ACE inhibitors are drugs used by experts like Best Nephrologist in Lahore for progressive kidney disorder of diabetic nephropathy. These drugs play a protective role, while also treating hypertension in the patient. Read on to know more about diabetic nephropathy and the role of ACE inhibitors in the disease:

What is diabetic nephropathy?

Diabetic nephropathy is a progressive kidney disorder that occurs due to uncontrolled type 1 and 2 diabetes. The risk of diabetic nephropathy increases with prolonged illness, and the concurrent presence of other risk factors like hypertension, atherosclerosis and family history of kidney disease. A high percentage of kidney failures every year occur due to untreated or complicated diabetic nephropathy.

Diabetics with kidney disease have a poorer prognosis than people with kidney disease alone. This is because the incidence of arteriosclerosis and other chronic conditions—including neuropathies, hypertension, hypercholesterolemia—is higher in diabetics, compared to non-diabetics.

Since diabetic nephropathy is a progressive disease, early management results in slowed progression. With prophylactic use of drugs like ACE inhibitors, this progression can even be stopped. 

What are the symptoms of diabetic nephropathy?

The symptoms of diabetic nephropathy include:

  • Protein in the urine
  • Nausea and vomiting
  • Fatigue
  • Persistent itching
  • Increase in blood pressure
  • Swelling in the limbs and face 
  • Confusion
  • Difficulty concentrating
  • Shortness of breath
  • Loss of appetite
  • Drowsiness (particularly in end-stage renal disease)
  • Hiccups
  • Muscle twitching
  • Abnormal heart rhythm
  • Headache

What are the risk factors of diabetic nephropathy?

The risk of diabetic nephropathy increases with:

  • Uncontrolled high blood glucose
  • Obesity
  • Uncontrolled high blood pressure
  • Smoking history
  • Family history of kidney disease
  • High serum cholesterol
  • Concurrently having other complications of diabetes like retinopathy or neuropathy

How is diabetic nephropathy diagnosed?

The diagnosis of diabetic nephropathy is based on history, physical examination and investigations like:

  • Urine test: the earliest sign of diabetic nephropathy is microalbuminuria or small amounts of albumin protein in the urine. This indicates that the kidney is not performing effectively in reabsorbing the protein from the urinary filtrate.
  • Serum creatinine test: this test measures the by-product creatinine in the blood. Normally, creatinine is removed from the body through the urine, and if the kidneys are not functioning effectively, there is buildup of creatinine in the blood. The levels of creatinine in the blood are used to determine the glomerular filtration rate (GFR)—which is used by the healthcare provider to know how well the kidneys are functioning.
  • BUN: high blood urea nitrogen is another indicator of kidney failure. Urea nitrogen is normally produced by the body when the protein is broken down. Thereafter, it is cleared through the urine. High levels of blood urea nitrogen indicate that the kidney is unable to eradicate them from the body.
  • Kidney biopsy: through this surgical procedure, small sample of kidney tissue is removed and viewed under the microscope. The histological changes typical of diabetic nephropathy can then be confirmed through this investigation.

ACE inhibitors and their protective role?    

Experimental researches suggest that micro- and macro-vascular complications i.e. the complications in the blood vessels of the kidneys which are responsible for filtration, can be prevented by use of effective anti-hypertensive drugs like angiotensin converting enzyme (ACE) inhibitors.

There is a growing body of data which supports the use of ACE inhibitors to improve heart and kidney function in people with diabetes. In fact, the long-term complications of nephropathy and retinopathy can also be prevented through ACE inhibitors.

ACE inhibitors work by stopping the angiotensin converting enzyme, which in normal circumstances converts the inactive angiotensinogen to the active form of angiotensin. Thereafter, angiotensin increases the blood pressure through constriction of vessels and increases the retention of salt in the body. With ACE inhibitors the process of vessel constriction and salt retention is by-passed. Thus, the blood pressure decreases and the load on the vasculature of the kidneys also diminishes. This effect of ACE inhibitors is used by nephrologists like Dr. Aurangzeb Afzal to battle diabetic nephropathy.

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