What is Diabetic Kidney Disease?

DKD, also called diabetic nephropathy, is a type of kidney disease caused by diabetes. Over time, diabetes can damage the tiny blood vessels (capillaries) in the kidneys, causing a loss of kidney function. DKD usually affects people who have had type 1 or type 2 diabetes for a long time. Not everyone with diabetes develops kidney disease, but it's a common complication.

Stages of DKD

There are typically 5 stages of declining kidney function in DKD, from early disease to kidney failure:

Microalbuminuria

Normally, the kidneys filter waste from the blood and only allow albumin, a type of protein, to pass through at very low levels. When the kidneys start to leak slightly higher than normal levels of albumin into the urine, this stage is called microalbuminuria. Losing albumin in the urine indicates underlying kidney damage.

Macroalbuminuria

 
At this stage, larger amounts of albumin are appearing in the urine, a sign that kidney damage is increasing. Microalbuminuria that persists may progress to macroalbuminuria if uncontrolled.

Moderate Reduction in Kidney Function

As kidney damage worsens, the kidneys start to lose more of their normal filtering ability, and waste builds up in the blood at this stage. Some medications may need dosage adjustments.

Severe Reduction in Kidney Function

More than half of kidney function is lost, and the kidneys can no longer adequately remove waste and help regulate fluid levels in the body. Careful control of diet, blood pressure, blood glucose and other factors is important.

Kidney Failure/End Stage Renal Disease (ESRD)
At this final stage, kidney function has declined to the point where dialysis or kidney transplantation is required for survival. Dialysis is needed to mimic some of the kidneys' important roles of removing waste and fluid from the body.

Risk Factors for Progression

Certain factors that can worsen diabetic kidney disease over time include:

- Poor blood glucose control - Higher blood glucose levels causes more damage to kidney filters over time.

- High blood pressure - Hypertension significantly increases strain on the kidneys. Blood pressure management is critical.

- Albuminuria - The higher the level of protein in the urine, the more severe kidney damage is likely to be present already.

- Smoking - Smoking accelerates kidney damage and progression to kidney failure.

- Other conditions - Conditions like heart disease also increase the risk of further kidney decline.

Treatment Options

Treatment focuses on slowing the progression of kidney damage as much as possible through lifestyle changes and medications. This may include:

- Strict control of blood glucose, blood pressure, lipids - Medical management is key to minimizing further harm.

- ACE inhibitors or ARBs - These classes of drugs are proven to protect kidney function in diabetes through blood pressure independent mechanisms.

- Diet modifications - A lower protein intake puts less strain on the kidneys.

- Dialysis - Dialysis cleans the blood if kidneys fail, buying time for a transplant.

- Kidney transplantation - Replacing failed kidneys with a living or deceased donor's healthy organ is the best option for ESRD.

In Summary, prognosis depends on how early diabetic kidney disease is detected and treated. With strict control and management according to stage, kidney damage progression can potentially be slowed by many years to prevent failure. Compliance is important for optimal outcomes. Overall, DKD remains a serious complication requiring close monitoring and care.