In the early stages of diabetic nephropathy, a patient usually doesn't experience symptoms. Typically, symptoms occur when her glomerular filtration rate (GFR) is 20% to 30% of normal. The GFR reflects the amount of plasma that passes through the glomerulus per minute. When signs and symptoms develop, they may affect virtually every body system and include:
* polyuria, nocturia, proteinuria, oliguria progressing to anuria
* hypertension, heart failure, pulmonary edema, peripheral edema, arrhythmias, pericarditis
* crackles, shortness of breath, dyspnea, Kussmaul's respirations, pleural effusion, depressed cough reflex, thick sputum, pneumonitis
* anorexia, constipation or diarrhea, hiccups, nausea, vomiting, stomatitis, unpleasant or metallic taste in the mouth
* altered level of consciousness, behavior changes, cognitive changes, lethargy, seizures, coma
* muscle cramps, bone fractures, footdrop
* anemia, increased risk of bleeding, infection
* decreased perspiration; dry, brittle hair; dry, flaky skin; yellow-brown skin; petechiae; pruritus; thin, brittle, ridged nails; uremic frost (urea crystals that form on the skin)
* nfertility; decreased libido; anovulation, amenorrhea, anorgasmy in women; impotence in men.
Some More Facts
Discuss potential kidney complications of diabetes with your patient and her family. Emphasize the relationship between tight blood glucose control and the onset and progression of kidney disease. Explain the importance of achieving and maintaining a healthy weight, following a safe exercise plan, stopping smoking, and controlling blood cholesterol levels. Explain dietary restrictions, including protein limitation, and refer your patient to a dietitian.
Inform your patient about the association between hypertension and renal disease. Explain that she'll need to have her blood pressure checked regularly, and emphasize the importance of treating her hypertension. Encourage her to report any adverse effects of antihypertensive drugs to her physician. Remind her not to stop antihypertensive therapy without notifying her physician.
Review the signs and symptoms of UTI and the importance of prompt and thorough treatment. Explain the importance of providing a followup urine sample for culture and sensitivity testing, if prescribed. Review the procedure for collecting a 24-hour urine sample . Advise your patient to delay or reschedule screening for urine albumin excretion if she recently participated in strenuous exercise or had an acute febrile illness or a UTI. These factors can temporarily increase urine albumin excretion. Ask your patient if she's taking drugs, such as NSAIDs and ACE inhibitors. These drugs can alter urine protein excretion and should be avoided during testing.
If the patient is receiving hemodialysis or peritoneal dialysis at home, a home care nurse can provide the support and education she needs to perform the procedure independently. In some cases, a family member may need to be taught how to perform it. Or the home care nurse may have to do it.
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