THE MAIN JOB of the kidneys is to clean the blood. When they fail, toxins build up in the body, which leads to loss of appetite, weight loss, and persistent nausea and vomiting. If the
disease goes untreated, it eventually leads to coma and death. In the United States, more than 100,000 patients are diagnosed with chronic kidney disease annually, costing $32 billion in 2005. The burden is not only financially enormous, but emotionally devastating.

Diabetic kidney disease (nephropathy) is the leading cause of end stage renal disease (ESRD) in the United States, accounting for 44 percent of all new cases in 2005.

whose kidneys have lost over 90 percent of their intrinsic function require dialysis to
artificially remove the accumulated toxins in the blood. This procedure involves removing the
patient’s “dirty” blood, running it through the dialysis machine to clean out its impurities, and then returning the clean blood to the body. To stay alive, patients require four hours of
dialysis, three times per week, indefinitely, unless they receive a transplant.

Diabetic kidney disease often takes fifteen to twenty-five years to develop, but, like retinopathy, it may occasionally be diagnosed before type 2 diabetes, itself. Approximately 2 percent of type 2 diabetic patients develop kidney disease each year. Ten years after diagnosis, 25 percent of patients will have evidence of kidney disease.

 Once established,
diabetic nephropathy tends to progress, leading to more and more kidney impairment until
eventually the patient requires dialysis or transplantation.


DIABETIC NERVE DAMAGE (neuropathy) affects approximately 60–70 percent of patients with
 Once again, the longer the duration and severity of diabetes, the greater the risk of neuropathy.

There are many different types of diabetic nerve damage. Commonly, diabetic neuropathy affects the peripheral nerves, first in the feet, and then progressively in the hands and arms as well, in a characteristic stocking-and-glove distribution. Damage to different types of nerves will result in different symptoms, including
• tingling,
• numbness,
• burning, and
• pain.
The incessant pain of severe diabetic neuropathy is debilitating, and the symptoms are commonly worse at night. Even powerful painkillers such as narcotic medications are often
ineffective. Instead of pain, patients may sometimes experience complete numbness. 

Careful physical examination reveals decreased sensations of touch, vibration, and temperature, and a loss of reflexes in the affected parts of the body.
While a loss of sensation may seem innocuous, it is anything but. Pain protects us against damaging trauma. When we stub our toes, or lie in the wrong position, pain lets us know that we should quickly adjust ourselves in order to prevent further tissue damage. If we are unable to feel pain, we may continue to experience repeated episodes of trauma.
Over years, the damage becomes progressive and sometimes deformative. A typical example is the foot. Significant nerve damage can lead to the complete destruction of the joint—a condition called Charcot foot—and may progress to the point where patients are unable to walk, and may even require amputation.

Another nerve disorder affecting the large muscle groups is called diabetic amyotrophy,
which is characterized by severe pain and muscle weakness, particularly in the thighs.

The autonomic nervous system controls our automatic body functions, such as breathing, digestion, sweating, and heart rate. Damage to these nerves may cause nausea, vomiting, constipation, diarrhea, bladder dysfunction, erectile dysfunction, and orthostatic hypotension (a sudden, severe drop of blood pressure on standing up). If the nerves to the heart are affected, the risk of silent heart attacks and death increases.

No current treatment reverses diabetic nerve damage. Drugs may help the symptoms of the disease but do not change its natural history. Ultimately, it can only be prevented.

Nephropathy Nephropathy Reviewed by Leembo on March 02, 2019 Rating: 5

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