Diabetes is the most common cause of kidney failure, accounting for nearly 44 percent of new cases.People with kidney failure undergo either dialysis, an artificial blood-cleaning process, or transplantation to receive a healthy kidney from a donor.
Diabetic kidney disease takes many years to develop. In some people, the filtering function of the kidneys is actually higher than normal in the first few years of their diabetes.
Over several years, people who are developing kidney disease will have small amounts of the blood protein albumin begin to leak into their urine. This first stage of Chronic Kidney Disease( CKD) is called microalbuminuria. The kidney’s filtration function usually remains normal during this period.
As the disease progresses, more albumin leaks into the urine. This stage may be called macroalbuminuria or proteinuria. As the amount of albumin in the urine increases, the kidneys’ filtering function usually begins to drop. The body retains various wastes as filtration falls. As kidney damage develops, blood pressure often rises as well.
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.
About 30 percent of diabetics with Type 1 (juvenile onset) diabetes and 10 to 40 percent of those with Type 2 (adult onset) diabetes eventually will suffer from kidney failure.
1.What does diabetes do to the kidneys?
With diabetes, the small blood vessels in the body are injured. When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine. Also, waste materials will build up in your blood.
Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that has a high sugar level.
2.What are the early signs of kidney disease in patients with diabetes?
The earliest sign of diabetic kidney disease is an increased excretion of albumin in the urine. This is present long before the usual tests done in your doctor’s office show evidence of kidney disease, so it is important for you to have this test on a yearly basis.
Weight gain and ankle swelling may occur. You will use the bathroom more at night. Your blood pressure may get too high.
As a person with diabetes, you should have your blood, urine and blood pressure checked at least once a year. This will lead to better control of your disease and early treatment of high blood pressure and kidney disease.
Maintaining control of your diabetes can lower your risk of developing severe kidney disease.
3.What are the late signs of kidney disease in patients with diabetes?
As your kidneys fail, your blood urea nitrogen (BUN) levels will rise as well as the level of creatinine in your blood.
You may also experience nausea, vomiting, a loss of appetite, weakness, increasing fatigue, itching, muscle cramps (especially in your legs) and anemia (a low blood count).
You may find you need less insulin. This is because diseased kidneys cause less breakdown of insulin. If you develop any of these signs, call your doctor immediately.
4.Signs Of Kidney Disease In Diabetics
Albumin/protein in the urine
High blood pressure
Ankle and leg swelling, leg cramps
Going to the bathroom more often at night
High levels of BUN and creatinine in blood
Less need for insulin or antidiabetic medications
Morning sickness, nausea and vomiting
Weakness, paleness and anemia
5.What will happen if my kidneys have been damaged?
First, the doctor needs to find out if your diabetes has caused the injury. Other diseases can cause kidney damage. Your kidneys will work better and last longer if you:
Control your diabetes
Control high blood pressure
Get treatment for urinary tract infections
Correct any problems in your urinary system
Avoid any medicines that may damage the kidneys (especially over-the-counter pain medications)
If no other problems are found, your doctor will try to keep your kidneys working as long as possible. The use of high blood pressure medicines called angiotensin converting enzyme (ACE) inhibitors has been shown to help slow the loss of kidney function.
6.How are the kidneys kept working as long as possible?
The kidney doctor, called a nephrologist, will plan your treatment with you, your family and your dietitian.
Two things to keep in mind for keeping your kidneys healthy are controlling high blood pressure in conjunction with an ACE inhibitor and following your renal diabetic diet.
Restricting protein in your diet also might be helpful. You and your dietitian can plan your diet together.
7.Renal Diabetic Diet
Diet is one of the most important treatments in managing diabetes and kidney disease. If you’ve been diagnosed with kidney disease as a result of diabetes, you’ll need to work with a dietitian to create an eating plan that’s right for you. This plan will help manage your blood glucose levels and reduce the amount of waste and fluid your kidneys process.
8.What is end stage renal failure in patients with diabetes?
End stage renal failure, or kidney failure, occurs when your kidneys are no longer able to support you in a reasonably healthy state, and dialysis or transplantation is needed.
This happens when your kidneys function at only 10 to 15 percent.
9. Chronic Kidney Disease (CKD)
Chronic kidney disease (CKD) is the progressive and irreversible destruction of the kidneys.
Your kidneys are essential parts of your body. They have several functions, including:
helping maintain the balance of minerals and electrolytes in your body, such as calcium, sodium, and potassium
playing an essential role in the production of red blood cells
maintaining the delicate acid-base balance of your blood
excreting water-soluble wastes from your body
Damaged kidneys lose their ability to perform these functions.
10.Effects of High Blood Pressure In Diabetics
High blood pressure, or hypertension, is a major factor in the development of kidney problems in people with diabetes. 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.
Blood pressure is recorded using two numbers. The first number is called the systolic pressure, and it represents the pressure in the arteries as the heart beats. The second number is called the diastolic pressure, and it represents the pressure between heartbeats. In the past, hypertension was defined as blood pressure higher than 140/90, said as “140 over 90.”
Hypertension can be seen not only as a cause of kidney disease but also as a result of damage created by the disease. As kidney disease progresses, physical changes in the kidneys lead to increased blood pressure. Therefore, a dangerous spiral, involving rising blood pressure and factors that raise blood pressure, occurs. Early detection and treatment of even mild hypertension are essential for people with diabetes.
