The two most severe side effects of diabetes are probably diabetic nephropathy and diabetic retinopathy. Together, they have a significant morbidity and death impact. As they worsen and eventually lead to end-stage renal disease and blindness, they place a tremendous financial, social, and medical strain on the patient as well as the healthcare system. The microvascular consequences of diabetes known are diabetic nephropathy (DN) and diabetic retinopathy (DR) seem to have a similar pathogenesis and clinical significance. Need to check fundus regularly by a retina specialist.

DEFINITION

What is diabetic nephropathy?

Deterioration of kidney function is referred to as nephropathy. End-stage renal disease, often known as ESRD, is the last stage of nephropathy. Diabetes is the most typical cause of ESRD, according to the CDC.

One frequent consequence of both type 1 and type 2 diabetes is diabetic nephropathy. Diabetes that is not properly managed over time might harm blood vessel clusters in your kidneys that filter waste from your blood. It may also result in excessive blood pressure and renal damage.

What is Diabetic Retinopathy?

Diabetic retinopathy is a disorder of the eye that affects the blood vessels in the retina, the lining at the back of the eye that converts light into pictures.Vision alterations or blindness can result from blood vessel swelling, fluid leakage, or bleeding. Usually, both eyes are affected. Diabetic retinopathy can scar and damage your retina if it is not corrected.

SYMPTOMS

What signs and symptoms show up in diabetic nephropathy?

• Blood pressure management gets worse.
• Urine contains protein.
• swelling of the hands, feet, ankles, or eyes.
• increased urge to use the restroom.
• reduced need for diabetic medication or insulin.
• confusion or attention deficit.
• respiration difficulty.
• decrease in appetite.

What are the signs and symptoms of diabetic retinopathy?

Before diabetic retinopathy gets severe, you might not exhibit any symptoms. If you do experience symptoms, you could witness:

• loss of center vision, which is necessary for driving and reading
• being unable to see color
• distorted vision
• dark spots or holes in your vision
• floaters, which are spots or dark threads that appear in your eyesight because of bleeding
• weak eyesight.
• parts of your eyesight that are dark or vacant.
• loss of vision

CAUSES

What are the causes of diabetic nephropathy?

Kidney damage affects the important organs and stops them from functioning normally.

When this occurs, the body begins to lose protein through the urine, the kidneys are unable to eliminate waste from the blood, and the kidneys are unable to keep the body’s fluid levels at a healthy level.

The onset of diabetic nephropathy is gradual. According to statistics, kidney disease is less likely among patients with diabetes who have had the condition for less than ten years.Additionally, the likelihood of getting nephropathy later on is minimal if a person does not exhibit any clinical indicators of it 20 to 25 years after the onset of their diabetes.

If a person with diabetes efficiently controls their glucose levels, diabetic nephropathy is less likely to occur.

Due to the damage to blood vessels caused by high blood glucose levels, high blood pressure risk is increased. Hypertension, or high blood pressure, may be a factor in renal disease.

What are the causes of Diabetic Retinopathy?

• Blood sugar levels that are excessively high for an extended period of time might block the tiny blood vessels that maintain your retina health. The new blood vessels that try to form in your eye won’t grow properly. It begins to weaken the blood vessels.
• Your retina may experience blood and fluid leakage. 
• Macular edema is a different ailment that may result from this. It may cause hazy vision.
• More blood vessels become clogged as your illness worsens. Because of the additional blood vessels in your eye, scar tissue accumulates. 
• Your retina may tear or separate as a result of this added strain.
• This may potentially result in vision-threatening eye diseases including cataracts or glaucoma (the clouding of your eye’s lens).

DIAGNOSIS

What is the Diagnosis of diabetic nephropathy?

To determine the shape and size of your kidneys, your doctor may employ X-rays and ultrasound. To examine how well blood is flowing throughout your kidneys, you may also undergo magnetic resonance imaging (MRI) and CT scanning.

• In some circumstances, other imaging tests could be employed.
• Regular screening exams might involve:
• test for urinary albumin. The blood protein albumin may be found in your urine with this test. Normally, albumin is not removed from the blood by the kidneys. A high level of protein in the urine might point to impaired kidney function.
• Creatinine to albumin ratio. A chemical waste product called creatinine is removed from the blood by healthy kidneys. Another indicator of kidney function is the albumin/creatinine ratio, which compares the amount of albumin to creatinine in a urine sample.
• Rate of glomerular filtration (GFR). Estimating how rapidly the kidneys filter blood may be done using the amount of creatinine in a blood sample (glomerular filtration rate).Poor kidney function is indicated by a low filtration rate.
• Kidney biopsy: An imaging tool, such as an ultrasound machine, is frequently used to guide the biopsy needle as it is put through your skin. As part of your diabetes care, regular testing is often used to identify diabetic nephropathy.
• Microalbuminuria (MA), the first and most widely used clinical indicator of DN, has been independently linked to an increased risk of cardiovascular disease in diabetes individuals.

