nephropathy

Nephropathy: description

The term nephropathy includes in medical parlance all diseases of the kidneys or their function. These include:

• diabetic nephropathy (due to diabetes)
• Hypertensive nephropathy (due to high blood pressure)
• Nephropathy due to toxins (for example, lead phlogathy) or drugs (analgesic nephropathy)
• Hypercalcemic nephropathy
• HIV-associated nephropathy
• Pregnancy-related nephropathies (Nephropathia gravidarum)

The kidneys are part of the body’s urinary system and are paired. That is, every human has two kidneys. They take over important functions:

• They are involved in the regulation of blood pressure,
• are involved in the formation of red blood cells,
• filtering metabolic waste products from the blood,
• produce urine,
• form different hormones,
• and regulate the fluid and electrolyte balance
• as well as the acid-base balance.

Each kidney consists of about one million small subunits called nephrons. The most important part of nephron is the renal body (glomerulum), a ball of the finest blood vessels. They have the task to filter the blood. If they are damaged, the kidney filter function suffers. This can be due to high blood pressure, but also due to long-term excessively high blood sugar levels.

In fact, diabetes is the leading cause of nephropathy, which may affect Type 1 as well as Type 2 diabetics. The risk of diabetic nephropathy can be significantly reduced if the blood sugar is optimally adjusted. If there is already a nephropathy, it is crucial to adjust the blood sugar well. It is equally important to keep blood pressure at low levels. This often prevents further damage to the kidneys.

If nephropathy continues, patients may need to undergo dialysis or kidney transplantation. In Germany, about one-third of all patients who regularly need a blood wash are diabetics. If the nephropathy is not treated in time, those at risk of renal failure within two to three years.

Nephropathy: symptoms

Nephropathy often progresses creeping for years without noticeable symptoms or discomfort. It is therefore often discovered only by accident, for example as part of a urinalysis, which is carried out regularly in diabetics. The reason: In diabetic nephropathy, one of the first signs is the increased amount of a specific protein (albumin) in the urine. As the filtering function of the kidney is disturbed, the body excretes more protein from the urine (proteinuria), which is normally free of these substances. Diabetic nephropathy can therefore be detected early if the doctor regularly examines the urine for albumin and checks various risk factors.

Only in advanced diabetic nephropathy symptoms become noticeable, but only after a few years. These include, for example:

• itching
• milk-coffee-colored skin
• inefficiency
• a headache
• Anemia
• increased water retention – especially in the legs (edema)
• increase in weight
• exhaustion
• fatigue
• foaming urine

Other forms of nephropathy have other signs:

• Nephropathy due to toxins: The toxins cause chronic damage to various functional units of the kidney, such as the renal tubules (tubules) or its vessels (glomeruli). In a lead nephropathy, the function of the renal tubule is disturbed: The body breaks down damaged cells, causing the Nierenkanälchen shrinks. Other symptoms include high blood pressure in the kidney or the rise of harmful metabolites in the kidney, which can lead to constipation or loss of appetite and eventually to kidney failure. Other toxins, such as mercury or arsenic, can also cause kidney failure.
• The Analgesic nephropathy due to painkillers leads to symptoms such as damage to the renal tubule, dissolution of red blood cells (hemolysis) up to an acute renal failure.
• In the Hypertensive nephropathy Symptoms only occur when high blood pressure has already caused damage to the kidney. Symptoms include nausea, vomiting, headache or seizures.
• In the Hypercalcemic nephropathy Symptoms include nausea, vomiting, muscle weakness, high blood pressure, fever and even kidney weakness.
• Of the pregnancy-related nephropathy is usually preceded by a high blood pressure. Again, the body loses a lot of protein through the kidneys; Water deposits (edema) often form, especially on the arms, legs and face.

