Diabetic Nephropathy - Signs and Symptoms

Signs and Symptoms

Kidney failure provoked by glomerulosclerosis leads to fluid filtration deficits and other disorders of kidney function. There is an increase in blood pressure (hypertension) and fluid retention in the body plus a reduced plasma oncotic pressure causes edema. Other complications may be arteriosclerosis of the renal artery and proteinuria.

Throughout its early course, diabetic nephropathy has no symptoms. They develop in late stages and may be a result of excretion of high amounts of protein in the urine or due to renal failure:

• edema: swelling, usually around the eyes in the mornings; later, general body swelling may result, such as swelling of the legs
• foamy appearance or excessive frothing of the urine (caused by the proteinuria)
• unintentional weight gain (from fluid accumulation)
• anorexia (poor appetite)
• nausea and vomiting
• malaise (general ill feeling)
• fatigue
• headache
• frequent hiccups

The first laboratory abnormality is a positive microalbuminuria test. Most often, the diagnosis is suspected when a routine urinalysis of a person with diabetes shows too much protein in the urine (proteinuria). The urinalysis may also show glucose in the urine, especially if blood glucose is poorly controlled. Serum creatinine and BUN may increase as kidney damage progresses.

A kidney biopsy confirms the diagnosis, although it is not always necessary if the case is straightforward, with a documented progression of proteinuria over time and presence of diabetic retinopathy on examination of the retina of the eyes.