What is Diabetic Nephropathy?

Diabetic nephropathy (Diabetic Kidney Disease) is defined as the progressive damage to the kidneys caused by diabetes. It is characterised by the scarring of the glomeruli in the kidneys due to prolonged diabetes mellitus.

What Causes Diabetic Nephropathy?

Diabetes is a condition characterized by high concentration of blood sugar. Although the cause of Diabetes Nephropathy is not yet well defined, it is likely that the high sugar levels in the blood damage the blood vessels present in the kidneys that help to filter waste products, thus resulting in decreased kidney function and ultimately, kidney failure.

Not everyone with diabetes suffers from diabetic nephropathy. Although, factors that can increase your chances of getting diabetic neuropathy are-

Smoking

Poor control of blood glucose

High blood pressure

History of kidney diseases

What are the symptoms of diabetic nephropathy?

In the early stages, there may be no symptoms at all, but as the disease progresses, you may notice swelling in the extremities like your feet. Thus it is recommended to get your blood albumin levels tested on a regular basis. If it is diagnosed in early stages, the damage can be reversed. Other symptoms that can indicate damage to the kidneys are-

Severe malaise

Headaches

Nausea

Lack of appetite

Frequent voiding

Itchiness of skin

General feeling of illness

Diagnostic tests that can confirm diabetic nephropathy are-

Routine urine test (urinalysis) - Kidney diseases are detected by the presence of a protein in the urine called albumin and this condition is called albuminuria. Other parameters that must be regularly monitored are-

Blood pressure

Cholesterol levels in your blood

How can you treat/ manage diabetic nephropathy?

If this type of nephropathy is diagnosed in the early stages, the damage to the kidneys can be reversible. The key to managing diabetic nephropathy are-

Diet: Reduce the dietary intake of salt, phosphorous and potassium in the advanced stages.

Glycemic Control: Monitor your blood glucose levels regularly

Management of Hypertension: It is important to manage your blood pressure as it can have a direct effect on the coronary blood vessels which in turn pump blood to the various blood vessels of the body

Renal Replacement Therapy: In chronically ill patients, renal replacement therapy is the best option. This can include haemodialysis (a procedure to flush out toxins from the blood, such as urea), peritoneal dialysis or ultimately renal transplantation.

Diabetic Nephropathy - Causes, Symptoms and Treatments

When your kidney function falls below a certain point, it is referred to as a kidney failure or renal failure. Fortunately, you can still continue to lead a normal life with the right treatment for renal failure. Here are the three best treatments that you can choose depending on your condition and lifestyle:

1. Dialysis: Dialysis is the process that takes over the function of your kidneys to filter out the waste from your blood and maintain the proper balance of chemicals in the blood. You may use dialysis for many years or as a short-term treatment while waiting for a kidney transplant. Dialysis is not a cure for kidney disease, rather it helps you deal with renal failure. It is life-saving and without it, the kidneys will no longer function.

There are two types of dialysis treatments that you can choose from:

Hemodialysis   This type uses a machine to remove waste from the blood and sends it back to your body. It can be done at home or at a dialysis center.
Peritoneal Dialysis   This type uses the lining of your belly called the Peritoneum to do the work of your kidneys. A catheter and dialysis solution is used to carry out the function.
There are benefits and complications for each type of dialysis. The treatment decision will largely depend on the patient s illness and their past medical history. Discuss with your doctor to decide the best option for you.

2. Kidney Transplant: Kidney transplants can provide a better quality of life than dialysis and can be seen as a potential cure for kidney failure. A healthy kidney from a live donor or deceased donor is surgically placed in your body as a replacement to the failed kidneys. Although this may be a better option for you, it has certain shortcomings. There is an element of rejection and you may have to wait for a long time to get a donor. Extensive testing and anti-rejection medications are prescribed with this treatment.

3. Palliative Care: Rather than cure, it is the care that people with serious illness need. With so much to deal with, the patients have an array of tough questions and challenges to deal with. Patients need to take into account all medical options and care options based on their condition and severity of the renal failure.

Making the right treatment choice is difficult and that too when you are ill. It is normal to be fearful and worried about the risks involved. Get support from your family and doctor to help you make the right treatment choice. It may also be helpful to visit a dialysis or transplant center to talks to others who have been through these treatments.

3 Best Treatments for Renal Failure!

Causes and symptoms of acute tubular necrosis

Damage or destruction to tube-like structures known as tubules in the kidneys can bring about the development of acute tubular necrosis (ATN) and subsequently, acute kidney failure.

What causes acute tubular necrosis (ATN)?

