Diabetes is the most common noncommunicable disease of our century. The incidence of type 2 diabetes is gradually increasing with the change of life styles of societies in developed and developing countries. The main reasons for this are the rapid increase in the population, the decrease in physical activity brought about by aging and urbanization. As a result, obesity has become widespread. Diabetes is a disease that affects all systems in the body. The system known to be most affected is the excretory system, namely the kidneys. There are about 1 million small structures called nephrons in each kidney. The task of these nephrons is to filter the blood and remove waste materials from our body. Diabetic nephropathy is damage to the kidneys at the microvascular level and is one of the most serious complications of diabetes. As a result of the development of diabetic nephropathy, these waste materials cannot be removed from the body and accumulate in the body over time. Diabetic nephropathy is more likely to occur in patients with type 2 diabetes. Because type 2 diabetes is more common than type 1 diabetes.
Stages of Diabetic Nephropathy
Glomerular Hyperfiltration (Stage 1): It is the increase in glomerular filtration rate. Present when a person is diagnosed with diabetes. Approximately 20% growth in the kidneys, that is, hypertrophy, can be observed with the help of ultrasound. It is characterized by a significant increase in urinary albumin excretion (UAE) during exercise. Except for thickening of the glomerular basement membrane due to increased plasma flow and filtration surface in the kidneys, no significant structural changes were observed.
Silent Period (Stage 2): Although there is no clinical finding, it may take 10-15 years. The increase in filtration rate continues, but it decreases over time and returns to its normal state. However, blood pressure and urinary albumin excretion are within normal limits. At this stage, if a person adopts a good lifestyle and reduces glycemic intake, GFR can be significantly reduced. It has been observed that many people do not transition from this stage to the third stage.
Development of Microalbuminuria (Stage 3): Its incidence starts 6-15 years after the onset of diabetes. At this stage, the amount of albumin excreted in the urine increases. While the urinary excretion of albumin is 20 mg in 24 hours in a healthy person, it is 30-300 mg in patients diagnosed with diabetes, and this condition is called microalbuminuria. This stage can last up to 1-20 years.
Macroalbuminuria Stage (Stage 4): It is characterized by protein excretion of 300 mg and above in the urine within 24 hours. Histological changes are evident in the person and hypertension is always present. The rate of decrease in GFR can be reduced by 60% with antihypertensive medicines and the development of uremia can be slowed down.
Last Stage Renal Failure (Stage 5): It can also be called terminal renal failure and becomes evident in about 7 years as a result of continuous proteinuria. The picture is accompanied by severe hypertension, high creatine and urea. In the presence of uremia, it begins to be seen in cases such as edema and fluid retention. It cannot perform kidney functions. Depending on the person, dialysis treatment or kidney transplant may be required. These are an answer to the question of what are the stages of Diabetic Nephropathy.
Diagnosis of Diabetic Nephropathy
In the examinations performed every 3 or 6 months, at least two or more controls, and the urinary albumin excretion of 300 mg or more in the last 24 hours is sufficient for the diagnosis of diabetic nephropathy. In this clinical picture, severe hypertension, gradually increasing proteinuria or protein excretion with urine and impaired renal functions are observed.
Diabetic Nephropathy Symptoms
The most common symptom of diabetic nephropathy is swelling of the hands and feet. In addition, frequent urination at night, palpitations, hypertension, decrease in urine amount are among the symptoms of diabetic nephropathy.
Diabetic Nephropathy Care Plan
The most important rule in preventing chronic complications of the disease is to gain self-monitoring skills and learn to manage the disease well. It is important to adopt proper nutrition and a more active life in order to increase the effect of oral antidiabetic medication or insulin therapy used in the treatment of diabetic nephropathy. The best diabetic nephropathy care plan should continuously monitor the fasting-postprandial blood sugar and blood pressure of the person, and support this with appropriate foods and an effective exercise program. The person should maintain his ideal weight, fluid retention, fatigue, dyspnea, activity intolerance and abdominal tenderness that occur when the albumin level in the urine increases should be followed closely. In order to prevent deterioration of the integrity of the skin, cotton clothes that do not tighten, sweat, should be used and the person should check their skin frequently. If the person has smoking and alcohol use, it is also recommended to stop at the earliest period.
Diabetic Nephropathy Diet
Diabetic nephropathy diet aims to have a balanced and sufficient intake of carbohydrate, protein, fat and fluid in a healthy and regular way. The energy that people diagnosed with diabetic nephropathy should receive during the day depends on the person’s gender, age, and physical activity level. However, the daily energy required can be calculated as 35-40 calories per kilo on average. Substances such as urea, creatine and uric acid that come out after the use of protein in the body are toxic and accumulate in the body. On the other hand, if protein is taken too little, damage may occur in the body. The amount of protein to be taken daily can be calculated as 0.6-0.8 g per kilo. We get most of the energy we get daily from carbohydrates. For this reason, foods to be consumed should be preferred not foods such as sugar, refined flour and rice, which we classify as simple carbohydrates, but whole grain products that we classify as quality carbohydrates and have a low glycemic index. In order to have a healthy heart and keep blood cholesterol values at a normal level, foods such as butter, olive oil or tail fat, which are single or double unsaturated fats, should be added to the diet instead of unhealthy saturated fats such as margarine. In the diabetic nephropathy diet, consumption of vegetables, fruits and sufficient water should not be forgotten, and fried and overly spicy meals should be avoided. In this way, a successful Diabetic Nephropathy diet is realized.
Diabetic Nephropathy Risk Factors
Hyperglycemia is one of the most important risk factors for Diabetic Nephropathy in the development of diabetic nephropathy, which is also supported in the literature. In addition, hypertension, hyperlipidemia, excessive weight gain, heart and kidney diseases are among the risk factors for diabetic nephropathy.
Diabetic Nephropathy Treatment
● Your doctor may give you oral anti-diabetic medicines.
● The most important diabetic nephropathy treatment is to provide blood sugar control. Strict monitoring of blood sugar level positively affects the excretion of albumin with urine and keeping HbA1C lower than 6.0% -7.0%.
● If the person has hypertension, it should be treated and blood pressure should be controlled at normal values of 130/80 mmHg.
● If there is a urinary tract infection, it should be treated without delay.
● A diet suitable for diabetes should be adopted and meals low in protein should be preferred.
● Fatty foods should not be preferred in order to prevent hyperlipidemia, the increase in blood fat ratios.
● Finally, regular exercise and weight loss are indispensable parts of diabetic nephropathy treatment.