Nephropathy is the deterioration of kidney function. The final stage of nephropathy is called kidney failure, end-stage renal disease, or ESRD.
According to the CDC, diabetes is the most common cause of ESRD. In 2011, about 26 million people in the U.S. were reported to have diabetes, and more than 200,000 people with ESRD due to diabetes were either on chronic renal dialysis or had a kidney transplant. Both type 1 and type 2 diabetes can lead to diabetic nephropathy, although type 1 is more likely to lead to ESRD.
There are five stages of diabetic nephropathy. The fifth stage is ESRD. Progress from one stage to the next can take many years.
Hypertension, or high blood pressure, is a complication of diabetes that is believed to contribute most directly to diabetic nephropathy. Hypertension is believed to be both a cause of diabetic nephropathy, as well as a result of the damage that is created by the disease. As kidney disease progresses, physical changes in the kidneys often lead to increased blood pressure.
Uncontrolled hypertension can make the progress toward stage five diabetic nephropathy occur more rapidly.
The high blood sugar associated with diabetes also causes damage to the kidney through many different and complicated pathways. Most of this damage is directed toward the blood vessels that filter the blood to make urine.
The onset and progression of diabetic nephropathy can be slowed by intensive management of diabetes and its symptoms, including taking medications to lower blood pressure.
You should have your urine tested at regular intervals to check for a protein called albumin. Normally, urine should not have any albumin. Having even a small amount of albumin in your urine is a sign that early kidney damage is present.
Specific treatment for diabetic nephropathy will be determined by your doctor based on:
Your age, overall health, and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Treatment may include any, or a combination of, the following:
Strict monitoring and controlling of blood glucose levels, often with medication and insulin injections
Medication to lower blood pressure
Treatment for ESRD often initially includes dialysis to cleanse the blood. Eventually, kidney transplant may also be a consideration.