Nephropathy (Kidney Disease)      

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Type 1 Diabetes

Pathophysiology

Etiology

Epidemiology

Diabetic nephropathy occurs when there is too much inflammation and glucose in the bloodstream, clogging the small capillaries that feed into the kidneys. In addition, there is an excess amount of acid waste in the blood that further clogs these small capillaries. The accumulation of calcium (due to the extra insulin) and acid waste in the kidneys causes the formation of kidney stones and ultimately causes kidney cells to die. Because kidney cells cannot be regenerated or repaired, the remaining cells have to work that much harder to filter substances from the blood.

To help with the filtering process, the heart increases the flow of blood plasma to the kidneys, which in turn elevates blood pressure. As the kidney cells continue to die, the risk of kidney failure increases dramatically. This eventually leads to one or both of the kidneys losing their ability to function properly, characterized by high protein levels in the urine. Alcohol, tobacco, conventional animal meat, and many of the other “dead” processed foods accelerate the deterioration of the kidneys.

Each kidney is comprised of more than a million units called nephrons. Each nephron has a tuft of blood vessels called a glomerulus. The glomerulus filters blood and forms urine, which drains down into collecting ducts to the ureter. The earliest detectable change in the course of diabetic nephropathy is a thickening in the glomerulus. At this stage, the kidney may start allowing more albumin (protein) than normal in the urine, and this can be detected by sensitive tests for albumin. This stage is called “microalbuminuria” (micro refers to the small amounts of albumin). As diabetic nephropathy progresses, increasing numbers of glomeruli are destroyed. This increases the amounts of albumin being excreted in the urine, and may be detected by ordinary urinalysis techniques. At this stage, a kidney biopsy clearly shows diabetic nephropathy.

Protein may appear in the urine for five to ten years before other symptoms develop. High blood pressure often accompanies diabetic nephropathy. Over time, the kidney’s ability to function starts to decline.

Diabetic nephropathy may eventually lead to chronic kidney failure. The disorder continues to progress toward end-stage kidney disease, usually within two to six years after the appearance of high protein in the urine (proteinuria).

Diabetic nephropathy is the most common cause of chronic kidney failure and end-stage kidney disease in the United States. People with both Type 1 and Type 2 diabetes are at risk. The risk is higher if blood glucose levels are poorly controlled. However, once nephropathy develops, the greatest rate of progression is seen in patients with high blood pressure.

Diabetic nephropathy is generally accompanied by other diabetic complications including high blood pressure, retinopathy, and vascular (blood vessel) changes, although these may not be obvious during the early stages of nephropathy. Nephropathy may be present for many years before high protein in the urine or chronic kidney failure develops.

Diagnosis & Tests
The first laboratory abnormality is a positive microalbuminuria test, which implies that you are very likely to develop diabetic nephropathy. Most often, the diagnosis is suspected when a routine urinalysis of a person with diabetes shows too much protein in the urine (proteinuria). The urinalysis may also show glucose in the urine, especially if blood glucose is poorly controlled.

The microalbumin test checks urine for the presence of a protein called albumin. Albumin is normally found in the blood and filtered by the kidneys. When the kidneys camera are working properly, albumin is not present in the urine. But when the kidneys are damaged, small amounts of albumin leak into the urine. This condition is called microalbuminuria.

Without treatment to slow the leakage of protein, the kidneys may continue to be damaged and eventually fail.

If the microalbuminuria test is positive, it indicates that the blood vessels to your kidneys are damaged. It also reflects more widespread blood vessel disease that can increase your risk of heart problems.

Warning! If you have been diagnosed with protein leaking in your urine, it is imperative that you take action! You need to change your diet immediately to protect your kidneys from further damage and possible kidney disease (nephropathy)! Otherwise, you will eventually end up on kidney dialysis!  Start with the Death to Diabetes diet, and add raw juicing, wholefood  nutritional supplements and herbal tinctures to nourish and protect the kidneys from further damage.

There may or may not be signs of other diabetic complications. High blood pressure may be present or develop rapidly and may be difficult to control. Serum creatinine and BUN (blood urea nitrogen) may increase as kidney damage progresses. If there is any doubt in the diagnosis, a kidney biopsy may be performed to confirm the diagnosis and to study the extent of the disease.

