MANILA TYTANA COLLEGES

Formerly Manila Doctors College

A Partner of the Metrobank Group

CASE ANALYSIS
“DIABETIC
NEPHROPATHY”

Submitted by:
Anabelle Joy Reyes
Jassel Escobar
BSN IV

Submitted to:
Prof. Ejay M. Reantillo RN, LPT, MSN.
 I. INTRODUCTION

Diabetic nephropathy is a long-term kidney disease that can affect people with diabetes. It occurs
when high blood glucose levels damage how a person's kidneys function. Diabetic nephropathy is
a kind of chronic kidney disease (CDK). The kidneys help regulate the levels of fluids and salts in
the body, which is vital for controlling blood pressure and protecting cardiovascular health.

When a person has diabetes, whether type 1, type 2, or gestational diabetes, their body cannot use
or produce insulin as it should. Gestational diabetes occurs during pregnancy and may increase the
risk of type 2 diabetes later in life. Diabetes results in high blood sugar levels. Over time, these
high glucose levels can damage various areas of the body, including the cardiovascular system and
kidneys. The kidney damage that results is known as diabetic nephropathy.

Diabetic nephropathy is a major cause of long-term kidney disease and end-stage renal disease
(ESRD). In ESRD, the kidneys no longer work well enough to meet the needs of daily life. ESRD
can lead to kidney failure with potentially life-threatening consequences.

How common is diabetic nephropathy?

Diabetic nephropathy is common. One in 4 women and one in 5 men with type 2 diabetes develops
diabetic nephropathy. It is even more common in type 1 diabetes. According to International
Diabetes Federation Philippines is one of the 22 countries and territories of the IDF WP region.
425 million people have diabetes in the world and 159 million people in the WP Region; by 2045
this will rise to 183 million. There were over 3.721.900 cases of diabetes in Philippines in 2017.

What are the symptoms of Diabetic Nephropathy?

Diabetic nephropathy usually has no symptoms early on. You can’t tell that there is protein in your
urine – it’s something that is detected with a urine test.

It can take many years for the kidney damage to progress. Symptoms usually only appear when
kidney damage has deteriorated significantly. Even then, the symptoms tend to be vague.
If the kidney damage becomes severe, you may notice:
 weight loss;
 a poor appetite or feeling sick;
 swollen ankles and feet (due to retaining fluid);
 puffiness around the eyes;
 dry, itchy skin;
 muscle cramps;
 needing to pass urine more often;
  feeling tired; and
 having difficulty concentrating.

What are the stages of Diabetic Nephropathy?

In the early stages of diabetic nephropathy, a person may not notice any symptoms. However,
changes in blood pressure and the fluid balance in the body may already be present. Over time,
waste products can build up in the blood, leading to symptoms.

A doctor may break down the stages of kidney disease, depending on the GFR, which also
represents the percentage of effective kidney function.
Stage 1: Kidney damage present but normal kidney function and a GFR of 90% or above.
Stage 2: Kidney damage with some loss of function and a GFR of 60–89%.
Stage 3: Mild to severe loss of function and a GFR of 30–59%.
Stage 4: Severe loss of function and GFR of 15–29%.
Stage 5: Kidney failure and a GFR of under 15%.

What causes Diabetic Nephropathy?

Diabetic nephropathy is a common complication of type 1 and type 2 diabetes.

Over time, poorly controlled diabetes can cause damage to blood vessel clusters in your kidneys
that filter waste from your blood. This can lead to kidney damage and cause high blood pressure.
High blood pressure can cause further kidney damage by increasing the pressure in the delicate
filtering system of the kidneys.
Damage to the kidneys puts stress on these vital organs and prevents them from working properly.
When this happens:
 the body starts to lose protein through the urine
 the kidneys cannot remove waste products from the blood
 the kidneys cannot maintain healthy fluid levels in the body

Diabetic nephropathy develops slowly. According to one study, a third of people show high levels
of albumin in their urine 15 years after a diagnosis of diabetes. However, fewer than half of these
people will develop full nephropathy.

Statistics have suggested that kidney disease is uncommon in people who have had diabetes for
less than 10 years. Also, if a person has no clinical signs of nephropathy 20–25 years after diabetes
starts, they have a low chance of developing it thereafter.
Diabetic nephropathy is less likely if a person with diabetes manages their glucose levels
effectively. High blood glucose levels increase the risk of high blood pressure because of the
damage to blood vessels. Having high blood pressure, or hypertension, may contribute to kidney
disease.

