Previous post:

Next post:

Diabetes & Kidney Disease

Q. I was told that kidney disease is a possible complication of diabetes. How does diabetes affect the kidneys?

A. If you have diabetes, uncontrolled high blood sugar can lead to a number of serious complications. One of those complications is chronic kidney disease, a condition which is called diabetic nephropathy.

Current statistics show that about 30 to 40 percent of people with Type 1 diabetes, and 20 to 30 percent of those with Type 2 diabetes, will develop moderate to advanced kidney disease. However, since the damage occurs slowly over time, when action is taken early there is time to prevent the worst of it.

How Diabetic Nephropathy Develops

The human kidney is part of the body’s efficient waste disposal system. A healthy kidney cleans the blood by filtering out waste products which are then routed to the urine. The tiny filters that do the filtering work are called glomeruli. When kidneys are healthy, blood and waste from the bloodstream are brought into the kidneys where the glomeruli clean the blood. Then waste and extra fluid go out into the urine through the ureter. Clean blood leaves the kidneys and goes back into the bloodstream.

The exact cause of diabetic nephropathy is unknown, but it is believed that over time, uncontrolled high blood sugar can damage your kidney’s delicate cleansing filters, causing them to thicken and become scarred. Slowly, more and more blood vessels are destroyed. Damaged kidneys do not do a good job of cleaning out wastes and extra fluid which causes a number of problems.

When the kidneys are working well, the tiny filters in your kidneys keep protein inside your body. But, as the kidney structures begin to leak, a protein called albumin begins to pass into the urine, and waste and fluid build up in your blood instead of leaving the body in urine. If the damage continues, the kidneys leak more and more protein and more and more waste builds up in the blood. Without intervention, this damage can continue to get worse until the kidneys fail.

How to Find Out If You Have Kidney Disease

Two of the greatest risk factors for chronic kidney disease are uncontrolled high blood sugars and high blood pressure. Both a family history of hypertension and the presence of hypertension appear to increase chances of developing kidney disease. Hypertension also accelerates the progress of kidney disease when it already exists.

Because, diabetic kidney disease takes many years to develop, and kidney damage begins long before you notice any symptoms, the best way to stay on top of kidney disease is to get tested by your physician before signs of kidney damage occur. You will know you have kidney problems only if your doctor checks your blood for a substance called creatinine, which is a waste product your body makes, and your urine for protein.

Each year, make sure your doctor checks a sample of your urine to see if your kidneys are leaking small amounts of protein called microalbumin. Having small amounts of protein in the urine is called microalbuminuria. This test is very important because when kidney disease is diagnosed early, several treatments may keep kidney disease from getting worse.

Also, at least once each year, your doctor should check your blood to measure the amount of creatinine. Your doctor can use your creatinine level to check your GFR. GFR stands for glomerular filtration rate. Results of this test tell you how well your kidneys are removing waste from the blood.

Overall, kidney damage rarely occurs in the first 10 years of diabetes, and usually 15 to 25 years will pass before kidney failure occurs. For people who live with diabetes for more than 25 years without any signs of kidney failure, the risk of ever developing it decreases.

How You Can Prevent Kidney Disease and Subsequent Damage

The best way to prevent kidney disease is to keep blood sugars as normal as possible. Unfortunately, once you have kidney damage, you cannot undo it. But you can slow it down or stop it from getting worse. Following the suggestions below will do a lot toward preventing the development of kidney disease and helping to keep it under control if detected early.

  • Have your health care provider measure your A1C level at least twice a year. The test provides a weighted average of their blood glucose level for the previous 3 months. Aim to keep it at less than 7 percent.
  • Have your urine checked regularly for microalbumin with a simple urine test. This detects kidney disease at its earliest stage when intervention is easiest. This test should be done at least yearly. If any abnormal readings occur, discuss with your doctor how and how often you should be monitored for kidney function, and develop a plan to keep your blood sugars within target range.
  • Have your blood pressure checked several times a year. If blood pressure is high, follow your health care provider’s plan for keeping it near normal levels. Aim to keep it at less than 130/80.
  • Control your blood pressure through diet, relaxation techniques, and blood pressure medications. Your doctor may prescribe the following medicines to lower your blood pressure and protect your kidneys from damage: Angiotensin-converting enzyme (ACE) inhibitors or Angiotensin receptor blockers (ARBs)
  • If you have a family history of high blood pressure or kidney disease, discuss with your physician the use of an ACE inhibitor to prevent kidney disease.
  • Be alert for bladder or urinary tract infections and treat them early. Symptoms include burning when urinating, frequent urination, cloudy urine, and a strong smell to the urine.

Leave a Comment

Previous post:

Next post: