Diabetes and Kidney Disease (cont.)
The Course of Kidney Disease
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.
Next: Effects of High Blood Pressure »
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- Kidney Failure - Learn about kidney failure, in which the body has fluid retention, risen blood pressure, toxin build up and lack of red blood cells. Symptoms include fatigue, nausea, and apetite loss.
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