Introduction
Diabetic nephropathy, commonly known as diabetic kidney disease (DKD), poses a significant threat to individuals battling type 1 and type 2 diabetes. This comprehensive article sheds light on the intricate nature of diabetic nephropathy, offering insights into its symptoms, underlying causes, and avenues for prevention.
The Prevalence
With a staggering impact, diabetic nephropathy affects approximately 1 in 3 people grappling with diabetes in the United States. Diabetic kidney disease (DKD) is the most common cause of chronic kidney disease in the United States. Approximately 30% to 40% of individuals with diabetes mellitus develop DKD, and the presence of DKD significantly elevates the risk for morbidity and mortality.
Impaired Kidney Function
At the core of diabetic nephropathy lies the impairment of the kidneys’ natural function—efficiently eliminating waste products and surplus fluids from the body. DKD is driven primarily by 3 intersecting processes:
- hyperfiltration injury to the glomerular filtration barrier (GFB)
- expansion of the glomerular mesangium
- oxidative stress.
Development of these processes is multifactorial and thought to be related to hemodynamic (physical study of blood flow), metabolic, and immune factors –
Slow down progression of Chronic Kidney Disease & accelerated ageing
68 naturopathic interventions spanning over 14 amazing chapters, supported by hundreds of medical studies published in journals of medicine, biochemistry and nephrology, to improve kidney’s health
Microalbuminuria / Proteinuria is esssentially leakage of proteins into the Urine and is both a hallmark of and a risk factor for DKD progression. Crusade Against Chronic Kindney Disease (CACKD) book explores three naturopathic / nutraceutical avenues to manage or reverse Microalbuminuria.
The Unseen Culprit
Over an extended period, the delicate filtration system of the kidneys succumbs to the insidious assault of diabetic nephropathy. The risks of development and progression of DKD primarily depend on the duration of diabetes, glycemic control, and hypertension control. 2, 3 For T2DM (Type 2 Diabetes), approximately 30% of patients develop microalbuminuria within 10 years of diabetes diagnosis, and approximately 5% progress to overt nephropathy every year. 2
Nearly all patients with low GFR from DKD have preceding albuminuria, and the degree of albuminuria predicts the rate of GFR decline.3-6 Effective hyperglycemia and hypertension management can delay the onset of microalbuminuria and slow DKD progression
The Precarious Stage
Left unchecked, diabetic nephropathy can escalate into a perilous stage: kidney failure, also termed end-stage kidney disease. At this juncture, the choices narrow down to dialysis or a kidney transplant—critical decisions that underscore the gravity of the situation.
Array of Symptoms
In its early stages, diabetic nephropathy operates in stealth mode, camouflaging its presence. As the condition matures, an array of symptoms emerges, including:
- Fluctuating blood pressure control
- Presence of protein in the urine
- Swelling in the extremities—feet, ankles, hands, or eyes
- Heightened urination frequency
- Decreased need for insulin or diabetes medication
- Cognitive challenges—confusion or concentration difficulties
- Breathlessness
- Appetite loss
- Episodes of nausea and vomiting
- Persistent itching
- Overwhelming fatigue
Seeking Professional Help
The necessity of seeking medical consultation arises when any signs or symptoms of kidney disease manifest. For those living with diabetes, proactive monitoring is vital, with regular doctor visits serving as a safeguard against potential complications.
The 2019 American Diabetes Association guidelines recommend yearly assessment of GFR and albuminuria via a spot urine albumin–to–creatinine ratio (UACR) in all patients with Type-2 and those with Type-1 diabetes for greater than or equal to 5 years.
The Inner Workings of Kidneys
At the heart of the kidneys’ intricate mechanism are minuscule clusters of blood vessels—glomeruli—tasked with waste filtration. These vital structures become casualties of diabetic nephropathy, resulting in reduced kidney function and an imminent threat of failure.
