Content Starts Here

Diabetic kidney disease

print Health amd Nutrition > Diseases > D

Diabetic kidney disease

Reviewed by Professor Ian W Campbell, consultant physician, adult diabetes and Dr Soon Song, consultant physician

What is diabetic kidney disease?

Long-standing diabetes causes changes in small blood vessels that can lead to damage of the kidneys. This damage can result in severe kidney failure.

Term watch Nephropathy: the medical term for the type of kidney disease that occurs in diabetes.

Who gets diabetic kidney disease?

There are wide differences in estimates of how many people with diabetes will progress to having diabetic kidney disease - from 6 to 27 per cent of people with Type 1 diabetes, to 25 to 50 per cent of Type 2.

Poor glucose control and even modestly high blood pressure can increase your risk of making kidney disease worse.

In Type 2 diabetes, people from an Asian or Afro-Caribbean origin are twice as likely to develop diabetic kidney disease.

What are the symptoms?

There are no symptoms when diabetic kidney disease first develops. Later, the following signs of decreased kidney function are:

fatigue

nausea and vomiting

itchy skin

a metal taste in the mouth

heartburn

swelling in the limbs and/or eyelids due to the build-up of fluid in the tissues (oedema).

What problems does diabetic kidney disease cause?

The kidneys are essential organs:

they filter and eliminate the waste products of metabolism

they have a central role in controlling blood pressure and fluid balance in the body

they produce the key hormone that stimulates the bone marrow to manufacture red blood cells.

Diabetic kidney disease is the most common cause of kidney failure in the UK.

People with very poor kidney function require some form of artificial kidney support (dialysis) or a kidney transplant.

The increasing numbers of people with Type 2 diabetes has meant the demand for these facilities has been steadily climbing for several years.

Because the kidneys have a central role in controlling blood pressure, it's common for people with diabetic kidney disease to have raised blood pressure.

High blood pressure accelerates the decline in kidney function in nephropathy â€“ in other words the two problems multiply each other's effect. By lowering blood pressure, diabetic kidney disease can be slowed down.

How is diabetic kidney disease diagnosed?

The kidney filtering system normally ensures proteins are kept almost completely out of urine. In diabetic kidney disease, these filters become leaky and start to let protein through.

If protein is found in your urine, diabetic kidney disease is likely to be present.

A diagnosis is made by measuring the amount of the protein albumin in the urine. The urine sample is usually taken from the first urine passed in the morning.

A value below 30 milligrams (mg) is normal.

A value between 30 and 300mg is called microalbuminuria (the beginning of kidney disease).

A value above 300mg is called proteinuria (a more advanced stage of diabetic kidney disease).

Microalbuminuria is not a harmless stage that can be ignored until it develops into more advanced kidney disease. People with microalbuminuria are two to four times more likely to develop coronary heart disease.

Checking urine for albumin is an important part of diabetes management that should be done at least annually. Test kits are now available that allow quick checks to be done in the GP's surgery.

What are the risk factors?

There is an increased risk of diabetic kidney disease:

with poor blood sugar control, ie levels are too high for too much of the time.

if you smoke

if you're male

if there's some protein in your urine

if you have high blood pressure

the older your are

the longer you've had diabetes

if you have raised levels of cholesterol and fats (triglycerides) in the blood

if you already have diabetic eye disease (diabetic retinopathy).

This list has some things in common with that for diabetic retinopathy.

How is diabetic kidney disease treated?

By normalising blood sugar levels with blood sugar lowering medicines.

If microalbuminuria is detected, ACE inhibitors or angiotensin II antagonists are used.

If you have high blood pressure, it needs to be well controlled and blood pressure medication may be given.

If kidney function is significantly reduced, you'll need to reduce the amount of protein in your diet.

If you have end-stage kidney disease, you'll need dialysis and ultimately a kidney transplant.

ACE inhibitor drugs

Good advice ACE inhibitors and angiotensin II receptor blockers can be given to a wide range of people, but they aren't suitable for all.

If widespread hardening of the arteries has reduced blood supply to the kidneys, these drugs can worsen kidney function.

To confirm the drugs aren't causing problems, blood checks on kidney function should be done shortly after starting treatment.

Go To Next Page>>

The documents contained in this web site are presented for information purposes only. The material is in no way intended to replace professional medical care or attention by a qualified practitioner. The materials in this web site cannot and should not be used as a basis for diagnosis or choice of treatment. Conditions for use

© Copyright 1998 - 2004 NetDoctor.co.uk - All rights reserved