In general, for good kidney health, avoid the processed foods, drink raw vegetable juices, and eat more green vegetables such as spinach, kale, and broccoli. Also, eat wild salmon and sardines for the Omega-3s. Foods and nutrients such as filtered water, celery, cucumbers, lemons, limes, and cranberries nourish, protect and cleanse the kidneys and the bladder. Refer to the wellness protocol section in Chapter 15  of the Death to Diabetes  book and the Power of Juicing ebook for more details about kidney health.

Early stage diabetic nephropathy has no symptoms. But, over time, the kidney's ability to function starts to decline. Symptoms develop late in the disease and may include:

• Fatigue
• Foamy appearance or excessive frothing of the urine
• Frequent hiccups
• General ill feeling
• Generalized itching
• Headache
• Nausea and vomiting
• Poor appetite
• Swelling of the legs (edema)
• Swelling, usually around the eyes in the mornings; general body swelling may occur with late-stage disease
• Unintentional weight gain (from fluid buildup)

Exams and Tests

The main sign of diabetic nephropathy is persistent protein in the urine. (Protein may appear in the urine for 5 to 10 years before other symptoms develop). If your doctor thinks you might have this condition, a microalbuminuria test will be done. A positive test often means you have at least some damage to the kidney from diabetes. Damage at this stage may be reversible. The test results can be high for other reasons, so it needs to be repeated for confirmation.

High blood pressure often goes along with diabetic nephropathy. You may have high blood pressure that develops rapidly or is difficult to control.

Laboratory tests that may be done include:

• microalbumin
• BUN
• Serum creatinine

The levels of these tests will increase as kidney damage gets worse. Other laboratory tests that may be done include:

• 24-hour urine protein
• Blood levels of phosphorus, calcium, bicarbonate, PTH, and potassium
• Hemoglobin
• Hematocrit
• Protein electrophoresis - urine

A kidney biopsy confirms the diagnosis. However, your doctor can diagnose the condition without a biopsy if you meet the following three conditions:

• Persistent protein in the urine
• Diabetic retinopathy
• No other kidney or renal tract disease

A biopsy may be done, however, if there is any doubt in the diagnosis.

Treatment

The goals of treatment are to keep the kidney disease from getting worse and prevent complications. This involves keeping your blood pressure under control (under 130/80). Controlling high blood pressure is the most effective way of slowing kidney damage from diabetic nephropathy.

Your doctor may prescribe the following medicines to lower your blood pressure and protect your kidneys from damage:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin receptor blockers (ARBs)

Unfortunately, these drugs don't work over the long term. Instead, eat more vegetables, avoid animal meat, and follow a superior wellness program like the Death to Diabetes program.

It is also very important to control lipid levels, maintain a healthy weight, and engage in regular physical activity.

You should closely monitor and control your blood sugar levels with a superior diet, including raw vegetable juicing. Doing so may help slow down kidney damage, especially in the very early stages of the disease. 

Urinary tract and other infections are common and can be treated with appropriate antibiotics.

Dialysis may be necessary once end-stage kidney disease develops. At this stage, a kidney transplant may be considered. Another option for patients with type 1 diabetes is a combined kidney-pancreas transplant.

Outlook (Prognosis)

Nephropathy is a major cause of sickness and death in persons with diabetes. It is the leading cause of long-term kidney failure and end-stage kidney disease in the United States, and often leads to the need for dialysis or kidney transplantation.

The condition slowly continues to get worse once large amounts of protein begin to appear in the urine or levels of creatinine in the blood begin to rise.

Complications due to chronic kidney failure are more likely to occur earlier, and get worse more rapidly, when it is caused by diabetes than other causes. Even after dialysis or transplantation, persons with diabetes tend to do worse than those without diabetes.

Possible Complications

Possible complications include:

• Anemia
• Chronic kidney failure (rapidly gets worse)
• Dialysis complications
• End-stage kidney disease
• Hyperkalemia
• Severe hypertension
• Hypoglycemia
• Infections
• Kidney transplant complications
• Peritonitis (if peritoneal dialysis used)

When to Contact a Medical Professional

Call your health care provider if you have diabetes and a routine urinalysis shows protein.

Call your health care provider if you develop symptoms of diabetic nephropathy, or if new symptoms develop, including little or no urine output.

But, don't wait for this to occur!!

Prevention