diseases

DIABETIC NEPHROPATHY


Introduction:
Nephropathy means any kidney disease or damage. The term Nephropathy is derived from the Greek words 'Nephros' meaning Kidney and 'Pathos' (Disease). Diabetic nephropathy is characterized by high protein levels in the urine.

It is one of the complications of diabetes. Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria (>300 mg/d or >200 mcg/min) that is confirmed on at least 2 occasions 3-6 months apart, a relentless decline in the glomerular filtration rate (GFR), and elevated arterial blood pressure.


Causes:
. It is one of the complications of diabetes. Each kidney is made of thousands of units called nephrons.Each nephron has a cluster of blood vessels called glomerulus.The glomerulus filters blood and forms urine, which drains into the ureter.

In case of diabetic nephropathy, there is thickening of the glomerulus, due to which more amount of albumin is passed in the urine. Diabetes damages this delicate filtering system. . As diabetic nephropathy progresses, a large number of glomeruli are destroyed. Hence, the amount of albumin excreted in urine increases.

The pathology is complicated with four types of lesions
1) Glomerulosclerosis
2) Arteriosclerosis of afferent and efferent arterioles
3) Arteriosclerosis of renal artery and its intrarenal branches.
4) Peritubular deposits of glycogen, fat and mucopolysaccharides.Diffuse or nodular Glomerulosclerosis (Kimmelstiel-Wilson lesion) may occur.
. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant
. People with both Type 1 and Type 2 diabetes are at risk. The risk is more if the blood sugar levels are not controlled. Early treatment delays or prevents the onset of diabetic nephropathy or diabetic kidney disease
. Diabetic nephropathy is associated with other complications of diabetes such as retinopathy (damage to the blood vessels of retina which may lead to blindness) and blood vessel changes. Protein may appear in the urine for 5 to 10 years before other symptoms develop

Signs and Symptoms:
. There are no symptoms in the early stages in diabetic nephropathy. So it's important to have regular urine tests to find kidney damage early. Sometimes early kidney damage can be reversed
. The principal clinical manifestation of diabetic kidney disease is passing of proteins in the urine (Protinuria).Initially protinuria is mild and asymptomatic. It is also known as microalbuminuria, this can be detected by sensitive tests for albumin. As diabetic nephropathy progresses, increased amount of proteins are passed in the urine and this can be detected by ordinary urinanalysis
. Foamy appearance of urine
. Fatigue or generalized ill health
. Itching
. Nausea and vomiting
. Frequent hiccups
. Swelling of legs. Also there is swelling around the eyes in the morning
. General body swelling may occur later
. Weight gain

Complications:
. Diabetic retinopathy is present in virtually all persons with IDDM ( Insulin dependent diabetes mellitus) who have nephropathy, whereas some of the patients with proteinuric NIDDM (Non Insulin dependent diabetes mellitus)have retinopathy
. Peripheral neuropathy is present in almost all patients with advanced nephropathy
. End stage kidney disease
. Hypoglycemia
. Complications due to dialysis
. Severe hypertension
. Side effects of medicines

Diagnosis
. Microalbuminuria test: The microalbuminuria test detects small quantities of protein called albumin in a urine sample
. Regular urine analysis shows microalbuminuria. Microalbuminuria is defined as albumin excretion of more than 20 mcg/min. This phase indicates incipient diabetic nephropathy and calls for aggressive management, at which stage the disease may be potentially reversible
. A 24-hour urinalysis for urea, creatinine, and protein helps to know the protein losses and estimating the GFR
. In case of advanced cases of diabetic nephropathy, routine urine analysis shows protinuria
. Renal ultrasound shows size of kidneys is increased in initial stages and later shrunken or decreased with chronic renal disease
. Blood tests shows increase in Serum Creatinine and Blood Urea Nitrogen(B.U.N.)
. Increase in blood pressure
. Kidney biopsy confirms the diagnosis

Treatment:
It is necessary to stop the progress of the disease to take care of the related complications. . Maintain blood pressure at normal levels
. Blood glucose levels should be controlled with medications, diet and exercise. Diet should be a balanced diet. If the disease progresses dialysis is required
. End stage renal disease may require kidney transplant. For type 1 diabetes combined kidney-pancreas transplant may be carried out

Homeopathic Management
It is necessary to start homeopathic medicines immediately once the person has diabetes. Constitutional homeopathic medicine maintains blood glucose levels and prevents the progress of disease.

Homeopathic medicines with balanced diet and exercise help to prevent the complications of diabetes such as diabetic nephropathy, retinopathy, Neuropathy etc.

Homeopathic physician spends nearly one to two hours during first consultation to understand the person. This helps to know the physical and mental state of a person. An in depth enquiry is made so to understand the person and know what has brought on the present condition.

The Homeopath takes into consideration mans illness not in one part as being sick but he considers the manifestation of illness in one part in its relation to the whole man.

In Homeopathy a deeper look is taken into the subtle and complex burden that we carry with us from our hereditary tendencies. The Homeopathic remedy acts at a deep level and helps to relieve the individual of these hereditary tendencies as much as possible. It also helps in building the immunity of the person to ward off further disease.

When homeopathic medicines are given to children, they will lead a healthier life and even the hereditary tendencies that parents carry can be minimized.

Homeopathic medicines can also be taken along with your regular medicines if you have approached homeopathic physician later. Homeopathic medicines will also maintain your blood pressure levels within normal limits.

In case of diabetic nephropathy, constitutional homeopathic medicines will reduce the frequency of dialysis, maintain blood glucose levels within normal limits, take care of side effects due to heavy conventional medicines and prevent the progress of the disease.

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