Diabetic kidney disease takes many years to develop. In some people, the
filtering function of the kidneys is actually higher than normal in the first
few years of their diabetes.
Over several years, people who are developing kidney
disease will have small amounts of the blood protein albumin begin to leak into their urine. This first
stage of chronic kidney disease is called microalbuminuria. The kidney's filtration function
usually remains normal during this period.
As the disease progresses, more albumin leaks into the urine. This stage may
be called macroalbuminuria or proteinuria. As the amount of albumin in the urine
increases, the kidneys' filtering function usually begins to drop. The body
retains various wastes as filtration falls. As kidney damage develops, blood
pressure often rises as well.
Overall, kidney damage rarely occurs in the first 10 years of diabetes, and
usually 15 to 25 years will pass before kidney failure occurs. For people who
live with diabetes for more than 25 years without any signs of kidney failure,
the risk of ever developing it decreases.
Diagnosis of Chronic Kidney Disease
People with diabetes should be screened regularly for kidney disease. The two
key markers for kidney disease are eGFR and urine albumin.
eGFR. eGFR stands for estimated
glomerular filtration rate. Each kidney
contains about 1 million tiny filters made up of blood vessels. These filters
are called glomeruli. Kidney function can be checked by estimating how much
blood the glomeruli filter in a minute. The calculation of eGFR is based on the
amount of creatinine, a waste product, found in a blood sample. As the level of
creatinine goes up, the eGFR goes down.
Kidney disease is present when eGFR is less than 60 milliliters per minute.
The American Diabetes Association (ADA) and the National
Institutes of Health (NIH) recommend that eGFR be calculated from serum
creatinine at least once a
year in all people with diabetes.
Urine albumin. Urine albumin is measured by comparing the amount of albumin
to the amount of creatinine in a single urine sample. When the kidneys are
healthy, the urine will contain large amounts of creatinine but almost no
albumin. Even a small increase in the ratio of albumin to creatinine is a sign
of kidney damage.
Kidney disease is present when urine contains more than
30 milligrams of albumin per gram of creatinine, with or without decreased eGFR.
The ADA and the NIH recommend annual assessment of urine
albumin excretion to assess kidney damage in all people with type 2 diabetes and
people who have had type 1 diabetes for 5 years or more.
If kidney disease is detected, it should be addressed as part of a
comprehensive approach to the treatment of diabetes.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
Diabetic Neuropathy is a complication of diabetes that causes damage to the nerves; this is related to the blood glucose of the body being too high for a long period of time. The four types of neuropathy include peripheral, autonomic, proximal and focal.
High blood pressure (hypertension) means high pressure (tension) in the arteries. Treatment for high blood pressure include lifestyle modifications (alcohol, smoking, coffee, salt, diet, exercise), drugs and medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers (CCBs), alpha blockers, clonidine, minoxidil, and Exforge.
High blood pressure can damage the kidneys and is one of the leading causes of kidney failure (end-stage renal kidney disease). Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. If you have kidney disease, you should control your blood pressure. Other treatment options include prescription medications.
The risks for developing type 2 diabetes include family history, ethnicity, birth weight, metabolic syndrome, and obesity. Warning signs pointing to an increased risk for developing type 2 diabetes include irregular menstruation, impaired fasting glucose, inflammatory markers, and other risks. Gestational diabetes is also a risk factor for developing type 2 diabetes later in life. Prevention of type 2 diabetes can be achieved through a healthy diet (Mediterranean diet), exercise, weight control, not smoking, and medication.
Managing your diabetes is important. The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Information about exercise, diet diet, and medication will help you manage your diabetes better. Blood glucose reagent strips, blood glucose meters, urine glucose tests, tests for urinary ketones, continuous glucose sensors, and Hemoglobin A1C testing information is also provided in this article.
Taking care of a disease such as diabetes is a life-long process. Learn how to care for yourself or loved one with diabetes in situations such as illness, work, school, travel, or a natural disaster.
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