Diabetes and Your Kidneys
Kidneys are amazing organs! They are the body’s filter system, there are millions of blood vessels in the kidney that are involved in removing waste products from the body. Kidneys also help to control blood pressure and they produce a hormone called erythropoietin, which stimulate the bone marrow to make red blood cells. As another important feature, kidneys also help to regulate the levels of sodium, potassium, calcium and phosphate in the blood.
Diabetic Kidney Disease (Diabetic Nephropathy)
Diabetes can damage the kidney filtering system and make them fail, resulting in kidney disease. How does this happen? High blood sugar levels cause a rise in some of the chemicals in the kidney. The chemicals make the kidneys leakier, and the kidneys start leaking protein. Ordinarily, healthy kidneys do a good job of getting rid of just the waste products that pass through them. That means red blood cells and the body’s proteins don’t pass through the kidneys and remain in the blood. Another issue with high blood sugars is that the proteins can bind together and cause scarring in the kidneys, making them leakier.
What are the symptoms of diabetic kidney disease?
The early stage of kidney disease does not usually cause any specific symptoms. Some people may have a vague sense that they are more tired, have less energy or generally just don’t feel good. However, as the kidney disease progresses, you may experience:
- Poor concentration
- Poor appetite
- Weight loss
- Dry, itchy skin
- Muscle cramps
- Swollen feet and ankles
- Puffiness around the eyes
- Urinating more or less often than usual
As the kidney function worsens, other problems can develop such as anemia (low red blood count), bone thinning and fractures (due to calcium and phosphate imbalance). End-stage kidney disease means the kidneys have little to no function and is treated with either dialysis or kidney transplant.
How is it Diagnosed
Your doctor will order a urine test to check the level of albumin (the main protein) being leaked by the kidneys.
Microalbuminuria- is when the amount of albumin that leaks into the urine is between 30-300 mg per day.
Proteinuria- is when the amount of albumin that leaks into the urine is more than 300 mg per day.
Microalbuminuria and Proteinuria are both indicators of Diabetic kidney disease. Once you have been diagnosed your doctor may want to refer you to a Kidney Specialist/Nephrologist to make sure your medications and lifestyle is optimal to help maintain your kidney function.
How to prevent Diabetic Kidney Disease?
Blood sugars, Blood sugars, Blood Sugars!!!
Having good blood sugar control (HgbA1C less than 7%) can reduce the risk of development of microalbuminuria and can even reverse it.
Controlling blood pressure, weight, and not smoking also helps.
Treatments for Diabetic Kidney Disease
Tight control of diabetes and blood pressure are very important. Losing weight, eating nutritious meals, avoiding alcohol and smoking, and regular exercise can all help with blood sugar and blood pressure control.
There are 2 main classes of medications that have been shown to be really good in prevention and delaying progression of kidney disease, in persons with diabetes. Those medications are called ACE-inhibitors and ARBs, an example of these medications are lisinopril, enalapril, losartan and candesartan (which are available in Bermuda).
Once kidneys fail, dialysis is necessary. A nephrologist will become a part of your medical team to help guide you through this process. If kidney transplant is desired this also can be discussed with your Nephrologist.
Kidney Disease (Nephropathy)- American Diabetes Association. May 2012. www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html
Diabetic Kidney Disease- Patient.co.uk. May 2012. www.patient.co.uk/printer.asp?doc=27001107