Diabetic Kidney Disease 101

Written by Deanne Haines

Having too much blood sugar in the body makes the blood vessels in kidneys work extra hard. Eventually this takes a toll on the kidneys and they start to leak protein in the urine while harmful waste builds up in the body. After many years, a person’s kidneys can become so damaged that the kidneys function at less than 15 percent of their normal level. This is called kidney failure, or end-stage renal disease (ESRD). ESRD is the most advanced stage of kidney disease, and is a very serious condition affecting about 30 percent of people with type 1 diabetes and 10-40 percent of people with type 2 diabetes. In fact, diabetes is the leading cause of kidney disease and kidney failure in the United States.

What You Should Look For
In its early stages, diabetic kidney disease shows no signs or symptoms, but people are at a greater risk of developing kidney disease if their blood sugar and blood pressure levels are not controlled. Family history of high blood pressure is also a risk factor. Lowering blood pressure can sometimes be achieved by regular exercise, losing weight, consuming less sodium and not drinking or smoking. Medication may also be necessary to manage blood pressure.

When symptoms appear, people may notice fluid build-up in their body and swelling in their ankles. They may lose their appetite, suffer from nausea, have trouble sleeping, experience weakness, and feel tired. They may also have the need to use the bathroom more frequently. If people with diabetes have these symptoms, they should see their doctor right away.

Why Annual Screenings Are Important
Because there are no recognizable symptoms early on, it’s important for people with diabetes to be screened for kidney disease every year. Doctors can measure the amount of waste present in the blood as well as how much albumin – or protein – is lost in the urine. They can also tell how well your kidneys are working to clean your blood through a test called the estimated glomerular filtration rate (eGFR). The American Diabetes Association recommends that people with type 1 diabetes have a urinary albumin test and an eGFR five years after they are diagnosed and annually thereafter. People with type 2 diabetes should start getting these annual tests right at diagnosis.

Small amounts of protein in the urine, called microalbuminuria, can sometimes be controlled with blood pressure lowering medication and tight control of blood glucose levels. Having a large amount of protein in the urine, called macroalbuminuria, usually leads to ESRD.

Treatment Options for ESRD
End stage renal disease can be treated in two ways: a kidney transplant or dialysis. Dialysis is a process where the patient is hooked up to a machine that cleans the person’s blood for the injured kidneys. Many people are treated with dialysis while waiting for a kidney donor to be found. If a donor is found who is a match for the patient, a kidney transplant can be performed replacing the diseased kidney with a healthy one – adding years to a person’s life.

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