Diabetic Nephropathy

Generality

Diabetic nephropathy is a disease that slowly but irreversibly deteriorates the kidney function of some diabetic patients, especially those in whom the disease has existed for many years. Indicatively, this complication affects 30-40% of type 1 diabetics and 10-20% of type 2 diabetics.

Symptoms

For further information: Symptoms Diabetic Nephropathy

Diabetic nephropathy is described as a clinical syndrome characterized by:

persistent microalbuminuria (between 50 and 300 mg / day)
slow and gradual decline in renal function with a tendency to proteinuria and renal insufficiency
hypertension
high risk of cardiovascular morbidity and mortality

The clinically established form generally appears about 15-25 years after the onset of diabetes.

Incidence

Diabetic nephropathy is the expression of poor glycemic control repeated over time; for this reason, in the various scientific texts and in the epidemiological studies themselves there are important differences on the real incidence of this complication in the diabetic population.

On the other hand, the recognition of the constant increase in cases of disease is unanimous: due to the spread of sedentary lifestyle and excessive caloric intake, it is estimated that the diabetic population worldwide will increase from 154 million registered subjects in 2001 to 285 million in 2025. With the "increase in the average life span, it should also be borne in mind that, since type 2 Diabetes Mellitus is a particularly slow and progressive disease, at the time of diagnosis many patients already present with microalbuminuria or, more rarely, full-blown diabetic nephropathy. the importance of periodic glycemic checks even in the apparently healthy population, from an early age.

Beyond the numbers, it is important to point out that diabetic nephropathy represents the leading cause of chronic renal failure in the United States.

Causes and risk factors

The likelihood of developing this complication is proportional to the duration of the diabetes (both insulin-dependent and insulin-independent): in other words, the longer the person suffers from diabetes, the greater the risk of developing diabetic nephropathy.

The risk also increases as a function of the quality of glycemic control: therefore, the patients most exposed to the risk of developing diabetic nephropathy are those less attentive to their diet, lifestyle and the correct use of the prescribed drug therapy.

Once onset, the rate of progression of diabetic nephropathy towards renal insufficiency correlates above all to blood pressure values: the higher these are, the more rapid and severe is the evolution of the nephropathy towards renal insufficiency. speech can be made for cholesterol values Diabetic patients suffering from hypertension and hypercholesterolemia are therefore more at risk of a rapid worsening of the disease after its onset.

Smoking, on the other hand, seems to favor both the onset of diabetic nephropathy and its evolution towards chronic renal failure.

Alongside all these correctable factors (hyperglycemia, hypercholesterolemia, hypertension, smoking habit) there is an innate non-modifiable component, namely the individual genetic predisposition; it has been seen, for example, that the risk of the onset of nephropathy and its evolution is greater when the diabetic has a family history of diabetes, hypertension or cardiovascular disease.

But what exactly does kidney failure mean? This is a disease in which the kidneys are no longer able to perform their functions; consequently there is a significant accumulation of waste substances normally eliminated in the urine. The toxicity of these substances compromises the functionality of the whole organism and, in the absence of medical intervention, causes its death.