What are the symptoms of nephropathy?

From the Guidelines

Nephropathy symptoms can be effectively managed and progression slowed with early detection and treatment, particularly with the use of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists, as recommended by recent clinical guidelines 1.

Key Symptoms and Detection

Nephropathy symptoms vary depending on the stage and cause of kidney damage. Early nephropathy often produces no noticeable symptoms, which is why regular screening is important for at-risk individuals. As kidney function declines, patients may experience:

• Fatigue
• Swelling in the legs, feet, and ankles (edema)
• Foamy or bubbly urine due to protein leakage
• Increased urination at night (nocturia)
• Decreased appetite
• High blood pressure that's difficult to control More advanced nephropathy can cause:
• Shortness of breath
• Nausea
• Vomiting
• Metallic taste in the mouth
• Itchy skin
• Muscle cramps
• Confusion Diabetic nephropathy specifically may present with persistent albuminuria (protein in urine) and gradually declining glomerular filtration rate, as defined by the presence of albuminuria (urinary albumin excretion >30 mg/24 h or urinary albumin to creatinine ratio [UACR] >30 mg/g) and reduced estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m² for at least 3 months 1.

Importance of Early Detection and Treatment

Regular monitoring of kidney function through blood and urine tests is essential for those with risk factors like diabetes, hypertension, or family history of kidney disease. The American Diabetes Association, the Kidney Disease: Improving Global Outcomes, and the European Association for the Study of Diabetes now recommend the use of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists for patients with diabetic kidney disease (DKD) to provide both kidney and cardiovascular protective benefits 1. Early detection and treatment can significantly improve outcomes, reducing the risk of progression to end-stage renal disease and improving quality of life.

Screening Methods

Screening for microalbuminuria can be performed by measuring the albumin-to-creatinine ratio in a random, spot collection, which is the preferred method, or through 24-h collection with creatinine or timed collection 1. At least two of three tests measured within a 6-month period should show elevated levels before a patient is designated as having microalbuminuria.

Management Approach

An integrated approach to patient care with a multidisciplinary focus can help achieve the necessary shift in clinical care of patients with DKD, emphasizing the importance of early detection, lifestyle modifications, and the use of evidence-based therapies to slow disease progression and improve patient outcomes 1.

From the Research

Nephropathy Symptoms

Nephropathy, also known as kidney disease, can manifest in various forms, including diabetic nephropathy, IgA nephropathy, and others. The symptoms of nephropathy can vary depending on the underlying cause and severity of the disease.

• Common symptoms of nephropathy include:
  • Proteinuria (excess protein in the urine) 2, 3, 4, 5, 6
  • Hematuria (blood in the urine)
  • Hypertension (high blood pressure) 3, 4, 6
  • Edema (swelling in the legs, feet, or hands)
  • Fatigue
  • Loss of appetite

Treatment and Management

The treatment and management of nephropathy depend on the underlying cause and severity of the disease.

• For diabetic nephropathy, treatment options include:
  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to control blood pressure and reduce proteinuria 2, 3, 4, 5, 6
  • Dual therapy with an ACE inhibitor and an ARB for patients with severe proteinuria or uncontrolled hypertension 3, 5
  • Optimizing glucose control with a target hemoglobin A1c goal of <7% 4
  • Managing blood pressure with a goal of <140/90 mmHg as the target for all patients with diabetes 4
• For IgA nephropathy, treatment options include:
  • Combination therapy with an ACE inhibitor and an ARB to reduce proteinuria 2
  • Olmesartan and temocapril combination therapy, which has been shown to have the highest probability of being the most effective treatment to reduce proteinuria in normotensive CKD patients with IgA nephropathy 2

Research Findings

Several studies have investigated the effectiveness of different treatment options for nephropathy.

• A Bayesian network meta-analysis found that all treatment strategies of ACEI, ARB, or their combination had significantly greater efficacy in reducing proteinuria than placebo in normotensive CKD patients 2
• A review of therapeutic strategies for diabetic nephropathy found that controlling blood pressure and proteinuria are crucial in preventing or retarding the development of diabetic nephropathy 3
• A meta-analysis of studies investigating combination therapy for diabetic nephropathy found that ACEI + ARB reduces 24-h proteinuria to a greater extent than ACEI alone 5
• A study on angiotensin receptor blockers in diabetic nephropathy found that ARBs induce favorable changes in systemic blood pressure, renal hemodynamics, and proteinuria similar to those induced by ACE inhibition 6