Diabetes and Kidney Disease
Diabetes is one of the most common causes of kidney (renal) failure. The kidneys are the body's natural filtering and waste removal system. With every heartbeat, blood passes through a complex system of delicate filters within the kidneys.
When these twin organs are damaged and are unable to do their job, kidney failure is the result.
with diabetes--whether Type I or Type II--is at
a high risk for developing kidney disease. For people
with Type I diabetes, there is a 460 percent chance
of renal problems twenty years after onset. Although
current advances in diabetes control are diminishing
that risk, kidney disease (or diabetic nephropathy)
remains an extremely serious problem. Diabetic patients,
as well as their physicians, should be aware of
the signs of kidney damage, and should include a
plan for kidney care within their overall diabetes
filtering process in the kidney occurs in millions
of tiny structures called glomeruli, which are made
up of capillaries. As the blood flows through these
capillaries, waste substances not needed by the
body are filtered out into the urine and passed
on to the bladder. Valuable proteins and glucose
causes a change in the kidneys. It is not believed
that, as a result of diabetes, the kidneys may start
to overwork, possibly attempting to filter out excess
sugar. Eventually the small blood vessels in the
kidney become damaged. Scar-like material builds
up on the capillary walls (called basement membranes)
where most of the filtering process takes place.
scarring and thickening of the basement membranes
interferes with the filtering process. Wastes are
not eliminated and can build up, while other valuable
substances "leak" out into the urine.
Kidney damage becomes renal failure when the kidneys
almost completely stop cleaning wastes out of the
blood. At this time, unless the disease is treated,
wastes build up to poisonous levels and can cause
to Prevent Kidney Failure
kidney failure shoudl be a goal of every person
with diabetes. Because renal disease has so far
proven to be irreversible in its later stages, medical
researchers and physicians focus their attention
on prevention in the earliest stages of the disease.
When diabetic kidney disease is diagnosed, the measures
outlined below have proven beneficial in some patients--slowing
the progression to end stage renal disease.
has shown that kidney destruction is directly tied
to the abnormal metabolic environment caused by high
blood sugar. Keeping blood sugar levels as close to
normal as possible may therefore slow or impeded the
destructive process--a compelling reason to make tight
control a priority. Also, tight glycemic control helps
control high blood pressure (hypertension).
High Blood Press (Hypertension)
scarring causes hypertension, and hypertension in
turn speeds up the rate of kidney damage by weakening
the blood vessels of the glomeruli (the kidney's filtering
system). With a better understanding of this cycle,
physicians now take a more aggressive position on
controlling hypertension. From the first sign of kidney
disease the following measures are prescribed:
Blood Sugar (control: Often this step alone greatly
Loss: Obesity raises blood pressure. Maintaining
ideal body weight is important for all diabetes
Regular exercise has many beneficial effects on
overall cardiac fitness, and helps to keep blood
pressure down. An exercise program should, of course,
be undertaken only after consultation with your
Diet: Salt makes your body retain water and raises
Medication: Many medications that lower high blood
pressure are available.
Urinary Tract Infections
direct connection between the urinary tract and the
kidneys means germs are easily spread. Prompt treatment
of any urinary tract infection is a must. Symptoms
of urinary tract infection are: pain or burning during
urination, frequently feeling the need to urinarte,
cloudy urine, blood in urine, fever or lower back
Protein Diet: Low protein diets have been suggested
as treatment for people with chronic renal failure.
Recent research supports the theory that high protein
diets may speed up renal destruction.
studies have shown that low protein diets may reduce
or even prevent glomerular damage and slow progressive
renal failure. Physicians will assess the correct
amount of protein for a person's body weight. Low
Phosphorus Diet: Many people with kidney disease suffer
from secondary hyperparathyroiditis, a condition in
which the body produces an excessive amount of the
parathyroid hormone-causing inflammation and kidney
damage. Restricting dietary phosphorus under the advice
of a physician can prevent this condition.
Options for Failed Kidneys
are two main classes of treatment for kidney failure--dialysis
(using a substitute to cleanse the blood) and transplantation.
Both treatment options usually relieve symptoms and
is the most common treatment for kidney failure. There
are three types of dialysis, each with its advantages
The oldest and still the most
widely used form, hemodialysis is a method in
which a person is connected to a blood filtering
machine (an "artificial kidney"). Blood
drawn from the patient's arm is pumped through
the machine's filtering system which removes wastes
such as urea and returns the cleansed blood to
the body. This treatment is required three times
each week. Hemodialysis is extremely effective.
The disadvantage is that it is slow, taking four
to five hours per session. Hemodialysis is done
either in a treatment center or at home, with
the help of a technician or trained family member.
Even though home dialysis is more convenient (and
less costly), it is generally recommended that
people with diabetes use a treatment center, so
that other related medical problems can be more
Dialysis: The peritoneum is a thin tissue
that lines the inside of the abdomen. In peritoneal
dialysis, a special solution (dialysate) is run
through a tube into the peritoneum. As the peritoneum
circulates blood, the dialysate draws out the
accumulated wastes. After several hours, the fluid
has absorbed the wastes, and is drained out. Peritoneal
dialysis is done in a hospital. Since dialysate
contains sugar, people who were not insulin-dependent
before dialysis, may need to take insulin with
Ambulatory Peritoneal Dialysis (CAPD): This
option enables people to do peritoneal dialysis
at home or practically anywhere, as long as the
place is clean. It requires pouring the dialysate
fluid through a tube into the abdomen and leaving
it in the abdomen for several hours. During this
time, normal activities are continued. CAPD gives
people the freedom to manage their own dialysis.
The danger of CAPD is that germs can enter the
peritoneum through the tube and cause infection.
However, new technologies are lowering the risk.
some patients, surgery and a kidney transplant may
be less intrusive than on-going dialysis. A kidney
transplant, when successful, can mean a chance to
live a more normal life.
Right Donor: Finding a suitable donor presents
obvious difficulties. Most kidneys come from
healthy people who died in accidents. The other
source is a close relative who agrees to donate
one kidney (people can survive with only one
kidney). Either way, finding a close "match"
in blood and tissue type is essential for successful
"acceptance" of the new organ into
the patient's body.
Transplant: During the operation, a healthy
kidney is placed into the patient's abdomen, and
connected to blood vessles and a ureter into the
bladder. Usually, the transplanted kidney immediately
starts cleansing wastes and making urine.
Rates: The chances are 75 to 80 percent that
the transplant will be successful and keep working
for five to fifteen years.
of Kidney Disease: For people with diabetes,
the same process that damaged their original kidneys
may damage the transplanted kidney; however, this
can take many years, and good blood sugar control
can slow the process of kidney destruction.
||Other Risks: In order to reduce the risk of organ rejection, transplant recipients must take medications that
suppress the immune system. When the immune system is suppressed, the body is less able to fight off other kinds of infections.