11.Preventing and Slowing Kidney Disease In Diabetics
Blood Pressure Medicines
Scientists have made great progress in developing methods that slow the onset and progression of kidney disease in people with diabetes. Drugs used to lower blood pressure can slow the progression of kidney disease significantly. Two types of drugs, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease. Many people require two or more drugs to control their blood pressure. In addition to an ACE inhibitor or an ARB, a diuretic can also be useful. Beta blockers, calcium channel blockers, and other blood pressure drugs may also be needed.
An example of an effective ACE inhibitor is lisinopril (Prinivil, Zestril), which doctors commonly prescribe for treating kidney disease of diabetes. The benefits of lisinopril extend beyond its ability to lower blood pressure: it may directly protect the kidneys’ glomeruli. ACE inhibitors have lowered proteinuria and slowed deterioration even in people with diabetes who did not have high blood pressure.
An example of an effective ARB is losartan (Cozaar), which has also been shown to protect kidney function and lower the risk of cardiovascular events.
Patients with even mild hypertension or persistent microalbuminuria should consult a health care provider about the use of antihypertensive medicines.
In people with diabetes, excessive consumption of protein may be harmful. Experts recommend that people with kidney disease of diabetes consume the recommended dietary allowance for protein, but avoid high-protein diets. For people with greatly reduced kidney function, a diet containing reduced amounts of protein may help delay the onset of kidney failure. Anyone following a reduced-protein diet should work with a dietitian to ensure adequate nutrition.
Intensive Management of Blood Glucose
Antihypertensive drugs and low-protein diets can slow CKD. A third treatment, known as intensive management of blood glucose or glycemic control, has shown great promise for people with diabetes, especially for those in the early stages of CKD.
The human body normally converts food to glucose, the simple sugar that is the main source of energy for the body’s cells. To enter cells, glucose needs the help of insulin, a hormone produced by the pancreas. When a person does not make enough insulin, or the body does not respond to the insulin that is present, the body cannot process glucose, and it builds up in the bloodstream. High levels of glucose in the blood lead to a diagnosis of diabetes.
Intensive management of blood glucose is a treatment regimen that aims to keep blood glucose levels close to normal. The regimen includes testing blood glucose frequently, administering insulin throughout the day on the basis of food intake and physical activity, following a diet and activity plan, and consulting a health care team regularly. Some people use an insulin pump to supply insulin throughout the day.
A number of studies have pointed to the beneficial effects of intensive management of blood glucose.
In the Diabetes Control and Complications Trial supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), researchers found a 50 percent decrease in both development and progression of early diabetic kidney disease in participants who followed an intensive regimen for controlling blood glucose levels.
The intensively managed diabetics had average blood glucose levels of 150 milligrams per deciliter—about 80 milligrams per deciliter lower than the levels observed in conventionally managed diabetics.
The United Kingdom Prospective Diabetes Study, conducted from 1976 to 1997, showed conclusively that, in people with improved blood glucose control, the risk of early kidney disease was reduced by a third.
Additional studies conducted over the past decades have clearly established that any program resulting in sustained lowering of blood glucose levels will be beneficial to patients in the early stages of CKD.
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12.Dialysis and Transplantation
When people with diabetes experience kidney failure, they must undergo either dialysis or a kidney transplant.
As recently as the 1970s, medical experts commonly excluded people with diabetes from dialysis and transplantation, in part because the experts felt damage caused by diabetes would offset benefits of the treatments.
Today, because of better control of diabetes and improved rates of survival following treatment, doctors do not hesitate to offer dialysis and kidney transplantation to people with diabetes.
Currently, the survival of kidneys transplanted into people with diabetes is about the same as the survival of transplants in people without diabetes.
Dialysis for people with diabetes also works well in the short run. Even so, people with diabetes who receive transplants or dialysis experience higher morbidity and mortality because of coexisting complications of diabetes—such as damage to the heart, eyes, and nerves.
13.Taking Care Of Your Diabetes Makes a Difference
People with diabetes should
1.Have their health care provider measure their A1C level at least twice a year. The test provides a weighted average of their blood glucose level for the previous 3 months. They should aim to keep it at less than 7 percent.
2.Work with their health care provider regarding insulin injections, medicines, meal planning, physical activity, and blood glucose monitoring.
3.Have their blood pressure checked several times a year. If blood pressure is high, they should follow their health care provider’s plan for keeping it near normal levels. They should aim to keep it at less than 140/90.
4.Ask their health care provider whether they might benefit from taking an ACE inhibitor or ARB.
5.Ask their health care provider to measure their eGFR at least once a year to learn how well their kidneys are working.
6.Ask their health care provider to measure the amount of protein in their urine at least once a year to check for kidney damage.
7.Ask their health care provider whether they should reduce the amount of protein in their diet and ask for a referral to see a registered dietitian to help with meal planning.
14.Important Points To Remember
1.People with diabetes should be screened regularly for kidney disease. The two key markers for kidney disease are estimated glomerular filtration rate (eGFR) and urine albumin.
2.Drugs used to lower blood pressure can slow the progression of kidney disease significantly. Two types of drugs, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease.
3.In people with diabetes, excessive consumption of protein may be harmful.
4.Good management of blood glucose has shown great promise for people with diabetes, especially for those in the early stages of Kidney Disease.
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