Which department to see for diabetic nephropathy

Written by Li Liu Sheng
Nephrology
Updated on September 13, 2024
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Diabetic nephropathy is a kidney disease caused by diabetes. The main clinical manifestations of diabetic nephropathy usually include varying degrees of increased urine protein. Severe cases may also present with lower limb edema and reduced kidney function. As for which department to consult for diabetic nephropathy, it depends on the severity of the condition. In the early stages of diabetic nephropathy, if there is only a slight increase in urine protein and the chronic kidney disease is at stage one or two, patients can choose to see a specialist in the endocrinology department for diabetic nephropathy. Once the condition of diabetic nephropathy worsens, progressing to stage three or above of chronic kidney disease, and the patient also has significant increases in urine protein, decline in kidney function, and the onset of anemia, it is advisable to seek treatment in a nephrology department.

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Written by Zhou Qi
Nephrology
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Is diabetic nephropathy stage 3 reversible?

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
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How is diabetic nephropathy diagnosed?

The diagnosis of diabetic nephropathy primarily relies on the clinical symptoms and medical history of the patient. Such patients often exhibit proteinuria, sometimes even severe proteinuria, and may also experience renal failure. Additionally, these patients have a history of diabetes, usually extending over ten years, followed by renal damage, and often accompanied by diabetic retinopathy. In such cases, a preliminary diagnosis can be made based on clinical features. However, there is still a risk of misdiagnosis, as the proteinuria could also be caused by other diseases affecting the glomeruli. Therefore, to confirm the diagnosis, it is best to conduct a renal biopsy, which can provide a definitive diagnosis.

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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.

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Nephrology
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How to prevent and treat diabetic nephropathy

The prevention and treatment of diabetic nephropathy include the following 6 aspects: The first is changing lifestyle, including controlling weight, diabetic diet, quitting smoking, quitting alcohol, and appropriate exercise. Changing lifestyle is the foundation of blood sugar control and a key to improving various metabolic disorders. The second is blood sugar control. Strict blood sugar control is the most important means to prevent the occurrence and development of diabetes and diabetic nephropathy. Under normal kidney function, it is recommended to keep glycated hemoglobin below 6.2%. For patients with abnormal kidney function or elderly patients, it can be relaxed to 7%. The third is to reduce blood pressure and proteinuria. The most commonly used medications are ACE inhibitors and angiotensin receptor blockers. Once diabetic microalbuminuria appears, blood pressure should be controlled below 130/80 mmHg. The fourth is to restrict the intake of dietary protein, with a focus on animal protein, i.e., high-quality protein. Early stage protein intake should be controlled at 0.8-1g/kg; for patients who have developed renal failure, controlling protein intake at 0.6-0.8g/kg is more appropriate. The fifth involves controlling other factors, including a low-salt diet and treating hyperlipidemia. The sixth is the treatment of end-stage diabetic nephropathy. Since diabetic nephropathy patients frequently have cardiovascular complications and symptoms of uremia appear earlier, it is appropriate to start dialysis treatment early. (Please take medications under the guidance of a doctor.)

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Does diabetic nephropathy hurt?

Diabetic nephropathy generally does not cause painful symptoms. Diabetic nephropathy refers to the kidney damage that results from long-term diabetes, caused by factors such as hyperglycemia, oxidative stress, and an increase in advanced glycation end products. In the early stages, patients may experience an increase in kidney size and an increased glomerular filtration rate. As the condition progresses, proteinuria may occur, and it could eventually lead to severe renal failure. Throughout this process, patients typically do not experience pain because the kidneys do not have nerve innervation and therefore do not feel pain. Thus, including diabetic nephropathy, various kidney diseases and nephritis generally do not manifest with pain.