Is diabetic nephropathy with facial swelling serious?

Written by Zhou Qi
Nephrology
Updated on November 18, 2024
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Patients with diabetic nephropathy who experience facial swelling should not use this symptom as a basis for judging the severity of their condition. Diabetic nephropathy is divided into five stages. The condition is relatively mild during the first three stages. By the fourth stage, patients begin to exhibit significant proteinuria, and by the fifth stage, they experience severe renal failure. Conditions in these last two stages are quite severe. However, patients might also experience facial swelling during the first three stages, and while the likelihood of facial swelling increases during the fourth and fifth stages, some patients in these stages might not show obvious edema. Therefore, it is difficult to determine the severity of the condition based solely on swelling. Patients need to undergo 24-hour urinary protein quantification and blood tests to assess kidney function in order to judge the severity of their condition.

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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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Can diabetic nephropathy cause blood in urine?

Generally speaking, diabetic nephropathy does not cause hematuria. The main site of damage in diabetic nephropathy is indeed the glomerulus. Prolonged hyperglycemia and metabolic disorders can lead to damage to the capillaries of the glomerulus. However, the main clinical characteristic of this damage is proteinuria, which causes glomerulosclerosis and may also lead to renal failure, but it is rare for patients to have red blood cells in their urine or to experience hematuria. Therefore, if a patient with diabetic nephropathy has visible hematuria, such as red or tea-colored urine, it is necessary to check for other causes beyond diabetes, such as urinary tract infections, urogenital system stones, tumors, etc., all of which can cause hematuria.

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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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Symptoms of stage 2 diabetic nephropathy

Diabetic nephropathy is divided into five stages. Speaking in terms of the severity of the condition, in the second stage, the clinical manifestations are not very obvious, and the patient's kidney size may increase. Generally, at rest, the patient's urine protein is negative, but after activity, there might be traces of albumin in the urine. Due to the presence of a small amount of protein in the urine, there may be an increase in urine foam, and the patient may experience mild edema, although the symptoms of this edema are also not very noticeable. At this stage, the damage of diabetes to other organs of the body is not very evident, therefore, retinopathy is not severe, and the patient’s vision decline is not significant. The patient may also have concurrent issues like hypertension and hyperlipidemia.

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How is diabetic nephropathy treated?

The treatment of diabetic nephropathy also depends on the specific stage the patient is in. During stages one to three, the main clinical treatments include controlling blood sugar, blood pressure, and lipids. Patients with diabetes often also have these metabolic disorders, including hypertension and hyperlipidemia, which can damage the kidneys. In addition, in the early stages, some medications are often chosen to reduce the pressure on the glomeruli. For example, using ACE inhibitors or angiotensin receptor blockers (ARBs) and inhibitors of the sodium-glucose cotransporter, these drugs can also slow the progression of kidney failure. However, if the patient's condition has progressed to stage five, which is essentially equivalent to the state of uremia, the patient will then need dialysis treatment.