Causes, differential diagnoses of Kidney Damage and/or excess microalbuminuria:
Infection
Pyelonephritis is an infection of kidney tissue; most often, it is the result of cystitis that has spread to the kidney. An obstruction in the urinary tract can make a kidney infection more likely. Infections elsewhere in the body, including, for example, streptococcal infections, the skin infection impetigo, or a bacterial infection in the heart can also be carried through the bloodstream to the kidney and cause a problem there.
Glomerular disease is triggered by an abnormal reaction of the immune system. In this case, the body’s own infection fighters mistakenly attack the kidney tissues. Sometimes, an autoimmune disorder such as systemic lupus erythematosus or Goodpasture syndrome is the cause. The attack on the glomerulus may also be the result of an inherited condition. An attack on the glomerulus may also occur after a bacterial infection in another part of the body, such as a strep infection of the throat or skin, the skin infection impetigo, or an infection inside the heart.
Symptoms
Diabetic nephropathy is called a "silent" problem because there are usually no symptoms in the early stages of the disease. Some of the earliest symptoms include ankle swelling and mild fatigue. Later symptoms include extreme fatigue, nausea, vomiting and urinating less than usual.
Diagnosis
The first sign of kidney damage is protein in the urine, which a doctor can measure in microscopic amounts, called microalbuminuria. Small amounts of albumin show up in the urine five to 10 years before major kidney damage happens.
Prevention
The best way to prevent diabetic nephropathy is to control your blood sugar. In addition, your blood pressure should be monitored frequently, and high blood pressure should be treated promptly. Two types of blood pressure medicines protect against kidney damage in ways that go beyond lowering your blood pressure. These medications are excellent choices for controlling blood pressure in people with diabetes. They include angiotensin-converting enzyme inhibitors (ACE inhibitors) — lisinopril (Zestril, Prinivil), enalapril (Vasotec), moexipril (Univasc), benazepril (Lotensin) and others — and angiotensin receptor blockers (ARBs), such as losartan (Cozaar), valsartan (Diovan) and others. Avoiding medications that can harm the kidneys also can help to prevent kidney disease. However, if you have high blood pressure, microalbuminuria or other evidence of kidney disease, the first line of treatment is an ACE inhibitor or ARB. These two medicine groups are closely related, so the drugs usually are not combined with each other. If two or more drugs are needed to control blood pressure, one of these agents is usually combined with a less closely related medication. ***CAUTION must be used in combining ACE Inhibitors and SSRI and TriCyclic Anti-depressant medications. Their combined use is contraindicated.
A low-protein diet (10 percent to 12 percent or less of total calories) also may slow or halt the progression of kidney disease. If you smoke cigarettes, you should quit. Elevated levels of lipids, such as cholesterol, are associated with kidney damage, so you may be able to reduce your risk of diabetic kidney disease by reducing your cholesterol and other lipid levels through diet, exercise and possibly medication.
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