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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Treatment of Anemia in Diabetic Nephropathy

Compared to primary chronic nephritis, patients with diabetic nephropathy develop anemia earlier and more severely. The treatment for this type of anemia is divided into two aspects. Firstly, since it is anemia caused by renal lesions leading to a lack of erythropoietin, it is necessary to supplement erythropoietin, as well as iron and folic acid, which are raw materials for blood production, for the anemia caused by diabetic nephropathy. Additionally, patients with diabetic nephropathy are prone to malnutrition and should enhance nutritional support, especially by increasing the intake of high-quality animal protein.

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Written by Zhou Qi
Nephrology
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How to check for diabetic nephropathy?

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 stage 2 diabetic nephropathy

Diabetic nephropathy is divided into five stages. Speaking in terms of the severity of the condition, in the second stage, the clinical manifestations are not very obvious, and the patient's kidney size may increase. Generally, at rest, the patient's urine protein is negative, but after activity, there might be traces of albumin in the urine. Due to the presence of a small amount of protein in the urine, there may be an increase in urine foam, and the patient may experience mild edema, although the symptoms of this edema are also not very noticeable. At this stage, the damage of diabetes to other organs of the body is not very evident, therefore, retinopathy is not severe, and the patient’s vision decline is not significant. The patient may also have concurrent issues like hypertension and hyperlipidemia.

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Written by Hu Lin
Nephrology
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What are the symptoms of diabetic nephropathy?

The symptoms of diabetic nephropathy mainly include the following aspects: The first one is proteinuria, where patients may notice an increase in foam in their urine, and upon examination, proteinuria will test positive. The second symptom is edema, which may initially appear as intermittent swelling but gradually develops into swelling of both lower extremities or even the entire body. Of course, pleural effusion and ascites may also occur. The third type of symptom is hypertension; diabetic nephropathy combined with hypertension often involves stubborn high blood pressure, which requires multiple antihypertensive drugs to control. The fourth point is that in the later stages of diabetes, signs of renal failure gradually appear, such as nausea, vomiting, difficulty breathing, anemia, renal osteopathy, skin itching, and more. The fifth is extrarenal manifestations, such as diabetic retinopathy presenting with vision loss or even blindness, and diabetic neuropathy leading to numbness and abnormal sensations in the hands and feet. Additionally, it is common for patients with diabetic nephropathy to also experience cardiovascular and cerebrovascular complications, such as coronary heart disease, myocardial infarction, stroke, and more.

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Written by Zhou Qi
Nephrology
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Can diabetic nephropathy with swollen feet be treated?

Diabetic nephropathy in the middle and later stages can cause edema, especially in patients with significant proteinuria or renal failure. Many patients can even experience generalized edema. For such patients, swollen feet and swelling in other parts of the body can be considered for appropriate use of diuretics to increase urine output and eliminate edema. However, generally, the extensive use of diuretics is not actively advocated because excessive diuresis can also lead to significant protein loss and even cause insufficient blood volume, affecting the blood supply to the kidneys. Nevertheless, some patients with severe conditions that cause pulmonary edema and heart failure may not respond well to diuretics. In such cases, dialysis ultrafiltration may be required to remove water, alleviate edema, and reduce cardiac stress.