Diabetic renal disease (nephropathy) is one of the most common complications of diabetes. Even before diagnosis of diabetes, the kidneys begin to suffer from the effects of elevated blood sugar. Excess glucose in the blood caused by insulin resistance or absence is flushed from the body in the form of urine. As a person with undiagnosed or unmanaged diabetes drinks and urinates excessive amounts, the kidneys become overworked. The kidneys are responsible for filtering waste products from the blood. This is done by capillaries that filter out the impurities while keeping red blood cells and proteins in the blood. Chronic high blood sugar levels cause the kidneys to filter increased amounts of blood, ultimately exhausting the capillaries and casing them to leak protein (microalbuminuria). If kidney disease is diagnosed at this stage treatment may help to repair damage. Unfortunately, there are rarely symptoms of kidney disease allowing it to go undetected until macroalbuminuria (large amounts of protein in the urine) occurs. At this point end-stage renal disease (ESRD) is usually inevitable. ESRD is renal failure, when the kidneys can no longer filter the blood and waste products build up. Once a person has ESRD they must receive a transplant or require dialysis. Statistically 30% of type 1 patients and 10-40% of type 2 patients will suffer from kidney failure.
Symptoms and Prevention of Diabetic Renal Disease
Symptoms of diabetic renal disease are vague. Early signs of kidney failure are: weight gain and ankle swelling, and using the bathroom at night. Lack of sleep, upset stomach, weakness, anemia, muscle cramps, poor appetite, and difficulty concentrating are all late symptoms of kidney disease. Prevention should include yearly examinations by your doctor, evaluating blood pressure and keeping blood glucose in a healthy range. Keeping blood glucose in-check is particularly important as increased levels can lead to urinary track and kidney bacterial infections.
Diabetic Renal Disease – Lowering Blood Pressure
Blood pressure is also highly related to the on-set of kidney disease, as are genetics. Blood pressure has a significant effect on the progression of the disease and should be seriously addressed. Losing weight, eating a low-sodium diet, avoiding alcohol and tobacco, and exercising are all useful in lowering blood pressure. Drugs may also be needed for treating blood pressure with ACE inhibitors being the preferred choice for people with diabetes. Some doctors recommend a low-protein diet for macroalbuminuria as it can decrease protein loss in urine. This should be decided in conjunction with your doctor. Never start a low-protein diet without consulting your doctor. In the event of ESRD a renal diabetes diet should be followed working closely with your nephrologist and diabetes team.
