Understanding Diabetic Kidney Disease: Stages, Symptoms, and Management

Introduction

Diabetic kidney disease (DKD) or diabetic nephropathy is a serious complication that can affect people living with diabetes. This condition develops when constant high blood sugar levels damage the kidneys’ ability to filter waste and excess fluid from the body. The reduced kidney functions may result in fluid accumulation, leading to swelling in ankles, feet, hands, and under the eyes. 

What is Diabetic Nephropathy?

It is a type of chronic kidney disease (CKD)  that explicitly affects people with diabetes. It’s a progressive condition that develops over many years due to prolonged exposure to high blood glucose levels. The kidneys have an essential role to play in maintaining overall wellness by regulating fluid balance, removing waste products, and controlling blood pressure. When diabetes damages the kidneys’ filtering system, it can result in a range of health problems and, if left untreated, may progress to kidney failure.

Causes of Diabetic Nephropathy

The primary cause of diabetic nephropathy is the long-term effects of high blood glucose levels on the kidneys. Here are some key factors contributing to the development of this condition:

• Hyperglycaemia: Consistently elevated blood glucose levels can damage the blood vessels of the kidneys, adversely affecting their ability to filter waste effectively.
• Hypertension: High blood pressure, which is common in people with diabetes, can further damage the kidneys’ delicate filtering system.
• Genetic Components: Some people may have a genetic predisposition to developing kidney disease when they have diabetes.
• Duration of Diabetes: The longer the history of diabetes, the higher the possibility of developing diabetic nephropathy.
• Smoking: Tobacco use can accelerate kidney damage in people with diabetes.
• Obesity: Excess body weight can contribute to insulin resistance and increase the risk of kidney problems.

Symptoms of Diabetic Kidney Disease

In the early diabetic nephropathy stages, there are often no noticeable symptoms. This is why regular kidney function tests are crucial for people with diabetes. As the condition progresses, the following symptoms may develop:

• Swelling in the hands, feet, or ankles due to fluid retention
• Increased blood pressure that becomes difficult to control
• Bubbly or foamy urine (due to excess protein)
• Frequent urination, especially at night
• Fatigue and weakness
• Loss of appetite
• Nausea and vomiting
• Itchy skin
• Shortness of breath
• Confusion or difficulty concentrating

It’s important to note that these symptoms may not come up until the advanced stages of the disease, emphasising the importance of regular check-ups and screenings for people with diabetes.

Stages of Diabetic Nephropathy

Diabetic kidney disease progresses through five stages, each characterised by the level of kidney function measured by the glomerular filtration rate (GFR). Understanding these stages can help patients and doctors manage the condition more effectively, says Dr. Sunil R.

Stage 1: Early Kidney Damage

• GFR: 90% or higher
• Kidney function: Normal or increased
• Symptoms: Usually none
• Management: Focus on controlling blood sugar and blood pressure

In this initial stage, the kidneys work harder than normal and may enlarge slightly. There’s a small amount of protein (albumin) in the urine, but kidney function tests may still appear normal. This stage is an early and mild stage of the disease, and many ways exist to treat and improve the condition.

Stage 2: Mild Kidney Damage

• GFR: 60-89%
• Kidney function: Mildly reduced
• Symptoms: Usually none
• Management: Continue blood sugar and blood pressure control, possibly start medications to protect the kidneys

This stage develops slowly over time. The kidneys still function relatively well but may show some signs of damage, with increased protein in the urine. Maintaining a healthy lifestyle & following the doctor’s advice are crucial at this stage.

Stage 3: Moderate Kidney Damage

• GFR: 30-59%
• Kidney function: Moderately reduced
• Symptoms May include swelling in hands or feet, high blood pressure, and anaemia.
• Management: More aggressive treatment of underlying conditions, possible referral to a nephrologist

Most people still won’t have noticeable symptoms at this point, but some may experience swelling in their extremities. It’s essential to start working with a kidney specialist (nephrologist) at this stage to manage the condition more closely.

Stage 4: Severe Kidney Damage

• GFR: 15-29%
• Kidney function: Severely reduced
• Symptoms: Swelling, changes in urination frequency, high potassium and phosphorus levels
• Management: Close monitoring by a nephrologist, preparation for possible dialysis or transplant

This stage is considered a serious condition that requires careful management to prevent kidney failure. Symptoms become more noticeable, and the risk of complications increases significantly.

Stage 5: Kidney Failure

• GFR: Less than 15%
• Kidney function: Kidney failure or very close to it
• Symptoms: Severe symptoms including nausea, vomiting, itching, fatigue, trouble breathing
• Management: Dialysis or kidney transplant

The kidneys have stopped working at this final stage or are very close to failure. Patients typically experience a range of severe symptoms & will need either dialysis or a kidney transplant to survive.

Conclusion

Diabetic kidney disease (DKD) is a serious complication of chronic diabetes that can lead to significant health problems if left unmanaged. However, with early detection, proper treatment, and lifestyle modifications, it’s possible to slow the progression of DKD and maintain a good quality of life. Regular check-ups, strict blood sugar control, and a healthy lifestyle are key to managing diabetic nephropathy effectively.