Diabetic Nephropathy: Symptoms, Diagnosis, Causes and Treatment

What is Diabetic Nephropathy

Diabetic nephropathy, a kidney-related disorder prevalent in individuals with type 1 and type 2 diabetes, affects the kidneys’ vital filtering function, leading to the impaired removal of waste products and excess fluids from the body. This condition is characterized by elevated levels of urine albumin emission, diabetic glomerular lesions, and a decline in the glomerular filtration rate (GFR) among diabetics. With approximately 1 in 4 women and 1 in 5 men with type 2 diabetes being diagnosed with diabetic nephropathy, it is a significant concern for healthcare professionals. Moreover, it is also observed to be common in individuals with type 1 diabetes.

Diabetic Nephropathy Causes

Diabetic nephropathy is primarily caused by prolonged and uncontrolled high blood sugar levels, which are characteristic of both type 1 and type 2 diabetes. Elevated blood sugar damages the blood vessels in the kidneys, leading to a cascade of events that result in kidney dysfunction. The main causes of diabetic nephropathy include:

Hyperglycemia: Consistently high levels of glucose in the blood cause damage to the blood vessels and capillaries in the kidneys over time.

• Hypertension: High blood pressure further stresses the already compromised blood vessels, worsening kidney damage.
• Genetic Predisposition: Some individuals are genetically more susceptible to diabetic nephropathy than others.
• Smoking: Smoking can exacerbate kidney damage in people with diabetes.
• Obesity: Being overweight or obese increases the risk of developing type 2 diabetes and subsequently diabetic nephropathy.
• High Cholesterol Levels: Elevated cholesterol levels contribute to vascular damage and kidney impairment.
• Proteinuria: The presence of excess protein in the urine (proteinuria) is both a symptom and a cause of kidney damage in diabetic nephropathy.
• Family History: A family history of diabetes or kidney disease can increase the risk of developing diabetic nephropathy.

Early Stage Diabetic Nephropathy

Detecting diabetic nephropathy in its early stages is critical for implementing timely interventions to slow down or halt its progression. During the initial phases, the signs and symptoms may be subtle or absent, making early detection challenging. However, routine screening and monitoring are essential for patient with diabetes to identify any kidney abnormalities promptly.

In the early stages of diabetic nephropathy, often referred to as microalbuminuria, the signs and symptoms might be subtle or even absent. This stage is crucial as it provides an opportunity for early intervention to slow down or prevent the progression of the disease. Early-stage diabetic nephropathy is characterized by:

Microalbuminuria: Small amounts of albumin, a type of protein, start to leak into the urine due to compromised kidney function.

• Normal GFR: The glomerular filtration rate (GFR), a measure of kidney function, remains relatively normal at this stage.
• Asymptomatic: Patients may not experience noticeable symptoms, making regular screening important for early detection.
• Blood Pressure Regulation: Blood pressure might begin to show minor fluctuations but generally remains within a normal range.

Early intervention at this stage can involve close monitoring of blood sugar levels, blood pressure, and kidney function. Lifestyle changes, such as adopting a kidney-friendly diet, maintaining a healthy weight, and managing blood pressure, can significantly impact the progression of the disease.

Diabetic Nephropathy Symptoms

In the primary phase, the signs and symptoms are almost negligible. In advanced phases, the signs and symptoms consist of:

• Deteriorating blood pressure regulation
• Protein in the urine
• Swelling of ankles, hands feet or eyes
• Increased want to urinate
• Decrease in the requirement for insulin or diabetes medication
• Confusion or trouble in focusing
• Shortness of breath
• Loss of appetite
• Nausea and vomiting
• Persistent itching
• Exhaustion

Diabetic Nephropathy Diagnosis

The diagnosis of diabetic nephropathy is characterized by various tests and procedures, such as:

• Blood tests- This is a basic test required to monitor the ailment and regulate how the kidneys are working.
• Urine tests- Urine samples deliver data regarding kidney function and whether there are excessive amounts of protein in the urine. Increased levels of the protein- microalbumin can indicate whether or not the kidneys are being affected by this disease.
• Imaging tests- X-rays and ultrasound are conducted to evaluate the kidney’s structure and size. Along with this, a CT scan and magnetic resonance imaging (MRI) is also conducted to understand how well the blood is circulating within the kidneys.
• Renal function testing- Using renal analysis testing, the kidney’s filtering capacity can be assessed.
• Kidney biopsy- A kidney biopsy may also be conducted to observe the kidney tissues.

Stem Cell Treatment for Diabetic Nephropathy

The conventional treatment options involve kidney transplants and kidney dialysis, which in turn comes with its own set of complications and side effects. It is high time that other alternative kidney treatment options are explored such as stem cell therapy.

Various research studies suggest that mesenchymal stem cells are extremely effective against Diabetic nephropathy. One such study by Sávio-Silva et al., (2020) indicates that Mesenchymal stem cell-based therapy possesses significant biological and therapeutic abilities for restricting Diabetic nephropathy progression. There is convincing evidence that MSC isolated from type 1 diabetes individuals uphold their basic characteristics, such as potency, secretion of trophic factors, and modulation of immune cells.

Another research study, on animal models, was conducted by Bai et al., (2019) which states that Mesenchymal stem cell involvement prevented Diabetic nephropathy procession and additionally repressed glomerulosclerosis and pro-inflammatory cytokines and eventually restored kidney homeostasis.

Adding more instances that stem cell therapy offers great promise in Diabetic nephropathy treatment, a review by Lin et al., (2021) states that in animal models of Diabetic nephropathy, mesenchymal stem cells may improve body weight, glycemic regulation, and pancreatic islet function to secrete insulin and lessen urinary protein, and renal hypertrophy. Mesenchymal stem cells can diminish the expression of inflammatory mediators and improve renal fibrosis.

Diabetic nephropathy research is developing in the direction of brilliant pharmaceutical and metabolic discoveries and Advancells is delighted to be a part of this. For more info about stem cells for kidney disorders, You can also contact us at [email protected]

REFERENCEs

Bai, Y., Wang, J., He, Z., Yang, M., Li, L., & Jiang, H. (2019) Mesenchymal Stem Cells Reverse Diabetic Nephropathy Disease via Lipoxin A4 by Targeting Transforming Growth Factor β (TGF-β)/smad Pathway and Pro-Inflammatory Cytokines. Medical science monitor: international medical journal of experimental and clinical research, 25, 3069–3076.

Lin, W., Li, HY., Yang, Q., Chen, G., Lin, S., Liao, C. and Zhou, T. (2021) Administration of mesenchymal stem cells in diabetic kidney disease: a systematic review and meta-analysis, Stem Cell Research Therapy, 12(1): 43.

Sávio-Silva, C., Beyerstedt, S., Soinski-Sousa, P.E., Casaro, E.B., Balby-Rocha, M.T.A., Simplício-Filho, A., Alves-Silva, J., Rangel, E.B. (2020)Mesenchymal Stem Cell Therapy for Diabetic Kidney Disease: A Review of the Studies Using Syngeneic, Autologous, Allogeneic, and Xenogeneic Cells”, Stem Cells International.