Diabetic nephropathy is the term used to describe kid- ney
damage that occurs
in diabetes, usually of long- standing. The damage
to the kidney in diabetes
can result from the high blood sugar itself, which leads to an expansion of certain types of material in the filter-
ing mechanism of the kidney. This expansion damages
the delicate cells responsible for filtering waste materi- als through the kidney. Eventually, there are abnormal pressures and changes in the important electrical bal- ance
in this complex
structure. These changes lead to leakage of
proteins
that are usually either
retained or reabsorbed by the kidney. The blood
pressure can rise due
to overload of fluid and
constriction of small blood vessels. The rise in blood pressure further damages the kidney if not treated. If there is an excessive
leak of protein,
the body becomes protein deficient, which
can
lead to generalized puffiness and swelling. Eventually,
the kidneys can
fail
and
their
functions
must be replaced
by the
processes of either
hemodialysis (blood filtering and removal
of
wastes
through a machine)
or
peritoneal dialysis (a simpler process whereby wastes are exchanged
into fluids introduced into the abdominal
cavity), or a kidney transplant is required.
Although complete kidney failure is not a common outcome in diabetes in percentage
terms, diabetes is the most common cause of kidney failure in working age adults
and occurs in more than 25,000 people each year in the United States. Kidney failure is
extremely disruptive to the sufferer’s life and is very expensive to treat. The tendency to get diabetic kidney
damage has an inherited component, so that
if a close relative
with diabetes suffers from it, an individual is more likely to
experience it. However, it can be delayed
or even
prevented. Good control
of blood sugar
and blood pressure, together with use of certain types of drugs known as ACE-inhibitors or ARBs, has been shown to markedly slow progression of diabetic kidney damage. Moreover, it can be
detected very early by sensitive tests in common use.
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