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Diabetic Kidney Disorder

The kidneys sometimes become diseased in people who have diabetes. In some cases, this can result in kidney failure. Controlling your blood. pressure and glucose level helps to minimise complications such as heart disease and stroke. Medication is also available. Diabetic kidney disease is a complication that occurs in some people with diabetes. It can progress to kidney failure in some cases. Treatment aims to prevent or delay the progression of the disease. Also, it aims to reduce the risk of developing cardiovascular diseases such as heart attack and stroke which are much more common than average in people with this disease.

Diabetic nephropathy is the name given to kidney damage caused by diabetes. It develops slowly, over many years, and is also referred to as kidney disease. Almost one in five people with diabetes will need treatment for diabetic nephropathy. This may be a worrying statistic, but there’s a lot you can do to reduce your risk of developing the complication. If spotted early enough, diabetic nephropathy can also be slowed down with treatment.Diabetes is a disease where your blood sugar (also called glucose) is too high because your body does not make or use insulin the way it should. Insulin is a hormone, which is a chemical your body makes. It helps your body turn the sugar from the food you eat into energy. When your body does not use insulin the way it should, too much sugar stays in your blood. Diabetes is one of the biggest factors that increases your risk for kidney disease and the number one cause of kidney failure. More than 34 million Americans have diabetes, and almost half of all kidney failure cases are caused by diabetes. It is important to manage your diabetes to prevent high blood sugar from damaging your kidneys.

There are two types of diabetes: type 1 and type 2.

Type 1 diabetes

Type 1 diabetes is an autoimmune disease, which is a type of disease where your immune system mistakenly attacks your body. In type 1 diabetes, your body makes little or no insulin because your body attacks the cells in your pancreas that make it. The pancreas is an organ in your upper belly area that makes insulin, as well as the digestive juices that help you digest food. You cannot prevent type 1 diabetes, but you can treat it with regular insulin shots.

Type 2 diabetes

In type 2 diabetes, your body makes insulin, but does not use it the way it should. You are also more likely to have type 2 diabetes if you are overweight or if someone else in your family has the disease. It is more common in adults but can also happen in children. In recent years, more children have type 2 diabetes due to the rise of childhood obesity.

The symptoms of type 1 and type 2 diabetes are very similar. Talk to your doctor if you notice any of these symptoms:

Being more thirsty or hungry than normal
Urinating (peeing) more than normal
Blurry vision
Crankiness or being easily irritated
Being very tired
Unexplained weight loss (symptom of type 1 diabetes)
Tingling, pain or feeling numb in your hands and feet (symptom of type 2 diabetes)


ABOUT DIABETIC KIDNEY DISEASE


Diabetic kidney disease, also called diabetic nephropathy, happens when high blood sugar damages your kidneys. Your kidneys are full of tiny blood vessels called glomeruli. These blood vessels help clean your blood. Too much sugar in your blood can hurt these blood vessels. Once your kidneys have been damaged by diabetes, they cannot be fixed. If diabetic kidney disease is not treated early, the damage can get worse over time and it can lead to kidney failure.

Diabetic kidney disease (diabetic nephropathy) is a complication that occurs in some people with diabetes. In this condition the filters of the kidneys, the glomeruli, become damaged. Because of this the kidneys 'leak' abnormal amounts of protein from the blood into the urine. The main protein that leaks out from the damaged kidneys is called albumin. In normal healthy kidneys only a tiny amount of albumin is found in the urine. A raised level of albumin in the urine is the typical first sign that the kidneys have become damaged by diabetes.

How does diabetic kidney disease develop and progress?

A raised blood sugar (glucose) level that occurs in people with diabetes can cause a rise in the level of some chemicals within the kidney. These chemicals tend to make the glomeruli more 'leaky' which then allows albumin to leak into the urine. In addition, the raised blood glucose level may cause some proteins in the glomeruli to link together. These 'cross-linked' proteins can trigger a localised scarring process. This scarring process in the glomeruli is called glomerulosclerosis. It usually takes several years for glomerulosclerosis to develop and it only happens in some people with diabetes. As the condition becomes worse, scarred tissue (glomerulosclerosis) gradually replaces healthy kidney tissue. As a result, the kidneys become less and less able to do their job of filtering the blood. This gradual 'failing' of the kidneys may gradually progress to what is known as end-stage kidney failure.

