Diabetes And Kidney Diseases

Roughly one in three Americans with diabetes are affected by diabetic nephropathy, which is one of the most serious complications of diabetes type 1 and 2.  The main function of kidneys is to remove waste products and eliminate excess fluid from the body.  High blood sugar levels damage the blood vessels and urinary symptoms over time. As a result, the kidney function deteriorates and if left untreated may progress to kidney failure. Although more tests and therapies are nowadays available, this condition is the leading cause of end-stage kidney diseases in the US. 

Read on to learn more about diabetic kidney disease, what are the symptoms, how can be prevented and treated. 

Diabetic kidney disease- risk factors 

Obviously, having diabetes is a key risk factor, and kidney diseases are more likely to develop if diabetes has been diagnosed for a long time and if it is poorly controlled. Kidney failure usually occurs 10 or more years after the onset of kidney disease. High blood pressure, abnormal cholesterol levels, and smoking are other risk factors. Researchers also identified a genetic component as certain genetic variations and having family members with diabetic kidney diseases are associated with increased risk. 

Signs and symptoms of diabetic kidney diseases

Many people do not experience any symptoms during the early stages. As the disease progresses, symptoms include increased need to urinate and passing foamy urine, puffy eyes and swelling of the hands, feet, and ankles, loss of appetite, persistent itching, nausea and vomiting, confusion, shortness of breath.   Furthermore, kidney diseases lead to fatigue,  difficulty controlling blood pressure, and reduced need for insulin or anti-diabetes drugs. 

Urine tests show proteins in the urine and a higher than normal glomerular filtration rate (GFR). GFR is a test that evaluates how well the kidneys are filtering. A GFR of 60 or higher is considered healthy. A GFR lower than 60 may suggest kidney diseases and a very low GFR  of 15 or lower is a sign of kidney failure. 

Diabetic kidney disease may increase the risk of urinary tract infections. Research also found an increased risk of kidney stones, especially in those with diabetes type 2. 

Ultrasound of the kidney can be useful to evaluate the size of the kidney. During the early stages, the kidneys have the normal size or slightly increased while in advanced stages they tend to decrease in size. 

Diabetes kidney disease- prevention and treatment 

There is good evidence that early treatment of diabetes (both type 1 and type 2 diabetes) helps delay or prevent the onset of diabetic kidney diseases. The best way to prevent or delay the development of diabetic kidney disease is to keep blood sugar levels under control using medication and a healthy lifestyle. Blood sugar levels should be monitored regularly, and the glycosylated Hb (HbA1C) – which shows how well diabetes is controlled long-term – should be kept at 7.0 or lower. It is important to prevent -or manage well blood pressure and cholesterol levels. 

Routine checkups are important to detect kidney diseases as soon as possible. Health experts recommend that those with type 1 diabetes without kidney diseases should be screened for protein in urine beginning 5 years after the diagnosis (of diabetes) and at least once a year afterward.  For individuals with type 2 diabetes, it is recommended to screen for kidney diseases at the time of diagnosis and once a year thereafter. 

Once the doctor diagnoses kidney disease, it is important to treat the condition early to slow the progression and risk of kidney failure. In addition to tight control of diabetes and high blood pressure (which should be kept below 120/70 mmHg),  there are specific drugs that can be used including Dipeptidyl peptidase (ie DPPV IV) inhibitors, alpha-glucosidase inhibitors (AGIs), sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists Dietary changes are needed to restrict salt, phosphorus and potassium are recommended in advanced stages of kidney diseases. Vitamin D is part of the treatment as well. The American Diabetes Association recommends that individuals with diabetes and documented kidney disease restrict proteins to about 0.8 to 1.2 grams protein per day.  End-stage kidney disease is treated with dialysis or kidney transplant. Kidney transplants are associated with an increased survival rate compared with dialysis and can be performed with or without a pancreas transplant. 

Doctors also recommend avoiding drugs that have the potential to be toxic to the kidneys like nonsteroidal anti-inflammatory medications (NSAIDs) and aminoglycosides. 

Overall, the prognosis is good for those who receive early treatment, follow the recommendations,  maintain healthy levels of blood sugar levels, and have regular follow-ups.  Evaluations for other complications of diabetes are needed, particularly testing eye health, nerves,  heart, and blood vessels.  Keeping the blood pressure levels healthy is very important, as even prehypertension (120 -139/80- 89 mm Hg) and stage 1 hypertension ( 140 to 159/90 to 99 mm Hg) can accelerate kidney damage. 

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