Nephropathy: causes

Nephropathy can have very different causes:

• In nephropathy caused by toxins, so-called toxic nepropathies, environmental toxins such as lead, mercury, arsenic or cadmium are the causes. They accumulate in the body, especially in the kidney and damage them.
• In so-called analgesic nephropathy, long-term abuse of analgesics (such as paracetamol or acetylsalicylic acid) is the cause of nephropathy, especially when taken in combination.
• Hypertensive nephropathy develops when excessive blood pressure damages the kidney corpuscles.
• Hypercalcemic nephropathy is caused by increased blood calcium (hypercalcaemia), which causes kidney disorders.
• In pregnancy-related nephropathy, proteins are deposited in the renal vessels. This form occurs, for example, in pregnancy-related hypertensive diseases such as preeclampsia.

Diabetic nephropathy is caused by a permanently elevated blood sugar level. This causes the blood vessels to be damaged. It forms deposits in the vessels, which lead to constrictions, so that the blood flow is disturbed (arteriosclerosis). The kidney as a heavily perfused organ suffers particularly strong. In diabetic nephropathy, especially the small vessels of the so-called renal corpuscles, the glomeruli, are affected. Due to the changes in the vessels, on the one hand, the blood pressure inside the renal body increases. As a result, kidney function, especially the kidney filter function, is limited. The body now increasingly excretes proteins with the urine, which is normally free of proteins.

People with diabetic kidney disease often suffer from elevated blood pressure. Arteriosclerosis (arteriosclerosis) of the renal vessels increases blood pressure.

Various risk factors accelerate the development of diabetic nephropathy. This includes:

• high blood pressure (hypertension)
• Smoke
• increased protein intake with the food
• elevated blood lipid levels
• genetic predispositions

Nephropathy: examinations and diagnosis

If a nephropathy is suspected, the doctor usually performs blood and urine tests as well as partial imaging procedures such as X-rays for diagnosis.

First, the doctor checks the amount of albumin in the urine. Albumin is a protein found in the blood. Usually the urine is free of albumin and other proteins. If more proteins are excreted in the urine, is in medicine of a so-called proteinuria the speech. It indicates a possible nephropathy. Diabetics should therefore regularly, at least once a year, check their urine for proteins out. Patients already suffering from nephropathy should be examined two to four times a year, depending on the stage. Also every newly diagnosed diabetic should have their albumin value checked.

Albumin rapid test

The doctor can perform a diabetic nephropathy exam using a rapid albumin test, however, the urine is usually collected over 24 hours and then examined. Already slightly increased amounts of albumin in the urine indicate kidney damage. Normal are albumin levels of less than 20 milligrams of albumin per liter of urine (mg / l) within 24 hours. Values ​​between 20 – 200 mg / l are called microalbuminuria and are an indication of incipient kidney damage. Values ​​of more than 200 mg / l albumin in urine are referred to as so-called macroalbuminuria and are indicative of advanced diabetic kidney disease.

Several checks necessary

There is no nephropathy behind every increased protein excretion in the urine. It can also increase for a short time due to physical exertion, urinary tract infections, feverish illnesses or short-term increased blood glucose levels. Therefore, a check-up is necessary, which must confirm the values. Diabetic nephropathy is present when albumin levels are elevated in at least two out of three samples.

Kidney function tests

To further diagnose diabetic nephropathy, the physician determines the renal function values ​​in the blood. These include the values ​​creatinine, urea and uric acid. If the kidneys are no longer working properly, they are elevated. Together with the albumin values, the doctor can determine from them the severity of a nephropathy.

X-ray & Co.

The physician uses imaging techniques, for example, for the suspicion of analgesic nephropathy or hypercalcemic nephropathy. These diseases can be diagnosed with procedures such as x-rays, ultrasound (ultrasonography) or computed tomography.

Nephropathy: treatment

A nephropathy is treated differently depending on the cause – in most cases, to treat the underlying disease necessary. These include antihypertensive agents and insulin for diabetics, antihypertensives for hypertensives or so-called complexing agents, which are used in poisoning with lead, for example.

In addition, there are other possible factors that influence the course and are therefore taken into account in the treatment.