What is the Diagnosis of diabetic retinopathy?

• During your eye exam and pupil dilation, your eye doctor can often determine if you have diabetic retinopathy. To check for any changes in the blood vessels in your eye or to see if any new ones have grown, your doctor will dilate your pupils. Additionally, they’ll check to determine whether your retina is bulging or detached.

• Fluorescein angiography Your doctor can use this test to determine whether you have severe diabetic retinopathy or DME. It reveals whether any of your blood vessels are damaged or leaking. Your physician will inject you with fluorescent dye into an arm vein. Your doctor will be able to examine images of the blood vessels in your retina when the dye reaches your eyes and identify any significant issues.

STAGES

What are the different phases of diabetic nephropathy?

Stage 1: Kidney damage is present, but kidney function is normal, and the GFR is 90% or above. Stage 2: Kidney impairment with some function loss and a GFR between 60 and 89%. Stage 3: GFR between 30 and 59% and a mild to severe loss of function. Stage 4: Extremely reduced function with a GFR of 15–29%.

What are the different phases of diabetic retinopathy?

These four phases often indicate diabetic retinopathy:

1. Mild nonproliferative retinal disease. Tiny blood vessels in your retina alter in the first stages of the illness. Small regions enlarge. They are referred to as microaneurysms. They might leak fluid into your retina. 
2. Moderate nonproliferative retinopathy- Blood vessels that need to maintain the health of your retina enlarge and alter form as your condition worsens. Your retina cannot get blood from them. This may alter how your retina appears. Diabetic macular edema may result from these blood vessel alterations (DME). That is swelling in the macula, a region of your retina.
3. Severe nonproliferative retinal disease- The third stage sees the blockage of several blood arteries.They are unable to provide blood to your retina to maintain its health. Your retina produces specific proteins called growth factors in regions where this occurs, and these proteins urge your retina to develop new blood vessels.
4. Proliferative diabetic retinopathy (PDR)- The most developed phase is this one. Your retina produces new blood vessels, which subsequently migrate into the vitreous humor, a fluid found within your eyes. New blood vessels that are brittle are more likely to bleed and spill blood. Starting to develop is scar tissue. When your retina peels away from the tissue underneath, this may result in retinal detachment. This may result in eventual blindness.

TREATMENT

What is the treatment provided for Diabetic Nephropathy?

Managing your diabetes and excessive blood pressure is the first step in treating diabetic nephropathy (hypertension).This covers your nutrition, your way of living, your exercise routine, and your prescription drugs. You can avoid or delay renal dysfunction and other consequences with excellent blood sugar and hypertension management.

Medications

Your treatment strategy may involve taking drugs to treat the following in the early stages of diabetic nephropathy:

• Regulation of blood pressure. High blood pressure is treated using drugs known as angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (ARBs).
• Blood sugar management. Drugs can assist diabetic nephropathy patients manage excessive blood sugar levels. Fortamet, Glumetza, and other brands of metformin increase insulin sensitivity while reducing hepatic glucose production. By delaying digestion and promoting insulin production in response to rising blood glucose levels, glucagon-like peptide 1 (GLP-1) receptor agonists aid in lowering blood sugar levels.GLT2 inhibitors prevent glucose from being reabsorbed into the circulation, which increases the amount of glucose excreted in the urine.
• High cholesterol. Statins are medications that lower cholesterol and lessen the amount of protein in the urine. They are used to treat excessive cholesterol.
• Kidney scarring. Finerenone (Kerendia) interferes with molecular processes thought to be responsible for tissue damage and inflammation in diabetic nephropathy. In people with chronic kidney disease linked with type 2 diabetes, research suggests that the medication may lower the risk of renal function loss, kidney failure, cardiovascular mortality, nonfatal heart attacks, and hospitalization for heart failure.

In order to monitor whether your kidney condition stabilizes or worsens, your doctor will likely advise periodic follow-up tests.

Diabetic nephropathy treatment for advanced cases

• Your doctor will likely go over treatment options targeted at either restoring kidney function or improving your comfort if your condition advances to kidney failure (end-stage renal disease). Options include:
• Renal dialysis-This procedure clears your blood of waste materials and surplus fluid. Hemodialysis and peritoneal dialysis are the two basic forms of dialysis.
• Transplant- A kidney transplant or a kidney-pancreas transplant may be the best option in some circumstances. If you and your doctor decide to have a transplant, you’ll be assessed to see if you qualify for the procedure.
• Symptom control- Your lifespan would typically be only a few months if you decided against dialysis or a kidney transplant.Treatment may be given to you to keep you comfortable.

