Treating Diabetic Kidney Disease

Written by Deanne Haines

Kidney disease progresses slowly over time and the symptoms and treatments depend on the stage of the disease. Doctors determine which stage a person is in by conducting a blood test that measures the glomerular filtration rate (GFR). GFR indicates how well a person’s kidneys are functioning by evaluating how much creatinine, or waste, is in the blood, also taking into account a person’s age, gender, and race. The GFR number gets lower as the kidneys get worse and a person advances through the different stages of kidney disease.

Stage 1
A GFR of 90 or higher indicates stage 1 kidney disease. During this stage, the kidneys still function normally, but there is some damage to the kidney. Usually, no physical symptoms are present at this time, but there are lifestyle changes that can help slow the disease. A nutritionist may make changes to a patient’s diet by lowering protein intake and doctors may prescribe medicine to lower blood pressure. Keeping blood sugar levels as close to normal as possible is also very important.

Stage 2
Test results with a GFR from 60 to 89 means a person has stage 2 kidney disease. A mild loss of kidney function is detected along with continued kidney damage. While not many symptoms will be visible, blood pressure and blood sugar levels need constant management. The patient will be monitored regularly to check on the progression of the disease.

Stage 3
A GFR between 44 and 59 means stage 3a kidney disease is present, while a GFR between 30 to 44 is labeled as stage 3b. Stages 3a and 3b indicate a moderate loss of kidney function, but a person may or may not experience any symptoms at this point. Some of the first signs of kidney disease are swelling around the eyes, hands or feet, fatigue, changes in appetite, and back pain. It’s also common for a person with kidney disease to develop weak bones and anemia – a condition in which not enough oxygen gets to tissues and organs through the blood. Doctors may treat these complications with changes in diet and medication. It’s important patients with stage 3 kidney disease continue to lead a healthy lifestyle keeping blood pressure and blood sugar levels in check.

Stage 4
Stage 4 kidney disease means that there’s a severe loss of kidney function and a person’s GFR is between 15 and 29. Symptoms may become visible and high blood pressure is usually present. Doctors will continue to treat the patient’s symptoms and may discuss with him a plan for treatment if the disease should advance to stage 5, or kidney failure.

Stage 5
Stage 5 kidney disease means a person has developed kidney failure, also called end-stage renal disease (ESRD). The GFR is below 15 and it’s common for a person to develop symptoms including extreme fatigue, weakness, nausea and vomiting, muscle cramps, itchy skin, headaches, frequent urinating at night, swelling, and difficulty breathing. A person with stage 5 kidney disease either will need to start regular kidney dialysis – a treatment that mechanically filters waste from the blood - or undergo a kidney transplant to survive.

Dealing with advancing kidney disease can be discouraging, but a health care team made up of experienced kidney professionals helps patients as they go through the different stages. A nephrologist is a doctor with specialized training and experience in treating kidney disease, while a registered dietitian aids patients in devising a diet plan that fits each individual’s unique needs. Nurses, social workers, and dialysis technicians also help patients along the way. Patients who undergo a kidney transplant will work with a transplant team consisting of a surgeon, doctors, and coordinators.

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Diabetic Kidney Disease 101