Diabetes and Kidney Disease

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By: Betty Wedman

Everyone needs to start giving kidney dysfunction and cardiovascular disease equal standing as complications in diabetes mellitus.

Many individuals I see in my office can proudly tell me their cholesterol and triglyceride numbers but don’t have a clue about creatinine, a protein produced by muscles and released into the blood, or urinary protein.

Better awareness of kidney dysfunction can help prevent or forestall the suffering and expense of diabetic kidney disease.

Kidney disease is a major devastating complication of diabetes. The progression of proteinuria—spilling of protein in the urine—may develop slowly over the years.

Changing diet, modifying blood pressure and exercising regularly can help reduce kidney damage and the need for dialysis.

The Four Stages of Kidney Disease

Early in the development of kidney disease, the kidneys begin working less efficiently to remove waste products from the blood. Proteins are lost in the urine instead of going for cell repair and growth. As the disease progresses, kidneys lose their ability to remove creatinine and urea (waste products) from the blood.

To help you become more pro-active in reducing the symptoms related to kidney failure, the following sections describe the stages of diabetic kidney disease.

Stage 1

Blood flow through the kidneys remains normal or near normal, but the glomeruli—the “filter paper”—begins to show damage. Tears or leaks in the “filter paper” allow small amounts of protein—called albumin—to leak into the urine. Your physician may refer to this as microalbuminuria, which is said to be present if urinary albumin excretion is 30 mg to 299 mg per 24 hours (or 20 micrograms to 199 micrograms per minute on a timed specimen or 30 mg/gram creatinine to 299 mg/gram creatinine on a random specimen). People with diabetes may live with small amounts of albumin loss for years if their blood glucose and blood pressure are well controlled.

Stage 2

The loss of albumin plus other proteins in the urine becomes greater than the amounts in Stage 1 for microalbuminuria. Blood levels of creatinine and BUN (blood urea nitrogen) begin to rise, indicating the kidney’s loss of filtering ability.

Stage 3

The glomeruli, or “filter paper,” of the kidneys becomes even less able to filter out waste products. Large amounts of protein are lost in the urine. Blood pressure usually increases significantly. Higher levels of creatinine are found in the blood.

Stage 4

End Stage Renal Disease (ESRD) is diagnosed when the glomerular filtration rate drops so low that dialysis is needed to remove waste products from the blood. Urine output declines and frequently ceases.

‘How Long Before Dialysis?’

The most frequently asked question as soon as testing indicates kidney dysfunction is, “How long do I have before dialysis?” The answer is not etched in stone.

Some people with type 2 diabetes may go 15 to 25 years before kidney problems become apparent. Others, especially those with type 1 diabetes, may have a rapid progression, in 5 to 10 years.

One statistic is pretty daunting: about 60 percent of those on dialysis have diabetes as the primary cause.

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