Diabetic Nephropathy (Kidney Disease)
According to the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), high blood pressure for adults is defined as:
140 mm Hg or greater systolic pressure
90 mm Hg or greater diastolic pressure
In an update of NHLBI guidelines for hypertension in 2003, a new blood pressure category was added called prehypertension:
120 mm Hg – 139 mm Hg systolic pressure
80 mm Hg – 89 mm Hg diastolic pressure
The new NHLBI guidelines now define normal blood pressure as follows:
Less than 120 mm Hg systolic pressure
Less than 80 mm Hg diastolic pressure
Nephropathy is the deterioration of the kidneys. The final stage of nephropathy is called end-stage renal disease, or ESRD.
According to the Centers for Disease Control and Prevention (CDC), diabetes is the most common cause of ESRD, accounting for about 44 percent of all new cases of kidney failure in 2008. In 2011, about 25.8 million people in the U.S. have diabetes, and more than 202,290 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, or deterioration of the kidneys. The fifth stage is ESRD. Progress from one stage to the next can take many years, with 23 years being the average length of time to reach stage five.
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 the cause of diabetic nephropathy, as well as the result of 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 onset and progression of diabetic nephropathy can be slowed by intensive management of diabetes and its symptoms, including taking medications to lower blood pressure.
Specific treatment for diabetic nephropathy will be determined by your physician 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:
- Proper diet
- 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, and, eventually, kidney transplantation may also be a consideration.
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