Kidney Disease and Diabetes
Robin Brain
November 22, 2008
Your kidneys are two of the hardest-working organs in your body; filtering approximately 50 gallons of fluid from the blood that passes through them daily. After the million or so nephrons in each kidney balance electrolytes and filter toxins, 49.5 gallons of fluid are returned to the bloodstream cleansed and chemically and hormonally balanced. The remaining half gallon leaves the body as urine.
E Fact
People of certain ethnic and racial backgrounds are at a higher risk for developing kidney disease, including African Americans, Hispanics, Mexican-Americans, and Native Americans. Blood vessel damage and hypertension associated with diabetes can take a serious toll on renal ( or kidney) function, damaging this amazing filtration capacity of the kidneys. As a result, diabetes has become the number one cause of end stage renal disease (ESRD, or chronic kidney failure), accounting for 35 percent of all cases. Both type 1 and type 2 patients are at risk for developing kidney problems, and the risk of developing ESRD increases with the length of time since diabetes diagnosis, possibly due to the prevalence of high blood pressure in diabetes and the added stress it places on the kidneys. In fact, uncontrolled hypertension is the second most common cause of kidney failure in America, accounting for about 23 percent of the ESRD patient population according to the National Kidney Foundation. Signs and symptoms of kidney disease include the following:
Blood and/ or protein ( albumin) in the urine
High blood pressure
Frequent urination, especially at night
Leg cramps
Puffiness and swelling around the eyes, hands, and feet (edema)
Excessive itching (pruritis)
Nausea and vomiting
Weakness
If your doctor suspects renal impairment, she will run several diagnostic tests to assess your kidney function, including a urine test for microalbumin, or trace amounts of protein in the urine. Microalbuminuria is one of the hallmarks of early kidney disease, and at one time was thought to be the beginning of the end of kidney function for people with diabetes. However, a Joslin Diabetes Center study published in the New England Journal of Medicine in June 2003 found that 58 percent of type1 study subjects who developed microalbuminuria were actually able to reverse the condition within six years with good control of blood glucose, blood pressure, and cholesterol levels.
Importance of Good Control
Several large-scale diabetes studies have demonstrated that tight blood glucose control can significantly reduce the risk of nephropathy. In fact, the DCCT found that people with type 1 diabetes who maintained an average Al c of 7.2 percent cut their risk of developing nephropathy and other complications up to 75 percent. And the United Kingdom Prospective Diabetes Study (UKPDS) found that people with type 2 diabetes achieved a 35 percent reduction in risk for nephropathy for each percentage point they lowered their Al c levels. If you develop kidney disease, you may have to watch your protein intake; a registered dietitian can help you to develop a meal plan that is low in dietary protein and compatible with blood sugar control goals. However, studies are still inconclusive on the benefits of low-protein diets in lowering the risk of developing kidney disease, and the ADA currently recommends that most adults who have diabetes without known kidney damage include the recommended daily allowance (RDA) of approximately 10 percent of total calories from protein in their diets. Because diabetic kidney disease often goes hand in hand with hypertension, you may be prescribed ACE inhibitors or other medication to control your blood pressure and cut the workload of your kidneys, as well.
Essential
Kidney failure is an irreversible condition. Once kidney function diminishes to less than 10 to 15 percent and ESRD occurs, hemodialysis, peritoneal dialysis, or kidney transplant are the only treatment options.
E Fact
People of certain ethnic and racial backgrounds are at a higher risk for developing kidney disease, including African Americans, Hispanics, Mexican-Americans, and Native Americans. Blood vessel damage and hypertension associated with diabetes can take a serious toll on renal ( or kidney) function, damaging this amazing filtration capacity of the kidneys. As a result, diabetes has become the number one cause of end stage renal disease (ESRD, or chronic kidney failure), accounting for 35 percent of all cases. Both type 1 and type 2 patients are at risk for developing kidney problems, and the risk of developing ESRD increases with the length of time since diabetes diagnosis, possibly due to the prevalence of high blood pressure in diabetes and the added stress it places on the kidneys. In fact, uncontrolled hypertension is the second most common cause of kidney failure in America, accounting for about 23 percent of the ESRD patient population according to the National Kidney Foundation. Signs and symptoms of kidney disease include the following:
Blood and/ or protein ( albumin) in the urine
High blood pressure
Frequent urination, especially at night
Leg cramps
Puffiness and swelling around the eyes, hands, and feet (edema)
Excessive itching (pruritis)
Nausea and vomiting
Weakness
If your doctor suspects renal impairment, she will run several diagnostic tests to assess your kidney function, including a urine test for microalbumin, or trace amounts of protein in the urine. Microalbuminuria is one of the hallmarks of early kidney disease, and at one time was thought to be the beginning of the end of kidney function for people with diabetes. However, a Joslin Diabetes Center study published in the New England Journal of Medicine in June 2003 found that 58 percent of type1 study subjects who developed microalbuminuria were actually able to reverse the condition within six years with good control of blood glucose, blood pressure, and cholesterol levels.
Importance of Good Control
Several large-scale diabetes studies have demonstrated that tight blood glucose control can significantly reduce the risk of nephropathy. In fact, the DCCT found that people with type 1 diabetes who maintained an average Al c of 7.2 percent cut their risk of developing nephropathy and other complications up to 75 percent. And the United Kingdom Prospective Diabetes Study (UKPDS) found that people with type 2 diabetes achieved a 35 percent reduction in risk for nephropathy for each percentage point they lowered their Al c levels. If you develop kidney disease, you may have to watch your protein intake; a registered dietitian can help you to develop a meal plan that is low in dietary protein and compatible with blood sugar control goals. However, studies are still inconclusive on the benefits of low-protein diets in lowering the risk of developing kidney disease, and the ADA currently recommends that most adults who have diabetes without known kidney damage include the recommended daily allowance (RDA) of approximately 10 percent of total calories from protein in their diets. Because diabetic kidney disease often goes hand in hand with hypertension, you may be prescribed ACE inhibitors or other medication to control your blood pressure and cut the workload of your kidneys, as well.
Essential
Kidney failure is an irreversible condition. Once kidney function diminishes to less than 10 to 15 percent and ESRD occurs, hemodialysis, peritoneal dialysis, or kidney transplant are the only treatment options.
Get more information on Diabetes Medication Pharmacy and National Diabetic Pharmacy.
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