Diabetic Nephropathy

Diabetic nephropathy refers to kidney disease that occurs in people with diabetes. The kidneys help regulate the amount of fluids and salts in the body, which helps to control blood pressure and releases different types of hormones.

Even if you regularly take diabetic and high blood pressure treatments like medicines, injections, exercise, herbs etc and successfully controlled your sugar and blood pressure and you develop kidney failure like increased serum creatinine. It means there are some other factors which you did not controlled. 

Diabetic nephropathy develops slowly and is more common in people who have had diabetes for 20 years or more.

Diabetic nephropathy is more likely to develop in people with diabetes who also have higher blood glucose levels. Doctors also believe that nephropathy is directly influenced by high blood pressure(hypertension), which may make an individual go through the stages of diabetic nephropathy more rapidly.

Other risk factors for diabetic nephropathy include:

• smoking
• age, as it is more common in older people
• sex, as it is more common in men
• race, as it is more common in African Americans and Mexican Americans
• obesity

Although diabetic nephropathy means the kidneys are not functioning properly, a person in the early stages may not experience any symptoms.

However, in the early stages, there are changes in blood pressure and the fluid balance in the body. Over time, this can produce a build-up of waste products in the blood and make a person very ill.

Severe illness usually occurs around stage four or five of diabetic nephropathy. Symptoms include:

• swollen ankles, feet, lower legs, or hands caused by water retention
• darker urine, due to blood in the urine
• shortness of breath
• fatigue, caused by lack of oxygen in the blood
• nausea or vomiting
• metallic taste

The stages of diabetic nephropathy are determined by the extent of the kidney damage and the glomerular filtration rate, or GFR. The GFR can tell a doctor how well the kidneys are working. A low GFR indicates kidney problems.

• Stage 1: Kidney damage present but normal kidney function; GFR above 90.
• Stage 2: Kidney damage with some loss of kidney function; GFR between 60 and 89.
• Stage 3: Mild to severe loss of kidney function; GFR between 30 and 59.
• Stage 4: Severe loss of kidney function; GFR between 15 and 29.
• Stage 5: Kidney failure; GFR less than 15.

डायलिसिस के सहारे अमेरिका में औसतन 3 वर्ष जिन्दा रहते हैं  और भारत में औसतन अवधि एक वर्ष से कम है, जबकि हमारे उपचार से अमेरिका में लोग वर्षों जिन्दा हैं. सही उपचार अपनाकर किडनी फेलियर को प्रोग्रेस करने से रोका जा सकता है. लेकिन अगर आप सिर्फ डायबिटीज अथवा उच्च रक्तचाप कण्ट्रोल करते हैं तो किडनी फेलियर को प्रोग्रेस होने से नहीं रोका जा सकता. 

Transplant failure rate in USA

7% failure within 1 year, 17% failure within 3 years, 46% failure within 10 years, 20% re-transplantation rate 

प्रायः किडनी फेलियर के मरीज समझते हैं कि ट्रांसप्लांट कराने से वह सामान्य जीवन जी लेंगे परन्तु ऐसा प्रायः नहीं होता. 

ट्रांसप्लांट उन्हीं लोगों का होता है जो पूर्णतः स्वस्थ हैं, ज्यादातर लोग मसलन 99 % किडनी के मरीज ट्रांसप्लांट के लायक ही नहीं होते.