Is diabetic nephropathy stage 3 reversible?

Written by Zhou Qi
Nephrology
Updated on November 06, 2024
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Patients with diabetic nephropathy actually have an irreversible condition. If a patient has developed mild to moderate proteinuria and entered stage three, it's generally because of long-term high blood sugar, oxidative stress, and an excess of glycation end products damaging the capillaries of the glomerulus, resulting in increased permeability and the occurrence of proteinuria. The damage that has already occurred cannot be reversed; however, patients still need active treatment to control their blood sugar and blood pressure in order to slow down the progression of diabetic nephropathy as much as possible. Stage three diabetic nephropathy is incurable, but treatment can slow the progression of the kidney disease, preventing the development from microalbuminuria to macroalbuminuria. Stage three refers to the early period of diabetic nephropathy, typically seen in diabetic patients who have had the disease for more than five years. It can feature a continuous increase in urinary albumin excretion rates. High filtration rates and long-term poor metabolic control may be reasons for the persistent microalbuminuria. During this stage, patients may experience a mild increase in blood pressure, and reducing blood pressure can decrease the excretion of microalbumin. During this period, strict control of blood sugar is necessary. Oral hypoglycemic drugs can be used for treatment, and it's crucial to regularly monitor fasting blood glucose, postprandial blood glucose, and glycated hemoglobin. Blood pressure should also be actively controlled, generally targeting a value of 130/80mmHg. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are preferred as they can lower blood pressure, reduce proteinuria, and have a protective effect on the kidneys, thus delaying the progression of kidney disease.

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Written by Zhou Qi
Nephrology
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How is diabetic nephropathy diagnosed?

The diagnosis of diabetic nephropathy primarily relies on the clinical symptoms and medical history of the patient. Such patients often exhibit proteinuria, sometimes even severe proteinuria, and may also experience renal failure. Additionally, these patients have a history of diabetes, usually extending over ten years, followed by renal damage, and often accompanied by diabetic retinopathy. In such cases, a preliminary diagnosis can be made based on clinical features. However, there is still a risk of misdiagnosis, as the proteinuria could also be caused by other diseases affecting the glomeruli. Therefore, to confirm the diagnosis, it is best to conduct a renal biopsy, which can provide a definitive diagnosis.

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Nephrology
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Does diabetic nephropathy hurt?

Diabetic nephropathy generally does not cause painful symptoms. Diabetic nephropathy refers to the kidney damage that results from long-term diabetes, caused by factors such as hyperglycemia, oxidative stress, and an increase in advanced glycation end products. In the early stages, patients may experience an increase in kidney size and an increased glomerular filtration rate. As the condition progresses, proteinuria may occur, and it could eventually lead to severe renal failure. Throughout this process, patients typically do not experience pain because the kidneys do not have nerve innervation and therefore do not feel pain. Thus, including diabetic nephropathy, various kidney diseases and nephritis generally do not manifest with pain.

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Nephrology
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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.

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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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How to supplement for anemia in diabetic nephropathy?

Patients with diabetic nephropathy who exhibit anemia are often in a state of chronic renal failure. This anemia caused by chronic kidney disease is mainly due to the decreased secretion of erythropoietin by the kidneys. Therefore, treatment involves the use of erythropoietin to stimulate bone marrow hematopoiesis. In addition to this medication, patients generally also need to supplement with iron preparations, such as ferrous succinate, sucrose iron, etc., and take oral folic acid, all of which are raw materials for blood formation. Furthermore, if patients have severe malnutrition, they should also supplement with foods rich in protein, such as eggs, milk, chicken, duck, fish, etc. (Please use medications under the guidance of a doctor.)