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Diabetes and Renal Disease

The kidneys have the important job of removing wastes from your body. When these organs are not functioning appropriately, harmful substances build up and can damage tissues and organs. Kidney, or renal, disease can progress to the point of failure. There are a number of possible causes of renal disease and certain diseases and conditions increase the risk of occurrence. According to 2007 statistics from the National Institutes of Health (NIH), diabetes is responsible for 44 percent of all new cases of kidney failure.

  1. Features

    • The blood vessels of the kidneys act as filters; harmful substances are removed from the blood while essential substances are retained. The waste products are removed from the body in the urine produced by the kidneys. High blood glucose levels, which occur in diabetes, can overwork the kidneys. Eventually, the filtering ability is impaired as the increased blood flow damages the small blood vessels of the kidneys. Essential proteins are lost and wastes products accumulate.

    Diagnosis

    • Appropriate diabetic management includes routine lab work to determine the effectiveness of treatment and the early identification of complications. As a diabetic, your urine should be checked routinely for the presence of proteins. This is the first indication that the kidneys are not functioning as they should. Your physician will follow up with blood tests which will quantify the level of certain waste products in the blood. It is based on the levels of proteins in the urine and wastes in the blood that the diagnosis of renal disease is made.

    Signs and Symptoms

    • There are no early physical symptoms of renal disease. Fluid retention and increasing blood pressure may be the first noticeable signs. Physical symptoms usually do not appear until renal disease is fairly advanced. Late symptoms include decreased concentration, change in mental status, decreased appetite, gastric discomfort and overall malaise.

    Management and Treatment

    • Management calls for controlling blood sugar levels, lowering blood pressure and reducing dietary protein. These measures are taken to slow the progression of renal disease to renal failure. Renal disease may occur in those diabetics whose blood sugars are under control; however, these diabetics have a slightly lower risk of developing this disease. Careful management is required to keep blood glucose levels within the recommended guidelines. Two particular classes of antihypertensive medications, ACEs and ARBs, are known to have renal protective effects. These drugs may be used primarily for this reason as opposed to use as blood pressure controlling agents. Limiting intake of dietary proteins can help delay development of renal failure as the workload of the kidneys is decreased, slowing blood vessel damage. Dialysis treatment and kidney transplantation are used only at the point at which renal failure has occurred.

    Prevention/Solution

    • In controlling your diabetes, you drastically reduce your risk of developing renal disease. The American Diabetes Association (ADA) reports that good blood sugar control reduces by one third the risk of developing the first stage of renal disease which is the presence of trace proteins in the urine. Even if you have the presence of small amounts of protein in your urine, you can prevent progression to renal disease by better managing your diabetes.

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