Diabetes causes injury to small blood vessels throughout the body. Small blood vessels in the kidney are often involved. This causes protein to spill into the urine. One type of protein, albumin, is detected in the urine even during early, mild kidney disease. If progressive chronic disease develops in kidney blood vessels, the kidneys cannot function normally and kidney failure develops.
Diabetes also causes scarring in the walls of arteries and arterioles in the kidneys and other tissues. Arterioles are the smallest arteries that connect to capillaries. Arteries and arterioles bring blood carrying oxygen to the tissues of the body. Sclerosis is scarring in the blood vessel wall that causes thickening of the wall and narrowing of the opening through which blood flows. Diabetes causes scarring of arteries and arterioles. When this happens, not enough oxygen reaches the tissue and injury results. This can injure many tissues. The heart, eyes, skin, nerves and kidneys can be affected.
The tiny structures that do the work in your kidneys are called nephrons. Each nephron has 3 parts: 1) a small blood vessel that brings in unfiltered blood, 2) a GLOMERULUS that filters the blood and 3) a small blood vessel that returns filtered blood to the body. The earliest detectable change in glomeruli is thickening of the thin basement membrane. This is part of the filter that separates the blood from the urine. Damage to this membrane causes proteins to leak from the blood into the urine. Damage to the membrane can be identified in a kidney using an electron microscope to show thickening of the membrane.
Why Kidney damage?
Small blood vessels in the kidney filter out the waste products from the body. High blood pressure and high blood sugar can damage these vessels thereby they will not be able to do their functions effectively.
Small blood vessels in the kidney filter out the waste products from the body. High blood pressure and high blood sugar can damage these vessels thereby they will not be able to do their functions effectively.
Stages of diabetic kidney damage
In the beginning stages of kidney damage, traces of protein also called 'albumin' begins to appear in the urine. This stage is called MICROALBUMINURIA. Early kidney damage has no symptoms and can be treated with diet and medicines and is reversable.
In the beginning stages of kidney damage, traces of protein also called 'albumin' begins to appear in the urine. This stage is called MICROALBUMINURIA. Early kidney damage has no symptoms and can be treated with diet and medicines and is reversable.
As the kidney damage gets worse, large amounts of protein can be detected in the urine which is called as the stage of PROTEINURIA or overt nephropathy. By this stage, the damage is often irreversable in most cases. Finally the stage of renal failure sets which can rapidly progress to End stage Renal Disease which requires either Dialysis or Transplantation to sustain life.
INVESTIGATIONS
If albuminuria is detected the following investigations are recommended :-
If albuminuria is detected the following investigations are recommended :-
* Check for the history of other renal diseases in the family.
* Check for urinary tract infection through urine and culture sensitivity test.
* Ultrasound examination of the kidneys.
* Measurement of urea and serum creatinine and comparison with previous levels.
* 24 hr urine collection for protein excretion.
* Blood pressure measurement.
* Check ECG and Chest X-ray.
* Retinal examination.
* Check for urinary tract infection through urine and culture sensitivity test.
* Ultrasound examination of the kidneys.
* Measurement of urea and serum creatinine and comparison with previous levels.
* 24 hr urine collection for protein excretion.
* Blood pressure measurement.
* Check ECG and Chest X-ray.
* Retinal examination.
RISK FACTORS LEADING TO KIDNEY DISEASE
1. Poor control of diabetes.
2. Long duration of diabetes.
3. Uncontrolled blood pressure.
4. Genetic Factors (Family History of kidney disease).
2. Long duration of diabetes.
3. Uncontrolled blood pressure.
4. Genetic Factors (Family History of kidney disease).
How to prevent kidney disease
1. Diagnosing diabetes at an early stage by regular screening.
2. Once diabetes is diagnosed, it should be kept under very good control.
3. Tight control of blood pressure (130/80mm/Hg) helps to prevent kidney damage.
4. Regular screening for microalbuminuria to identify early stages of kidney damage.
5. Use of ACE inhibitors or other drugs, which have very good effect in early stages of kidney disease.
6. Regular check up at diabetes centre.
7. Strict diet as advised. If there is proteinuria, the protein intake in the diet may have to be reduced.
1. Diagnosing diabetes at an early stage by regular screening.
2. Once diabetes is diagnosed, it should be kept under very good control.
3. Tight control of blood pressure (130/80mm/Hg) helps to prevent kidney damage.
4. Regular screening for microalbuminuria to identify early stages of kidney damage.
5. Use of ACE inhibitors or other drugs, which have very good effect in early stages of kidney disease.
6. Regular check up at diabetes centre.
7. Strict diet as advised. If there is proteinuria, the protein intake in the diet may have to be reduced.
KEY MESSAGES
* Diabetic kidney disease is one of the commonest causes of kidney failure.
* Kidney disease is asymptomatic till late stages.
* Kidney disease is preventable by early detection of diabetes and good control of diabetes and blood pressure.
* Screening for diabetic kidney disease should be done at least annually.
Prevention and awareness are very important to everyone with diabetes:
Urinalysis (urine test): All diabetics should have a urine test at least once every year. This test looks for the presence of the protein albumin. This indicates possible kidney damage.
Blood Sugar Control: Keeping blood sugar levels well controlled helps maintain kidney health. In a recent study, diabetic patients that kept their blood sugar below 150 mg/dl greatly reduced the risk of kidney disease. Some diabetics can manage blood sugar with just oral medication. Others need insulin. Doctors who specialize in diabetes can prescribe insulin. The American Diabetes Association recommends that blood sugars be kept between 90-130 mg/dl on an empty stomach. Blood sugar should be less than 180 mg/dl one hour after eating.
Blood Pressure: High blood pressure is extremely common in diabetics. It is a major cause of kidney disease. Additionally, kidney disease can make high blood pressure even higher. This creates a vicious cycle. Often, it takes multiple medications to control high blood pressure. This is especially true for diabetics, obese patients, and the elderly. The American Diabetes Association recommends checking blood pressure twice every year. Keeping blood pressure below 130/80 is also recommended. Patients who cannot control their blood pressure with diet and exercise alone are usually prescribed blood pressure reducing medicine. This is known as an "ACE inhibitor" or an "ARB".
Cholesterol: High cholesterol is common in diabetics. Therefore, the risk of developing kidney disease from high cholesterol is a concern. This concern makes controlling cholesterol very important. Sometimes a healthy, balanced diet is enough to control cholesterol. Sometimes medication is needed. The American Diabetes Association recommends that the LDL (bad cholesterol) be less than 100. HDL (good cholesterol) should be higher than 40. Triglycerides should be less than 150.
Controlling protein intake: Experts disagree about how much protein diabetics should eat. Evidence shows that too much or too little protein can be harmful. The American Diabetes Association recommends following USDA guidelines. Patients should consume 5-6 ounces of meat and 2-3 servings of dairy every day.
Smoking: Smoking worsens the progression of kidney disease. Quitting smoking is extremely difficult. There are several treatments which have been proven to help people quit.
Weight loss and Exercise: Being overweight contributes to kidney disease by making diabetes harder to control. It raises blood pressure and causes scarring in the kidneys. Weight loss often improves blood sugars. It also decreases the number of medications necessary to control blood pressure.
Body Mass Index (BMI) is a scale that uses weight and height to determine whether someone is overweight. A BMI 25-30 indicated that someone is overweight. An obese person has a BMI over 30. Planning a diet and exercise program to reach a BMI of less than 25 will greatly reduce diabetic risk factors.
Prevention and awareness are very important to everyone with diabetes:
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