Causes, Risk factors and Stages for Diabetic Kidney Disease
Diabetic nephropathy occurs when the tiny blood vessels in the kidneys that filter waste from blood are destroyed due to high blood sugar from diabetes. Gradually the blood vessels lose their function completely leading to kidney failure.
Some of the diabetic nephropathy risk factors include:
- High blood pressure
- High cholesterol
- Ethnicity – Native or African Americans and Hispanics are more prone to develop nephropathy
The disease goes through five predictable medical stages:
- Stage 1 (very early stage of diabetes) - Above-normal glomerular filtration rate (GFR) indicates very early stage of diabetes.
- Stage 2 (developing diabetes) - The GFR remains elevated or may be normal, but above-normal levels of the protein albumin (micro-albuminuria) in the urine is indicative of glomerular damage. Patients may excrete more than 30 mg of albumin in the urine over a 24-hour period.
- Stage 3(overt diabetes) - A 24-hour period evaluation shows that the urine contains more than 300 mg of albumin in it. This is indicative of glomerular damage that has progressed to clinical albuminuria. Hypertension is also commonly seen in patients with stage 3 nephropathy.
- Stage 4(late-stage diabetes) - Glomerular damage continues, the kidneys lose their filtering abilities and more amount of protein albumin accumulates in the urine. Blood urea nitrogen (BUN) and creatinine (Cr) levels increase. Hypertension is common at stage 4.
- Stage 5(end-stage renal disease, ESRD) - GFR falls to approximately 10 milliliters per minute. Renal replacement therapy, including hemodialysis, peritoneal dialysis and kidney transplantation, is required for patients in this stage of the disease.
Approximately, 5 to 15 percent of patients with type-2 diabetes experience the five stages of diabetic nephropathy. Once they reach the end stage disease the only option is to give them a renal replacement therapy in the form of dialysis or consider the patient for kidney transplantation.
Help in Early identification of Diabetic Retinopathy
- Am Heart J. 1978 Sep;96(3):401-6. Diabetic angiopathy--its lessons in vascular physiology.
- McMillan DE.