A lack of supply of oxygen to the cells in the kidney is the most common cause of this condition. The reason as to why oxygen may not reach the cells and tissues of this organ could be restriction or blockage of the pathways. When this happens, the kidneys get damaged. Dehydration is the most important cause of ATN which may be because of loose motions, vomitings, heat stroke etc.

Health conditions such as diabetes, heart attack, and stroke can bring about a decrease in blood flow to the organs resulting in ATN and death of cells. Similarly, the presence of toxic substances in the blood can also lead to tubules damage and change the way the cells function in the tubules.

Other causes that may lead you to develop ATN may be medications, radiology dyes, anesthetics and chemicals that cause your body to react adversely.

In addition to these causes, a number of factors can put you at risk of ATN and there are:

- An injury to the body, more specifically your kidneys can cause clotting of the blood vessels
- An adverse response to blood transfusion
- Instances of septic shock can slow down blood flow to the organs
- A major surgery that can interrupt blood supply to the organs

What are the symptoms of the condition?

The symptoms associated with the condition can vary depending on the severity of the problem.

You may experience:

- Troubles in waking up
- Drowsy feeling even during daytime
- Feelings of lethargy
- Feelings of excessive thirstiness
- Problems with urination
- Fluid retention problems
- Instances of confusion
- Feelings of nausea



Can Acute Tubular Necrosis Cause Kidney Failure?

Needless to say, your kidneys play an incredibly important role in filtering waste from your blood, and therefore maintain healthy functioning of the body. Blood pressure, production of red blood cells, and electrolyte balance, all of these are regulated by the proper functioning of the kidneys. Kidney failure causes too much build-up of waste nitrogen products,acids and/or excess fluid,which causes major cardio respiratory problem to the patient.
Symptoms-

Shortness of breath 
A reduced amount of urine
Swelling of your legs, ankles, and feet
Excessive drowsiness or fatigue  
Confusion
persistent nausea
Pain or pressure in your chest
Seizures
Coma 
Inability to properly remove potassium that runs in the bloodstream can lead to irregular heartbeat and ultimately, death that is sudden and unforeseen.

How can it be treated?
The causes of kidney failures are many and the key to treat them is to correct the underlying cause first. Chronic kidney disease, however, has no cure. Treatment generally comprises measures that aid in controlling symptoms and signs, reduce complications, and slow down the progression of this disease. Despite efforts to treat the cause, the condition might keep worsening and there is little to guarantee the fact that complications will not arise. This is precisely why it is of utmost importance to opt for examinations at regular intervals so that you may ascertain if your disease has remained stable or worsened.

End-stage of Kidney disease 
In the case that your kidneys are unable to keep up with fluid and waste clearance as is normally expected, then there s a good chance that you have developed a near-complete or complete case of kidney-failure, and are afflicted by end-stage kidney disease. If this is indeed the case, then you have two options to resort to:

Dialysis: This helps remove the extra waste products that the kidneys fail to do. In haemodialysis, fluid and waste filtering takes place with the aid of a machine that drives these excesses from the blood. In peritoneal dialysis, catheters are employed to rid the body of the accumulated waste products.
Transplant: Kidney transplants involve a surgical placement of a healthy kidney in your system from a compatible donor, either living or dead. Medications will be a necessity since the body has to be prevented from rejecting this new organ.
You may also opt for treating the condition with conservative measures in case you don t want to resort to the aforementioned procedures.

Kidney Failure - What Should You Know About it?

Our kidneys act as filters which constantly flushes out toxins and excess minerals with water in form of urine. Urine contains lots of minerals which may precipitate and form stones. Urine has lots of pro-precipitating agents and anti-precipitating agents. When their balance disturbs due to some disease, stones start forming. These stones may often lead to abdominal pain which is referred to as renal colic. 

What exactly is renal colic? 

Renal or ureteric colic is the term used for typical pain in one side of abdomen in flank region starting from back and radiating forward towards lower abdomen up to scrotum. This is usually associated with nausea, vomiting and urinary discomfort. There may be blood in urine. 

How kidney stones are related to renal colic? 

Kidney stones usually form inside kidney and lies there without causing any pain. But whenever they are dislodged and stuck at mouth of kidney (pelvis) or anywhere in ureter, they block the passage of urine of that kidney. This causes swelling in kidney termed as hydronephrosis. This swelling in kidney causes renal / ureteric colic. This colic is protective phenomenon and tries to push out the stones. Small stones do come out in urine by this natural process. This spontaneous expulsion of small stones is common and many local practitioners used to get credit of it feigning benefit of their medicine. However large stones need some form of intervention to come out. Otherwise, they do harm to kidneys in long term. 