Diabetic nephropathy – treatment

The longer the blood glucose levels in diabetes are poorly adjusted, the higher the risk of developing diabetic nephropathy. The blood sugar levels also influence the further course of the disease. If the nephropathy is recognized in good time and the diabetes is then optimally adjusted, the progression of the kidney disease can often be prevented or at least slowed down. In the very early stages, the pathological changes can even be remedied with appropriate measures. Important for judging whether the blood sugar is set correctly is the long-term blood glucose value HbA1c. In order to prevent the progression of nephropathy, a value of less than 7.0 percent is desired.

If the doctor detects signs of diabetic nephropathy, he may re-adjust your diabetes therapy. For example, some medications (such as metformin) put extra strain on the kidneys. He will also tell you which drugs you should also avoid (for example, certain painkillers).

Nephropathy and hypertension

Also important in the treatment of nephropathy is the early treatment of hypertension, as it additionally damages the kidneys. This is especially true at the Hypertensive nephropathywhose main cause is an elevated blood pressure.

• This reduces the risk of nephropathy if high blood pressure is set early to low levels. Values ​​of less than 140 mmHg are recommended for systolic and less than 80 mmHg for diastolic blood pressure.
• When nephropathy starts, certain antihypertensive medications (preferably ACE inhibitors or AT1 antagonists) can stop the disease.
• Treatment of elevated blood lipid levels
• Low-protein diet
• low-salt diet
• Reduction of overweight
• Abstain from nicotine
• In case of a Hypercalcemic nephropathy It is important that as little calcium as possible is ingested with the food.

Further measures in the treatment of nephropathy:

Ultimately, only hemodialysis (dialysis) or kidney transplants help with advanced stage renal failure.

Nephropathy: prevention

The most common form of kidney disease is diabetic nephropathy. It can be prevented by an optimal blood sugar adjustment. If renal disease is already known, regular early detection or follow-up can help prevent diabetic nephropathy from progressing. Only in this way is it possible to check the success of the treatment and possibly to improve the treatment.

Regular checks

Have your individual risk profile checked regularly so that you can respond to critical values ​​as quickly as possible. These include, for example, the control of blood pressure and blood lipids (cholesterol). Since patients with diabetic nephropathy also have an increased risk of diseases of the heart and vascular system, special attention must be paid to cholesterol levels. Crucial is the value of LDL cholesterol, colloquially referred to as “bad cholesterol”. A value of less than 100 micrograms per deciliter (mg / dl) is recommended.

If you have diabetic nephropathy your diet is important. Pay particular attention to the protein and cholesterol content of your food. A doctor or dietician can give you more information.

Live kidney health

Live “kidney health”! Here are the most important tips at a glance to prevent nephropathy:

• Keep blood sugar and blood pressure within normal limits.
• Eat healthy.
• Drink enough.
• Be reluctant to take painkillers.
• Take medication only as prescribed.
• Inform yourself about possible interactions.
• Avoid pollutants, if possible.
• Avoid smoking and drugs.

Nephropathy: disease course and prognosis

Depending on the cause, nephropathies can be severe and even lead to acute renal failure. If the treatment starts on time, the course of the disease can be positively influenced and sometimes even stopped.

Diabetic nephropathy is divided into five stages during its course of disease:

• In the first stage, the body secretes more and more the protein albumin. The kidneys are so damaged, but still work as normal. A distinction is made between two forms: a small amount of albumin in the urine is referred to as microalbuminuria, with an increased amount of albumin doctors speak of macroabluminuria.
• The other four stages are characterized by kidney damage with varying degrees of renal insufficiency (renal insufficiency): mild, moderate and severe renal insufficiency. In the final stage, there is talk of terminal renal insufficiency.

Without treatment, the kidney function continues to deteriorate in a nephropathy – ultimately only help the blood (dialysis) or a kidney transplantation. Diabetic nephropathy also increases the risk of heart attack, stroke or diabetic sequelae such as diabetic eye disease (retinopathy).

Therefore, it is very important to be diabetic nephropathy prevent or recognize them in good time and treat them accordingly.