Microalbuminuria is usually the first sign that diabetic kidney disease has developed. Over months or years, microalbuminuria may go away (especially if treated - see below), persist at about the same level, or progress to proteinuria. Proteinuria is irreversible. If you develop proteinuria it usually marks the beginning of a gradual decline in kidney function towards end-stage kidney failure at some time in the future.

What are the symptoms of diabetic kidney disease?

You are unlikely to have symptoms with early diabetic kidney disease - for example, if you just have microalbuminuria (defined above). Symptoms tend to develop when the kidney disease progresses. The symptoms at first tend to be vague and nonspecific, such as feeling tired, having less energy than usual and just not feeling well. With more severe kidney disease, symptoms that may develop include:

Difficulty thinking clearly.
A poor appetite.
Weight loss.
Dry, itchy skin.
Muscle cramps.
Fluid retention which causes swollen feet and ankles.
Puffiness around the eyes.
Needing to pass urine more often than usual.
Being pale due to anaemia.
Feeling sick (nausea).

As the kidney function declines, various other problems may develop - for example, anaemia and an imbalance of calcium, phosphate and other chemicals in the bloodstream. These can cause various symptoms, such as tiredness due to anaemia, and bone 'thinning' or fractures due to calcium and phosphate imbalance. End-stage kidney failure is eventually fatal unless treated.
How is diabetic kidney disease diagnosed and assessed?

Diabetic kidney disease is diagnosed when the level of albumin in the urine is raised and there is no other obvious cause for this. Urine tests are part of the routine checks that are offered to people with diabetes from time to time. Urine tests can detect albumin (protein) and measure how much is present in the urine.

The standard routine urine test is to compare the amount of albumin with the amount of creatinine in a urine sample. This is called the albumin:creatinine ratio (ACR). Creatinine is a breakdown product of muscle.

A blood test can show how well the kidneys are working. The blood test measures the level of creatinine, which is normally cleared from the blood by the kidneys. If your kidneys are not working properly, the level of creatinine in the blood goes up. An estimate of how well your kidneys are working can be made by taking into account the blood level of creatinine, your age and your sex. This estimate of kidney function is called the estimated glomerular filtration rate (eGFR).
What increases the risk of developing diabetic kidney disease?

All people with diabetes have a risk of developing diabetic kidney disease. However, a large research trial showed that there are certain factors that increase the risk of developing this condition. These are:

A poor control of your blood sugar (glucose) levels. (The greater your HbA1c level, the greater your risk.)
The length of time you have had diabetes.
The more overweight you become.
Having high blood pressure. The higher your blood pressure, the greater your risk.
If you are male.

This means that having a good control of your blood glucose level, keeping your weight in check and treating high blood pressure will reduce your risk of developing diabetic kidney disease.

If you have early diabetic kidney disease (microalbuminuria), the risk that the disease will become worse is increased with:

The poorer the control of blood sugar levels. The greater your HbA1c level, the greater your risk.
Having high blood pressure. The higher your blood pressure, the greater your risk.
Smoking.

What are the possible complications?
End-stage kidney failure

In people with proteinuria (described above), end-stage kidney failure develops in approximately 1 in 12 people after 10 years. If this occurs then you would need kidney dialysis or a kidney transplant.
Cardiovascular diseases

All people with diabetes have an increased risk of developing cardiovascular diseases, such as heart disease, stroke and peripheral arterial disease. If you have diabetes and diabetic kidney disease, your risk of developing cardiovascular diseases is increased further. The worse the kidney disease, the further increased the risk. This is why reducing any other cardiovascular risk factors is so important if you have diabetic kidney disease (see below).
High blood pressure

Kidney disease has a tendency to increase blood pressure. In addition, increased blood pressure has a tendency to make kidney disease worse. Treatment of high blood pressure is one of the main treatments of diabetic kidney disease.
What is the treatment for diabetic kidney disease?

Treatments that may be advised are discussed below. Treatments aim to:

Prevent or delay the disease progressing to kidney failure. In particular, if you have early diabetic kidney disease (microalbuminuria) it does not always progress to the proteinuria phase of the disease.
Reduce the risk of developing cardiovascular diseases such as heart disease and stroke.