Microangiopathy and Diabetes

Small-blood-vessel disease (microangiopathy) is responsible for many problems related to the kidneys (nephropathy), to the eyes (retinopathy), and to some degree to the muscle of the heart (cardiomyopathy). (While heart disease is associated mainly with macroangiopathy, some microangiopathy also occurs.)

Kideny Damage (Nephropathy) Nephropathy may be associated with infection of the kidneys, ureters, bladder, or urethra. Infection of the urinary tract is common in people with diabetes because of sugar in the urine and/or because urine may be kept in the bladder as a result of neuropathy. If the infection starts in the bladder and either occurs over and over again or goes up the ureters to the kid, neys, damage to the kidneys may occur. Any damage to the kidneys will eventually result in decreased kidney function. Diabetic nephropathy (damage of the kidney) is often a result of blood, vessel damage, with scarring of the filtration system of the major part of the kidney. This may be caused by thickening (and thus weakening) of membranes in the blood, vessel walls as a result of elevated blood, glucose levels. Bleeding could occur, or protein could leak from these blood vessels.

Checking for protein in the urine helps in early detection of renal disease (note, however, that protein in the urine is not always due to kidney damage but can also be due to some other stressor, such as infection or intense exercise). Control of hypertension is extremely important, as is prompt treatment of any urinary tract infection.

Where kidney damage has occurred, renal dialysis (washing the blood out through the use of a machine) or, as a last resort, renal transplant now offers hope of improved quality and quantity of life. Improved tissue, matching techniques and new immunosuppression drugs (medicine to keep the recipient from rejecting the transplant) have resulted in more successful transplantation.

Diabetic nephropathy is detected by finding protein in the urine. If there is a small amount of protein (called microproteinuria), the condition can be reversed by careful control of blood sugar and blood pressure, especially with drugs called ACE inhibitors. But if there is a large amount of protein in the urine (called gross protein, uria), then it is too late and the condition can only be slowed, not stopped, and kidney failure is inevitable. Therefore, be sure your doctor follows the ADA guidelines and measures microprotein or microalbumin at least once and preferably twice a year. It is a simple and inexpensive test and can save your kidneys and possibly your life.

Retinopathy may occur in various stages, the earliest of which are more reversible. Stage I involves the formation of a microaneurysm, which is the ballooning of a weak wall of a blood vessel. Microaneurysms may burst and hemorrhage. Exudates, or defined yellow spots, can sometimes be seen. While these were once thought to be fat or lipid deposits, they have actually been found to be scars from areas of bleeding in the retina. Stage II involves new vessel formation, hemorrhage, and scarring. Once this has occurred, it is not possible to reverse the condition. However, stabilization is possible through laser treatment.

The lens of the eye may also have problems. In the presence of higher glucose levels, the lens can become more translucent than transparent, and osmotic changes (the pulling of fluid into the lens) can result in a cataract. This leads to blurring of vision. The cataract can be easily removed and a new lens transplanted.

If hemorrhage (bleeding) has occurred in the eye, the fluid in the eye may become cloudy. Removal and replacement of this fluid may restore clear vision and can also help to remove scarlike membranes that have formed on the retina.

If there is too much pull on the retina, as can occur because of multiple bleeding episodes and subsequent scarring, the retina may pull away from the back wall of the eye. Retinal detachment can be corrected.

Retinopathy need not inevitably cause blindness. When retinopathy is discovered early and treated vigorously, vision can be preserved; therefore, have a dilated eye exam at least once a year according to ADA guidelines.

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