How to check for diabetic nephropathy?

Written by Zhou Qi
Nephrology
Updated on September 21, 2024
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For the examination of diabetic nephropathy, patients first need to undergo routine urinalysis and check for the urinary albumin excretion rate. Generally speaking, one characteristic of diabetic nephropathy is the presence of urinary protein. A urinary albumin excretion rate between 20 and 200 µg/min is an important basis for diagnosing early diabetic nephropathy. If a patient’s urinary albumin excretion rate consistently exceeds 200 µg/min, significant diabetic nephropathy is often considered. Of course, this is under the assumption that the patient has had diabetes for at least ten years and has diabetic retinopathy. A kidney biopsy is needed for confirmation. Of course, to assess the impact of diabetic nephropathy on kidney function, blood tests for serum creatinine and urea nitrogen are necessary.

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Written by Zhou Qi
Nephrology
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Symptoms of diabetic nephropathy anemia

Patients with diabetic nephropathy who exhibit anemia indicate that they are experiencing relatively severe renal failure. Such patients may show clear clinical symptoms, such as significant edema, excessive proteinuria, and renal failure. The impaired water excretion can lead to swelling in the lower limbs and facial area. The presence of anemia causes fatigue in patients, potentially leading to chronic ischemia and hypoxia in some organs. Symptoms such as listlessness and drowsiness may occur. In the state of anemia due to diabetic nephropathy, the accumulation of metabolic waste may also affect the patient's appetite, causing poor food intake. Additionally, diabetic damage to the retinal arteries can lead to a decline in vision, or even complete blindness.

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Written by Zhou Qi
Nephrology
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How to reduce proteinuria in diabetic nephropathy

One major characteristic of patients with diabetic nephropathy is the increase in urine protein, and some patients may even have a large amount of urine protein. The treatment of this disease is indeed quite challenging, and there are not many effective treatments available clinically. In the early stages, when the patient's serum creatinine has not exceeded 256 µmol/L, clinicians often choose ACE inhibitors or angiotensin receptor blockers (ARBs) to reduce the pressure within the glomerulus and decrease urine protein. At the same time, it is recommended for patients to use insulin to control blood sugar. However, in recent years, there has been some progress in the treatment of diabetic nephropathy, such as the use of sodium-glucose cotransporter 2 inhibitors, which may help reduce urine protein. (Medication should be used under the guidance of a clinician, based on the specific condition of the patient.)

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Nephrology
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How to reduce proteinuria in diabetic nephropathy.

A major clinical feature of diabetic nephropathy is the occurrence of proteinuria, which, if the condition continues to progress, can lead to kidney failure. Controlling proteinuria in the early stages of the disease is indeed very important. In terms of treatment, it is primarily necessary to use medications or insulin to control the patient's blood sugar, as hyperglycemia is the fundamental cause of diabetic nephropathy. Additionally, these patients often also have hypertension, necessitating the use of antihypertensive drugs to control blood pressure. When the patient's kidney function is not severely impaired, ACE inhibitors or ARBs can be the preferred choice of antihypertensive drugs, as they not only control blood pressure but also reduce proteinuria. However, if the patient's serum creatinine is significantly elevated, such as over 264 µmol/L, these drugs should no longer be used. (Medications should be used under the guidance of a doctor.)

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Written by Zhou Qi
Nephrology
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Symptoms of stage four diabetic nephropathy

Stage four of diabetic nephropathy indicates the presence of significant amounts of urinary protein. At this stage, patients may exhibit symptoms of nephrotic syndrome, which means the total urinary protein quantification over 24 hours may exceed 3.5 grams, and the plasma albumin level may be lower than 30 grams per liter. Due to the large amount of protein leakage, patients may experience edema, presenting as swelling of the lower limbs or eyelids, or even severe generalized swelling. In addition to edema, patients may also have pleural and abdominal effusion, leading to pulmonary edema. Excessive fluid can overburden the heart, causing heart failure, which manifests as chest tightness, shortness of breath, and difficulty breathing, especially when the patient is active, these symptoms of chest tightness and shortness of breath become more pronounced.

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Is stage three diabetic nephropathy severe?

Stage three of diabetic nephropathy refers to patients who have persistent microalbuminuria, indicating a relatively mild state of the disease at this time. In fact, diabetic nephropathy is divided into five stages. During the first and second stages, patients generally do not exhibit specific symptoms clinically and may even test negative for proteinuria; however, an increase in kidney size and glomerular filtration rate may occur. By the third stage, patients begin to exhibit small or micro amounts of urinary albumin. The pathological damage to the kidneys at this stage is not considered particularly severe. Patients may experience hyalinization of small arteries and nodular lesions in the glomeruli. Within the staging of diabetic nephropathy, this does not constitute a particularly severe phase; however, the condition of the patients may continue to progress, leading to significant proteinuria and even renal failure.