Diabetes and Kidney Disease
Careful management of your diabetes and kidney disease could be the least of your concerns.
Some of our smallest blood vessels are in the kidney. Knowing that, it's no surprise that the microvascular effects of periodontal disease and diabetes, and the harmful health effects they cause, are frequently played out in this vital organ, creating a direct link between diabetes and kidney disease.
Diabetes is the leading cause of end-stage renal disease (ESRD), responsible for nearly 40 percent of kidney disease cases. The rust effect, which I discussed in my column "The Rust Effect –Evidence of Microvascular Disease", does serious damage here, causing a gradual decrease of the kidney's ability to excrete wastes and concentrate urine. ESRD happens when kidney function drops to less than 40 percent of normal. Without dialysis or a transplant, the accumulation of fluids and waste in the body causes severe complications and, finally, death.
More than 400,000 people in the U.S. are on dialysis and more than 20,000 have had a transplant. The largest share of people on dialysis have diabetes.
A "little ball of yarn" that's critical to your health
One of the kidney's most important structures is extremely vulnerable to the rust effect. These are the many tiny balls of capillaries called the glomerulus. Glomerulus translates from Latin as "little ball of yarn," which gives you a great visual of what these look like. Their primary job is to help filter the blood to form urine. That's why gradual loss of kidney function is measured by the glomerular filtration rate. It measures the blood plasma that's filtered in a certain period of time through a measure called creatinine clearance. Creatinine is produced by the body and filtered by the glomerules. If you have diabetes you need to know your creatinine clearance number because it indicates how your kidneys are working. Normal levels are 70 for men and 60 for women.
When medical professionals see creatinine levels rise, they look at kidney function. As tiny capillaries in the glomerules begin to suffer from the rust effect, up to half their filtering surface can be lost before creatinine levels increase. By then, you could already have mild kidney disease or early kidney damage.
But that's only the beginning
There are other serious health effects that stem from diminished kidney function. They include:
•High blood pressure caused by the constriction of blood vessels by the angiotensin-converting enzyme called ACE. ACE is created when angiotensin is released by cells in the surface layer of the kidney.
•Heart attack, stroke or microvascular issues caused by a higher volume of blood flowing into the arterial system. The extra liquid can break the system's "weakest link" leading to a serious, maybe fatal health event.
•An enlarged heart, caused by this muscle working overtime to develop the capacity to pump more blood into a system that's become resistant to blood flow. As the heart overworks, it weakens and is less effective. Eventually it can't pump enough blood to deliver the nutrients cells need. That's called congestive heart failure, which can be debilitating or fatal.
What can you do?
You've probably heard of ACE inhibitors. They're widely used to keep this enzyme from converting angiotensin into its vessel-constricting form. ACE inhibitors help you keep your blood pressure in the normal range. They've developed into a first-line treatment recommended by the American Diabetes Association, which also recommends angiotensin receptor blockers (ARBs). These block the converted angiotensin from constricting your vessels and are used if you can't tolerate ACE inhibitors. Since both compounds reduce blood pressure and decrease the potential for macrovascular damage, they help protect against kidney disease.
Another ADA recommendation is to take a diuretic, if you have been prescribed an ACE inhibitor or an ARB but still have high blood pressure. The idea is that the diuretic will help increase the kidney's glomerular filtration rate. As filtration increases, the kidney can concentrate more wastes from the bloodstream into urine, more liquid is removed from the blood supply and the pressure on the vascular walls is reduced. All of which means, simply, lower blood pressure.
Fortunately, good dental care can reduce the rust effect and help you avoid such catastrophic health problems. Careful management of your diabetes and kidney disease can be the least of your health concerns.
For more information about diabetes and kidney disease, visit http://www.dentistryfordiabetics.com and Dr. Martin's blog, http://www.dentistryfordiabetics.com/blog.
Read Dr. Charles Martin's bio here.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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