About Diabetic Kidney Disease
Why Kidneys Count
The kidneys are the waste management system of the body, removing excess fluid and toxins from the blood stream and filtering them into the urine. The role they play is vital; if kidney function is significantly reduced and a patient develops end-stage renal disease (ESRD); the situation is life-threatening and a kidney transplant or regular dialysis treatments are the only treatment options.
One of the reasons people with diabetes are at a higher risk for kidney disease (also called nephropathy) is their increased incidence of high blood pressure. The stress of long-term hypertension can cause damage to the blood vessels of the nephrons, the functional filtering units of the kidney. Up to 65% of people with diabetes have high blood pressure; controlling it is essential to preventing diabetic kidney disease.
Early Detection Saves Kidneys
Traditionally, kidney disease has been considered an irreversible and progressive condition that will eventually lead to renal failure (called end-stage renal disease). But recent research shows that early detection can actually save kidney function. A 2003 study in the New England Journal of Medicine found that if the earliest sign of kidney disease—microalbuminuria (or minute amounts of protein in the urine)—is detected it could be reversed if treated properly. Over half of type 1 patients with microalbuminuria in the study recovered their kidney function with a treatment plan designed to achieve good blood glucose control, normal blood pressure, and lower cholesterol levels.
However, early detection remains key to slowing the progression of diabetic kidney disease. Familiarize yourself with the signs and symptoms:
- Frequent urination
- Blood and/or protein in the urine
- Burning during urination
- Puffiness and swelling (edema) in the face, hands, and feet
- High blood pressure
- Skin itching
- Nausea and vomiting
The American Diabetes Association recommends that people with type 1 diabetes should get a urine test for albumin (a protein) starting at puberty and/or five years after diagnosis of the disease (more frequently if there are additional risk factors for kidney disease). In addition to an annual assessment of urinary microalbumin, serum creatinine - a metabolic byproduct of creatine, the acid that supplies energy for muscle contractions - should be measured at least annually. This test is used to estimate GFR (a value known as eGFR or estimated glomular filtration rate) and will indicate which of the five stages of end-stage renal disease a patient has reached. Other measures of kidney function include blood urea nitrogen (BUN). BUN is an end-product of protein metabolism formed in the liver. Both urea and creatinine are filtered out of the bloodstream by the kidneys; high amounts of these substances in the bloodstream indicates renal impairment.
You may have reduced kidney function if:
- Your microalbumin levels are > 30 mg in a 24-hour urine test.
- Your blood creatinine is > 1.2 (women) or 1.4 (men). (Note: this is a different test and measurement than urinary creatinine).
- Your BUN levels are >8.
- Your healthcare provider can help you interpret your lab test results.
1-American Diabetes Association. 2011. ADA Standards of Medical Care in Diabetes — 2011. Diabetes Care 34: Suppl 1.
2-National Kidney & Urologic Diseases Information Clearinghouse. Kidney Disease of Diabetes. http://kidney.niddk.nih.gov/kudiseases/pubs/kdd/index.aspx. (Accessed 8/12/11.)
Reviewed by Susan Weiner, RD, MS, CDE, CDN. 05/12.
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