3-part #medicine #threadstorm series about diabetic nephropathy! This is sourced from an article I wrote here a few months ago.
Here’s part 3:
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3-part #medicine #threadstorm series about diabetic nephropathy! This is sourced from an article I wrote here a few months ago.
Here’s part 3:
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How is this condition treated? A typical approach would be to treat both the underlying disease (diabetes) and the kidney itself. Chronic damage may be difficult to reverse, especially if it’s been developing for quite a few years.
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Diabetes is typically treated with a combination of medications (commonly insulin, including long-acting and short-acting forms to keep the blood sugar steady throughout the day; other types are added if insulin is ineffective)…
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... and lifestyle modifications, including a decrease in carbohydrate-rich foods, an increase in exercise, and monitoring of blood sugar levels throughout the day.
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Progress is measured through changes in a value called HbA1c, which is an analog of the average of blood sugar levels over 3 months.
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The kidney disease is often treated with intravenous fluids, which can help increase the volume of blood flowing through the kidney. As patients with uncontrolled diabetes…
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... tend to urinate more (this is the body’s mechanism of removing excess sugar from the blood), they are often dehydrated, which causes further damage to the kidneys due to lower blood flow.
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Thus, rehydration will help a larger volume of blood reach the kidneys, and not only will more blood reach the filtration system (glomerulus), so that it can receive oxygen and nutrients to function better…
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... but more blood is filtered through the glomerulus itself. This all improves the GFR, BUN, and creatinine that we track in the bloodwork.
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Kidney disease, of course, can become very complicated. There’s often an association of hypertension with kidney disease, in combination with diabetes, along with other comorbidities, and these affect our choice of medications.
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We’ll sometimes use antihypertensives (blood pressure medications) which are also shown to protect kidneys, such as ACE inhibitors; these have been shown to improve kidney function in patients with congestive heart failure.
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Of course, they have their own sets of side effects, so a lot of other factors are taken into consideration to determine the best treatment.
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When medications don’t work, and the kidneys do not at all improve or continue to get worse, we may resort to a process known as hemodialysis, which acts as an external glomerulus / filtration system for the blood.
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Dialysis usually takes place between 3-7 days per week, for 2-3 hours at a time. Typically, once a person is placed on dialysis, they have to continue receiving it for the rest of their lives.
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There are more advanced forms of dialysis, and if those fail, the only remaining option is a kidney transplant – and that’s a whole other Pandora’s box of issues!
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