Diabetes and Kidney Disease (cont.)
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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
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People with diabetes should be screened regularly for kidney disease. The two key markers for kidney disease are eGFR and urine albumin.
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.
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.
Medically Reviewed by a Doctor on 4/4/2014
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