Kidneys are remarkable organs.
Inside them are millions of tiny blood vessels that act as filters. Their job is to remove waste products from the blood. Sometimes this filtering system breaks down. Diabetes can damage the kidneys and cause them to fail. Failing kidneys lose their ability to filter out waste products, resulting in kidney disease.
How does diabetes cause kidney disease?
When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood.
Diabetes can damage this system. High levels of blood glucose make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak and useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria.
When kidney disease is diagnosed early, during microalbuminuria, several treatments may keep kidney disease from getting worse. Having larger amounts of protein in the urine is called macroalbuminuria. When kidney disease is caught later during macroalbuminuria, end-stage renal disease, or ESRD, usually follows.
In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. This failure, ESRD, is very serious. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis).
Who gets kidney disease?
Not everyone with diabetes develops kidney disease. Factors that can influence kidney disease development include genetics, blood glucose control, and blood pressure. The better a person keeps diabetes and blood pressure under control, the lower the chance of getting kidney disease.
What are the symptoms?
Early kidney disease, sometimes called renal insufficiency, may have no signs or symptoms. You may not feel any different until the disease is advanced but the damage is still being done.
The first symptom of kidney disease is often fluid buildup. Other symptoms of kidney disease include lack of sleep, poor appetite, upset stomach, weakness, and difficulty concentrating.
Kidney failure means damage to the kidneys has progressed to the point that they are not doing a good job of filtering wastes such as urea and creatinine
from the blood so it can be excreted in the urine. The waste buildup can make you sick and you may have these symptoms: swelling of the ankles, face or belly, vomiting, loss of appetite, fatigue, weakness, confusion and headaches
It is vital to see a doctor regularly. The doctor can check blood pressure, urine (for protein), blood (for waste products), and organs for other complications of diabetes.
How can I prevent it?
Kidney disease can be prevented by:
- Keeping blood glucose in your target range
- Controlling your blood pressure
- Stopping smoking
- Control the cholesterol Level
- Managing your weight
- Working closely with your health care team to ensure your urine albumin levels are being monitored
Treatments for kidney disease
Important treatments for kidney disease are tight control of blood glucose and blood pressure.
Blood pressure has a dramatic effect on the rate at which the disease progresses. Even a mild rise in blood pressure can quickly make kidney disease worsen.
Four ways to lower your blood pressure are losing weight, eating less salt, avoiding alcohol and tobacco, and getting regular exercise.
When these methods fail, certain medicines may be able to lower blood pressure. There are several kinds of blood pressure drugs, however, not all are equally good for people with diabetes. Some raise blood glucose levels or mask some of the symptoms.of low blood glucose. Doctors usually prefer people with diabetes to take blood pressure drugs called ACE inhibitors.
ACE inhibitors are recommended for most people with diabetes, high blood pressure and kidney disease. Recent studies suggest that ACE inhibitors slow kidney disease, in addition to lowering blood pressure. In fact, these drugs are helpful even in people who do not have high blood pressure.
Another treatment some doctors use with macroalbuminuria is a low-protein diet. Protein seems to increase how hard the kidneys must work. A low-protein diet can decrease protein loss in the urine and increase protein levels in the blood. Never start a low- protein diet without talking to your health care team.
Once kidneys fail, dialysis is necessary. The person must choose whether to continue with dialysis or to get a kidney transplant. This choice should be made as a team effort.
The team should include the sndocrinologist and diabetes educator, a nephrologist (kidney doctor), a kidney transplant surgeon, a social worker, and a psychologist.