Symptoms of kidney stones along with renal /ureteric colic - 

Most stones which are lying in calyces of kidney are asymptomatic 
Nausea & vomiting 
Frequent urinary tract infections 
Fever with chills 
Foul smelling urine 
Hesitency, frequency and burning in urination 
Blood in urine (urine with a reddish, pink or brownish hue) 
Passage of small stones in urine 
Treatment of renal colic 

Treatment of ureteric/renal stones involves control of symptoms and stone removal. 

Expectant Treatment or Medical Expulsion Therapy: Small stones of less than 4 mm size usually pass on its own and some medicines like alpha-blockers and steroid hasten up their expulsion. Medium size stone (4-6 mm), sometimes passes with aid of these medications. But stones larger than 6 mm usually require intervention. 
Lithotripsy: This method involves breaking of stones by shock waves into small dusty particles which pass through urine on its own. This is usually suitable for stones upto 1.5 cm and lying in kidneys. This is non-operative treatment which can be done on OPD or Daycare basis. 
Ureteroscopy (URS): This method involves entry of very thin semirigid scope through urethra into ureter. Stone is broken by LASER and removed. This involves single day admission and spinal anaesthesia. 
RIRS- Retrograde Intra Renal Surgery: In this method very thin flexible scope in maneuvered through urethra into the upper ureter and pelvi-calyceal system of kidney. Stones in kidney or upper ureter are broken by LASER and removed. This is also done under anaesthesia and requires a day admission. 
Mini- PCNL: This method is suitable for large renal stones. In this technique, a small hole is made into the kidney through back and tiny scope is entered into the kidney. Stones are broken by LASER and removed. This is done under anaesthesia and require two to three days admission.

Renal Colic - Ways it Can Be Treated?

A lot of bad things can and do happen when the kidneys fail.  The kidneys are vital for proper bodily functioning because they filter liquid and solid waste products out of the blood and allow vital chemicals (which the body needs for functioning) to flow into the body through the bloodstream.  People can become very sick when the kidneys either fail to perform these functions or fail to perform them properly.  Many people will get chronic kidney disease, therefore, they need to know what the causes and symptoms are in order to treat, and even prevent these diseases from occurring.

People who suddenly experience the following symptoms should see a nephrologist as soon as possible for a medical examination:  blood or protein in the urine, kidney stones, acute kidney injury, kidney infections, and/or pain, and Hepatitis C and kidney disease.  

Blood in the urine can be a sign of kidney problems which can lead to kidney disease.  Additionally, people who urinate frothy or bubbly urine, or have swelling in the hands, face, and feet should see a doctor because this is a sign of protein in the urine.  Protein in the urine can be detected by a urine test.  Kidney stones can be very painful and are problematic.  They are caused by mineral buildup in the kidneys.  Men and white people tend to get kidney stones more, and they can cause blood in the urine, painful urination, sharp lower abdominal or back pain, and nausea and vomiting.

Acute kidney injury occurs when the kidneys stop functioning altogether in a short period of time.  Because this disease can be deadly, those with this disease should get immediate medical help.  Usually, the very sick patients in hospitals get this disease, but it can also be caused by certain medicines, injury, or infections.  This type of kidney disease is easily reversible.  

Symptoms include

Not passing enough urine when urinating
Leg, ankle, or feet swelling
Fatigue
Breathing problems
Confusion
Nausea, and chest pressure or pain. 
Kidney infections tend to be caused by bacteria that have spread from the urinary tract.  Women, because of their anatomy, tend to get kidney infections more than men. 

Symptoms include:

Fever
Vomiting
Back, side or groin pain
Chills
Nausea
Frequent urination
Frequent urges to urinate
Painful or burning urination
Pus or blood in the urine
Cloudy or foul-smelling urine
Kidney pain in the lower back or sides can signify more serious kidney problems.  They can be caused by urinary tract infections, polycystic kidney disease, kidney infections, blood clots, and/or bleeding in the kidneys.  
Hepatitis C is a disease that attacks the liver and can cause kidney disease.  

Symptoms include

Loss of appetite
Nausea
Fever
Fatigue
Vomiting
Dark colored urine
Grey colored stool
Joint pain
Yellow skin and eyes
While kidney diseases are at best unpleasant, and at worst, life-threatening, they can be avoided by drinking lots of water, eating a healthy low salt diet, and watching for any changes in health and urine over time.



What Happens When Kidneys Fail & Signs That Indicate It

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