Diabetic nephropathy is an extremely common complication of diabetes. The essence of this disease lies in the fact that against the background of long-lasting diabetes of the first or second type of kidney, namely their vessels, undergo pathological changes. The result of this process is the replacement of normal renal tissue with connective tissue areas, which gradually leads to the development of chronic renal failure. This pathology is quite dangerous. In the absence of necessary medical care, it can even be fatal.
As we have said, the kidneys can be affected both in the first and in the second type of diabetes. However, it has been observed that people with the first type of this disease are somewhat more likely to experience irregularities in the work of the urinary system. According to statistics, among all patients with diabetes, about twenty percent of people suffer from diabetic nephropathy. At the same time, it was noticed that the males most often encounter this disease. Diabetic nephropathy is one of the main causes of death among people with diabetes. Fifteen percent of the patient’s death is due to the disease.
The essence of diabetic nephropathy in the first place is that the vascular structures, as well as the renal glomeruli, undergo morphological changes. There are several theories explaining the mechanism of development of this disease. Each of them has its supporters. The most popular is the exchange theory. It is argued that the kidneys are affected as a result of disturbances from biochemical processes against the background of constantly elevated glucose levels.
There is another theory called hemodynamic. She explains the formation of this disease by a systematic increase in blood pressure, due to which the intrarenal blood flow is disturbed . As a result of these changes, there is an increase in pressure inside the glomerular structures, which leads to an acceleration of their filtration activity and a gradual replacement of normal tissues by connective tissue foci.
The third theory combines both of the above. It is called genetic. The essence of this theory is that a person has genetically determined factors that predispose to the occurrence of both metabolic and hemodynamic disorders.
There are times that significantly increase the likelihood of developing diabetic nephropathy. First of all – non-compliance with the recommendations of the doctor, aimed at maintaining a normal level of glucose. Overweight, frequent increase in blood pressure, the presence of bad habits, existing infectious diseases of the urinary system – all of these factors create favorable conditions for kidney damage. The important role is also played by the drugs taken with nephrotoxic effect.
The classification of diabetic nephropathy includes several of its stages, distinguished on the basis of how severely the functional activity is depressed. the kidneys. We will talk more about each of the stages below.
Symptoms of diabetic nephropathy
In this pathological process, the symptoms have a gradual development. Their severity depends on the stage of the disease. As a rule, for several years a sick person does not present any complaints at all. However, during examination, it can be found that the functional activity of the renal glomeruli has increased, and their filtration rate has also increased. In this case, the protein in the urine cannot be detected.
The further progression of diabetic nephropathy can take several years. The second stage is characterized by initial structural changes. Laboratory this is manifested by a slight increase in the level of albumin in the urine. Often occurring symptom at this stage is intermittent arterial hypertension. Most often it is associated with any physical activity. In general, a sick person feels normal and in most cases does not even suspect about the problem he has.
Much more pronounced clinical manifestations occur at the moment when morphological changes in the renal structures become more pronounced. When conducting a urine test, resistant proteinuria can be detected. Blood pressure begins to rise more and more difficult to reduce. Due to the fact that fluid is retained in the body, symptoms such as peripheral edema, accumulation of fluid in the abdominal cavity, generalized edema of subcutaneous fat, and so on appear.
A sick person begins to complain of increased weakness, dry mouth, loss of appetite and frequent headaches. He is often present convulsions. As the pathological process progresses, the resulting disturbances become more pronounced. Chronic renal failure develops, accompanied by damage to other internal organs.
Diagnosis and treatment of the disease
This disease is diagnosed using a range of additional research methods. General and biochemical blood and urine tests, the Reberg test and the Zimnitsky test are mandatory . An important point is the differential diagnosis of diabetic nephropathy with other renal diseases. For this purpose, ultrasound and radiological methods, bacteriological studies and so on are used.
The main focus in the treatment of diabetic nephropathy is to maintain normal glucose levels and blood pressure. Among the drugs, there are drugs that normalize the lipid spectrum of the blood, antiazotemic drugs, and also means aimed at reducing intraglomerular hypertension. Sometimes it is not possible to normalize the work of the kidneys without hemodialysis.
Prevention of kidney damage
The main and often the only method prophylaxis is strict control over their condition in identifying diabetes.