy after diagnosis of Diabetes for 10 to 15 years.

Stage 4, clinical proteinuria stage. Approximately 40% patients with Type 1 Diabetes develop into this stage after Diabetes existing 15 to 25 years. Glomerular filtration rate declines and 24h protein in urine is more than 0.5g.

Stage 5, end-stage kidney disease. Patients have systemic complications, such as anemia, vomiting, skin itching, swelling, etc. GFR is very low. The patients may prepare for dialysis or transplant.

Not every patient with Diabetes develop all the above five stages of Diabetic Nephropathy. In some cases, the patients stay in the first two stages after Diabetes for 20 to 30 years without evident kidney damage.

However, once Diabetic Nephropathy into stage 3, the microalbuminuria stage, the illness condition is very likely to progress and pose more severe clinical manifestations. The treatment targets to stop deterioration of stage 3 Diabetic Nephropathy for once at stage 4, kidney condition can irreversibly decline and most patients will develop into end-stage kidney failure.

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What are the symptoms and complications of Diabetic Nephropathy?

The symptoms of Diabetic Nephropathy tend to become apparent once the condition has reached the later stages.

Typically the following symptoms can start to be noticed starting around stage 4 of Diabetic Nephropathy:

﹡Swelling of the ankles, feet, lower legs or hands caused by retention of water

﹡Rising blood pressure

﹡Foams or bubbles in urine which doesn’t disappear after urinating, which suggests severe loss of proteins in urine

﹡Becoming short of breath

﹡Darker urine, caused by blood in urine

﹡Tiredness or weakness as a result of lack of oxygen in blood

﹡Nausea and vomiting

In addition to the above, Diabetic Nephropathy often accompanies other blood vessel diseases caused by Diabetes in its developing process, such as retinopathy, diabetic foot, heart disease, etc. Hence the illness condition tends to be more complicated than other types of kidney disorders.

To help find Nephropathy before it develops to later stages, it is essential that people with Diabetes are screened for kidney disease once a year. The test involves a simple urine test to detect whether there is protein in urine and blood tests to evaluate the functions of kidneys.

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What is the diet for Diabetic Nephropathy?

Diet is an important part of treatment for Diabetic Nephropathy, a kind of kidney problem caused by long time diabetes. Key components of the diet include managing blood sugar through carbohydrate control, managing blood pressure by decreasing sodium intake, and reducing protein intake.

Carbohydrate: Carbohydrate is the main energy source of our body. Through spreading carbohydrate intake, blood sugar can be managed well. To achieve this purpose, eating a smaller meals and snacks and eat a consistent amount from day to day is helpful. Common foods with carbohydrate include bread, grains, fruit, milk, vegetables.

Sodium: high intake of sodium not only elevates blood pressure, but also worsening edema symptom. For a patients with Diabetic Nephropathy, keeping blood pressure lower than 130/80 will be helpful. Therefore, try to avoid canned, cured, processed foods and so on.

Protein intake: protein is the essential for building and repairing body tissues. However, due to kidney problem, Diabetic Nephropathy patients need to limit protein intake so as to avoid worsening kidney condition. Generally speaking, 0.36 to 0.45 gram of protein per pound of body weight is recommended.

Potassium: High potassium level can affect heart rhythm, so avoid foods with high potassium is very good for patients who have high potassium level. Common foods with high potassium level include fresh apricots, bananas, cantaloupe, kiwi, prunes, organs, raisins, winter squash, avocado, green and so on. Foods low in potassium contain apples, canned apricots or nectar, berries, grape, grapefruit, honeydew melon and so on.

Phosphorus: High phosphorus level can make bones more brittle and causing itchy skin and bone and joint pain. Therefore, limiting phosphorus intake is necessary. Because phosphorus is found in many high protein foods, start by making sure you have your protein intake from fish, chicken and dairy and so on.

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