Diabetes: The Common Thread
Both type 1 and type 2 diabetes provide fertile ground for the growth of diabetic nephropathy. A prolonged battle against diabetes can inflict considerable damage upon the blood vessel clusters responsible for waste elimination. Managing diabetes, especially for Type-2 type, is a better lever to control Diabetes Kidney Disease (DKD)
Weighing the Risks
For individuals living with diabetes, certain factors elevate the risk of succumbing to diabetic nephropathy:
- Uncontrolled hyperglycemia (high blood sugar)
- Unmanaged hypertension (high blood pressure)
- Active smoking habits
- Elevated blood cholesterol levels
- Obesity
- A familial history of diabetes and kidney disease
The Unfolding Complications
Complications of diabetic nephropathy unfold over time, gradually casting their shadows over a span of months or even years. These complications encompass:
- Fluid retention—culminating in swelling of the limbs, high blood pressure, or pulmonary edema
- Elevation in potassium levels—hyperkalemia
- Cardiovascular disease—increasing the likelihood of stroke
- Damage to light-sensitive retinal tissue—diabetic retinopathy
- Reduced red blood cell count—resulting in anemia
- Nerve and blood vessel damage—leading to foot sores, erectile dysfunction, diarrhea, and related issues
- Disruption of bone and mineral balance—manifesting as calcium and phosphorus imbalances in the blood
- Pregnancy-related complications—carrying risks for both mother and fetus
- The ominous arrival of end-stage kidney disease—demanding either dialysis or a kidney transplant for survival
A Blueprint for Prevention
Shielding oneself from the clutches of diabetic nephropathy involves strategic choices:
- Prioritize regular appointments for meticulous diabetes management
- Harness the power of effective diabetes treatment to deter the onset of diabetic nephropathy
- Take charge of high blood pressure and other medical conditions under the guidance of healthcare professionals
- Exercise caution with over-the-counter medications, adhering to dosage instructions meticulously
- Maintain a healthy weight through consistent physical activity and prudent caloric consumption
- Bid farewell to smoking habits, recognizing the dire implications of smoking on kidney health
Better management of diabetes, blood pressure (BP), and albuminuria is the cornerstone of evidence-based DKD management. More recently, sodium-glucose cotransporter 2 inhibitors (SGLT2Is) and glucagon-like peptide-1 (GLP-1) analogues, agents developed for blood glucose control, have emerged as important agents for DKD management, because they have been shown to slow DKD progression independent of their effect on glucose lowering. 7
Holistic Care
As Crusade Against Chronic Kindney Disease (CACKD) proposes research-backed naturopathic & nutraceuticals interventions.
- One of the simplest is complete removal of red meat. 8
- One of the disastrous effects of diabetes & chronic kidney disease is AGE or Advanced Glycation-end Products. AGE forms when proteins or lipids (fats) become glycated as a result of exposure to sugars. The mechanism by which AGEs induce damage is through a process called “cross-linking“ that causes intracellular damage and apoptosis (death of cell). AGEs are pretty important for those suffering from Diabetes and its complications affecting kidney and other organs. Kidneys play a crucial role in clearing up compounds formed by breakdown of AGEs (like any proteins in the body, AGEs are broken down). With a dysfunctional kidney, AGEs keep accumulating in the body, eventually requiring a transplant. 9 It turns out, garlic (especially aged garlic) prevent formation of AGEs. 10
References
- Bonner, R., Albajrami, O., Hudspeth, J., & Upadhyay, A. (2020). Diabetic Kidney Disease. In Primary Care: Clinics in Office Practice (Vol. 47, Issue 4, pp. 645–659). Elsevier BV. https://doi.org/10.1016/j.pop.2020.08.004
- Adler AI, Stevens RJ, Manley SE, et al. Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int 2003;63(1):225–32.
- Gæde P, Tarnow L, Vedel P, et al. Remission to normoalbuminuria during multifactorial treatment preserves kidney function in patients with type 2 diabetes and microalbuminuria. Nephrol Dial Transplant 2004;19(11):2784–8.
- Costacou T, Ellis D, Fried L, et al. Sequence of Progression of Albuminuria and Decreased GFR in Persons With Type 1 Diabetes: A Cohort Study. Am J Kidney Dis 2007;50(5):721–32.
- Kunzelman CL, Knowler WC, Pettitt DJ, et al. Incidence of proteinuria in type 2 diabetes mellitus in the Pima Indians. Kidney Int 1989;35(2):681–7.
- Nelson RG, Bennett PH, Beck GJ, et al. Development and Progression of Renal Disease in Pima Indians with Non-Insulin-Dependent Diabetes Mellitus. N Engl J Med 1996;335(22):1636–42.
- American Diabetes Association. 11. Microvascular complications and foot care: Standards of Medical Care in Diabetes – 2019. Diabetes Care 2019;42:S124–38.
- de Mello VD, Zelmanovitz T, Perassolo MS, Azevedo MJ, Gross JL. Withdrawal of red meat from the usual diet reduces albuminuria and improves serum fatty acid profile in type 2 diabetes patients with macroalbuminuria. Am J Clin Nutr. 2006 May;83(5):1032-8. doi: 10.1093/ajcn/83.5.1032. PMID: 16685043.
- Gugliucci, A., & Bendayan, M. (1996). Renal fate of circulating advanced glycated end products (AGE): evidence for reabsorption and catabolism of AGE-peptides by renal proximal tubular cells. Diabetologia, 39(2), 149–160. https://doi.org/10.1007/bf00403957
- Ahmad MS, Pischetsrieder M, Ahmed N. Aged garlic extract and S-allyl cysteine prevent formation of advanced glycation endproducts. Eur J Pharmacol. 2007 Apr 30;561(1-3):32-8. doi: 10.1016/j.ejphar.2007.01.041. Epub 2007 Feb 1. PMID: 17321518.
Slow down progression of Chronic Kidney Disease & accelerated ageing
68 naturopathic interventions spanning over 14 amazing chapters, supported by hundreds of medical studies published in journals of medicine, biochemistry and nephrology, to improve kidney’s health