Diabetes and Kidney Disease

If you have diabetes, you’re at risk for kidney disease, also called diabetic nephropathy. In fact, diabetes is the leading cause of kidney failure. But there are things you can do to prevent, delay, or treat kidney disease, including keeping blood glucose (sugar) and blood pressure on target.


WHAT DO MY KIDNEYS DO?

Your kidneys clean your blood by constantly filtering it through millions of tiny blood vessels.


The filters in the kidneys perform two important functions:
    They remove unwanted substances from your blood, such as extra fluid and the waste products made by normal processes within the body. To prevent unwanted materials from building up in the blood and making you sick, your kidneys remove them and send them to your bladder. The waste products and extra fluid then leave the body in the urine.
     The filters keep needed materials in the blood, such as protein and minerals. The cleaned-up blood is returned to your bloodstream.


Your kidneys perform other functions as well, such as helping to regulate blood pressure, stimulating your bone marrow to produce red blood cells, and helping your bones and your blood absorb calcium.


HOW CAN DIABETES HURT MY KIDNEYS?

Frequent high blood glucose levels over years can lead to changes in how the kidneys function. High blood glucose causes extra blood to flow through the filters, making the kidneys work harder than usual. Many people with diabetes have high blood pressure. High blood pressure in the kidney’s tiny blood vessels also puts added strain on the kidneys. High blood glucose and blood pressure levels can lead to scarring inside the filters so they don’t work as they should.


WHAT HAPPENS ONCE THE DAMAGE IS DONE?

Even though the filters aren’t working properly, symptoms may not occur until most of the kidney’s working capacity is lost. Before symptoms occur, substances such as protein leak through the walls of the filters instead of being retained. Protein then leaves the body in the urine.


span class="p_heding">HOW WILL I KNOW IF I HAVE KIDNEY PROBLEMS?

Because kidney damage can occur for years without symptoms, the best way to learn whether you have kidney problems is to have a sample of your urine checked once a year. This test, called a microalbumin (MY-kro-al-BYOO-min) test, can show whether your kidneys are leaking protein (also called albumin).


It’s best to have this test when you’re first diagnosed with type 2 diabetes and then once every year. Many people have protein in their urine when they’re first diagnosed with type 2 diabetes or soon afterward because they may have had diabetes for years before it was detected. If diabetes is present, even if it hasn’t been diagnosed, damage from high blood glucose levels can occur. If you have type 1 diabetes, you’re unlikely to have kidney damage at diagnosis. But you’ll need this test 5 years after diagnosis and every year after that.


Kidney Disease: Signs and Treatment

WHAT ARE THE EARLY SIGNS OF KIDNEY DISEASE?

Your doctor will test for protein in your urine if you have diabetes. If your test shows protein in the urine, your doctor will repeat the test to confirm the results. Additional blood tests and urine tests may be helpful, such as comparing the amount of protein with the amount of another compound, creatinine, in your urine. (Creatinine is a waste product from protein and muscles in the body.)


Protein in the urine also can be an early warning sign of cardiovascular (heart and blood vessel) disease or of diabetic retinopathy (eye disease) so your doctor may check your heart and your eyes as well.


WHAT ARE THE OTHER SIGNS OF KIDNEY DAMAGE?

As kidney disease progresses, waste products remain in the blood, so you may experience fluid retention, fatigue, nausea, and vomiting. You also may have anemia, which means you have too few red blood cells.


Your kidneys make a hormone called erythropoietin (eh -RITH -roh-POY-uh-tin) that signals your body to make red blood cells. With kidney disease, you don’t make enough erythropoietin, so you may not have enough red blood cells. Without them, your blood won’t be able to carry enough oxygen to all parts of your body, leaving you feeling tired and weak. Your health care provider may give you an injection of erythropoeitin and have you take iron pills to combat the anemia.


IF I ALREADY HAVE KIDNEY DAMAGE, HOW CAN I SLOW IT DOWN?

If you already have kidney damage, it’s not reversible. But you can slow down the rate of damage and keep it from getting worse. You’ll want to keep blood glucose and blood pressure levels on target, lose weight if needed, and continue to take your medications. In addition, these steps can help:


Change the way you eat.

Many people find that lowering the amount of sodium in their meal plan helps lower blood pressure. If you usually have large servings of protein-rich foods such as meat, chicken, and fish, your health care team may recommend that you eat fewer protein-rich foods to protect your kidneys. A registered dietitian can help you plan how to make these changes.


Watch out for your kidneys when you have certain X-ray tests.

Some X-ray tests use a liquid dye for better images. However, these dyes can harm the kidneys. The doctor may decide to do a different type of test without dye.


See your doctor right away for bladder or kidney infections.

If you have pain or burning during urination, a frequent urge to urinate, cloudy or reddish urine, nausea, a fever, or pain in your back or on your side below the ribs, you may have an infection in your bladder or kidneys. Left untreated, infections can damage your kidneys.


KIDNEY FAILURE

After a number of years, kidney disease can damage kidneys so much that they stop working entirely. This is called kidney failure or end-stage renal disease. People with kidney failure must find another way to clean their blood. One method is dialysis, which involves cleaning the blood with special equipment.


There are several types of dialysis. Some can be done at home, and for some the patient goes to a dialysis center.


Another way to restore kidney function is to have a kidney transplant. In a kidney transplant, a surgeon places a healthy kidney from another person into your body. The new kidney takes over the work your kidneys used to do. After the transplant, you’ll need to take medications that keep your body’s immune system from rejecting the new kidney.


WHAT CAN I EXPECT IF I HAVE KIDNEY FAILURE?

Serious kidney problems can bring many changes in your day-to-day life: how you feel, what you do every day, and how you treat your diabetes.


Your schedule

If you’re using a dialysis center, you’ll be there three times a week for 3 to 5 hours at a time. While you’re attached to the dialysis machine, you can read, sleep, or work. If you’ve chosen a type of dialysis that’s done at home, you’ll still be on a schedule but you’ll be able to move about and do your usual activities during the dialysis process. Some people do peritoneal dialysis overnight, while they’re sleeping.


Your food and beverages

It’s likely that your meal plan will change, depending on what type of dialysis you’re using. Because waste products can build up in the blood between dialysis sessions, you’ll need a special diet to stay healthy. A dietitian will help you make a meal plan that provides all of the things your body needs without putting extra waste products in your bloodstream. If you’re planning to get a transplant, you’ll have different dietary needs.


Your physical activity

You can still benefit from physical activity, even with serious kidney problems. However, you’ll want to talk with your health care team about what activities are best for you and when to do them.


Your diabetes carey

Serious kidney disease can lead to changes in how you manage your diabetes. Because of changes in your blood, the results of your A1C may not be reliable


If you use insulin, you may be at risk for low blood glucose (hypoglycemia). This can happen because part of insulin is broken down by the kidney. If your kidneys aren’t working, the way your body processes insulin can become unpredictable. This can also happen with certain diabetes pills. Your health care team can advise you on how to avoid low blood glucose by adjusting your dosage of diabetes medication.