What is the treatment provided for Diabetic Retinopathy?

Diabetic retinopathy is treated with:

• Anti-VEGF injection therapy- Drugs that inhibit VEGF, a protein that causes abnormal blood vessels to form in your eye, can stop the growth of aberrant blood vessels and reduce fluid buildup in your retina.
• Laser surgery for the macular fovea/grid- The vessels in your macula that are leaking are lightly burned by lasers. After this operation, anti-VEGF treatment can be required.
• Corticosteroids- These drugs can be implanted or injected into your eye by a doctor. There are both long-acting and short-acting varieties. Steroid use increases the risk of developing cataracts or glaucoma. If you take them, your eye doctor will keep track of the pressure within your eye.
• Scatter laser surgery-This procedure creates up to 2,000 microscopic burns to cure areas where your retina has come away from your macula. This may cause aberrant blood vessels to shrink. Two or more sessions could be necessary. While laser surgery can preserve your central vision, it may impair your peripheral, color, or night vision. If you obtain it before those new vessels begin to bleed, it will function best.
• Vitrectomy- You could require this operation if blood vessels bleed into your retina and vitreous humor and your eyesight becomes cloudy. It takes out the blood leak so you can see more clearly. This can clear any visual problems.

COMMON QUESTIONS RELATED TO DIABETIC NEPHROPATHY

Is diabetic nephropathy reversible?

The diabetic nephropathy lesions have been thought to be permanent.

How long does it take for diabetic nephropathy to manifest?

Within two to five years of the diagnosis, almost all individuals with Type I diabetes show some signs of functional alteration in the kidneys. Within 10 to 30 years, roughly 30 to 40 percent of cases advance to more severe renal disease.

Is diabetic nephropathy a lifelong condition?

Diabetic nephropathy cannot be cured, however therapies can slow or halt the disease’s development. Through medication and dietary adjustments, treatments aim to manage blood sugar levels and maintain target blood pressure levels.

What percentage of diabetics develop into nephropathy?

Diabetic nephropathy affects 30 to 40% of persons with diabetes mellitus (DM).

How may nephropathy be stopped?

A healthy, balanced diet helps lower your risk of kidney disease by maintaining appropriate levels of blood pressure and cholesterol. A balanced diet should contain lots of fruit and vegetables; aim for at least 5 servings each day. Meals that contain starchy ingredients, such as potatoes, whole-grain bread, rice, or pasta.

What is the diabetic nephropathy pathogenesis?

Diabetic nephropathy is most likely caused by metabolic and hemodynamic abnormalities in diabetes that interact with each other and with multiple reactive oxygen species-dependent pathways.

Is chronic kidney disease the same as diabetic nephropathy?

No. Diabetes-related kidney disease is referred to as diabetic nephropathy. Diabetes or other illnesses may be the cause of chronic kidney disease (CKD).

COMMON QUESTIONS RELATED TO DIABETIC RETINOPATHY

What type of diabetic retinopathy is the most severe?

The advanced stage of proliferative retinopathy is marked by the development of aberrant new blood vessels on the retina’s surface.These blood vessels have the potential to burst and leak into the vitreous, the transparent, watery gel that fills the eye, which can seriously impair vision. Treatment for diabetic retinopathy at this stage is typically urgent.

How can you prevent the progression of diabetic retinopathy?

By maintaining healthy blood sugar, blood pressure, and cholesterol levels, you can lessen your chance of developing diabetic retinopathy or stop it from getting worse. Making healthy lifestyle choices can frequently achieve this goal, while some people may additionally require medicine.

Does diabetic retinopathy improve with time?

Diabetic retinopathy is incurable. However, treatment is a highly effective way to stop, prevent, or minimize eyesight loss. The easier it is to cure the problem, the sooner it is discovered. And there is a better chance that the vision will be preserved.

What results from a lack of treatment for diabetic retinopathy?

Diabetic retinopathy can result in blindness if neglected. Fluid can build up in the eye’s focusing lens when persons with diabetes have extended periods of high blood sugar. This alters the lens’s curvature, which affects how you see.

Does diabetic retinopathy advance over time?

If the patient does not receive therapy as the illness worsens, irreversible vision loss is a distinct possibility. Only your doctor can establish which of the several types of diabetic retinopathy you have. One form may cause blood vessels to enlarge and leak fluid.

Can laser therapy help diabetic retinopathy?

The use of laser photocoagulation may help this disease progress or end. However, laser therapy is not always an option for diabetic retinopathy. Sometimes, eye surgery or eye injections are necessary (injections).