What happens to the kidneys in diabetes?

The main function of the kidneys is to filter waste products and excess water from the bloodstream
so that they can be excreted in the form of urine. This is carried out by a system of tubes and blood
vessels known as nephrons. Inside the nephrons are tiny blood vessels called capillaries and tiny
urine-collecting tubes. One of the major structures in the nephron is a group of blood vessels
known as the glomerulus, which acts as a filter.

Having high blood glucose levels can interfere with the function of the glomerulus. The filtering
function of the kidneys doesn’t work properly and proteins start to leak from the blood into the
urine.

High blood glucose levels can also cause scarring of the glomerulus (called glomerulosclerosis).
As the scarring gets worse, the kidneys stop being able to filter waste products from the blood.
When enough glomeruli have been damaged, kidney failure results.

People who have diabetic nephropathy also often have high blood pressure. High blood pressure
can further contribute to kidney damage.

What complications may develop if you have Diabetic Nephropathy?

It may develop gradually over months or years. They may include:

 Fluid retention, which could lead to swelling in your arms and legs, high blood pressure,
or fluid in your lungs (pulmonary edema)
 A rise in potassium levels in your blood (hyperkalemia)
 Heart and blood vessel disease (cardiovascular disease), possibly leading to stroke
 Damage to the blood vessels of the retina (diabetic retinopathy)
 Anemia

 Foot sores, erectile dysfunction, diarrhea and other problems related to damaged nerves
and blood vessels
 Pregnancy complications that carry risks for the mother and the developing fetus

 Irreversible damage to your kidneys (end-stage kidney disease), eventually needing either
dialysis or a kidney transplant for surviva
II. RISK FACTORS

Your risk of diabetic nephropathy is greater if you have type 1 or type 2 diabetes. Several other
factors may increase your risk of diabetic nephropathy, including:
• High blood sugar (hyperglycemia) that's not well-controlled
• High blood pressure (hypertension) that's not controlled

• Being a smoker - Kidney damage may result from a link between smoking and higher
levels of inflammation. While the link between smoking and diabetes remains unclear, there
appears to be a greater incidence of diabetes, as well as hypertension and kidney disease, among
people who smoke.
• High blood cholesterol
• A family history of diabetes and kidney disease

III. DIAGNOSTIC PROCEDURE AND LAB TEST

How is Diabetic Nephropathy diagnosed?

To determine whether you have diabetic kidney disease, you may need certain tests and
procedures, such as:

 Blood tests. Blood tests are also recommended to check your kidney function. The level of
creatinine, a waste product in the blood, can be measured to calculate your estimated
glomerular filtration rate (eGFR). The eGFR gives an indication of how well the kidneys are
working to filter waste products from your blood.

 Urine tests. Urine samples are tested for a protein called albumin. The amount of albumin
found in the urine indicates the amount of damage to your kidneys. Microalbuminuria (tiny
amounts of albumin in the urine) indicates that you are at risk of developing diabetic
nephropathy or may have early stage diabetic nephropathy. Proteinuria, or macro
albuminuria, (larger amounts of albumin in the urine) indicates that you have more advanced
diabetic nephropathy that may be affecting the ability of your kidneys to filter wastes.

 Imaging tests. Your doctor may use X-rays and ultrasound to assess your kidneys' structure
and size. You may also undergo CT scanning and magnetic resonance imaging (MRI) to
determine how well blood is circulating within your kidneys. Other imaging tests may be
used in some cases.

 Renal function testing. Your doctor can assess your kidneys' filtering capacity using renal
analysis testing.
  Kidney biopsy. Your doctor may recommend a kidney biopsy to remove a sample of kidney
tissue. You'll be given a numbing medication (local anesthetic). Then your doctor will use a
thin needle to remove small pieces of kidney tissue for examination under a microscope.

IV. NURSING MANAGEMENT

V. MEDICAL MANAGEMENT

REFERENCES:

https://www.mayoclinic.org/diseases-conditions/diabetic-nephropathy/diagnosis-treatment/drc-
20354562
https://www.mydr.com.au/diabetes/diabetic-nephropathy
https://www.medicalnewstoday.com/articles/319686.php
https://www.diabetes.org/diabetes/complications/kidney-disease-nephropathy