DIABETES & KIDNEY DISEASE

Kidney disease is characterized by a deterioration that takes place around the glomeruli which are the blood-filtering units of the kidney.  Doctors measure the presence and extent of early kidney disease by measuring the protein in your urine.  The kidneys lose their ability to remove waste products, such as creatinine and urea from the blood, later in the disease.

Symptoms of kidney failure usually occur only in the later stages of the disease when the kidney function has diminished to less than 25 percent of normal capacity.  Before that occurs kidney disease can be a silent disease.
 

STAGES OF KIDNEY FAILURE

Scientists have described five stages that lead to end-stage renal disease:

Stage 1 - the flow of blood through the kidneys increases and the kidneys are larger than normal.  This is called hyperfiltration.  Some people remain in stage 1 indefinitely.

Stage 2 - The rate of filtration remains elevated or at near normal levels and the glomeruli begin to show damage.  Albumin (small amounts of blood protein) leak into the urine.  Some people can remain in Stage 2 for many years, especially if they have good control of their diabetes and a normal blood pressure.

Stage 3 - This stage is referred to as "dipstick positive proteinuria).  Some patients develop high
blood pressure.  The glomeruli suffer more damage while the kidneys progressively lose the ability to filter waste.  The level of creatinine and urea-nitrogen rise in the blood.  People can remain at this stage for many years.

Stage 4 - This is known as "advanced clinical nephropathy.  Large amounts of protein pass through the urine.  High blood pressure almost always occurs.  Levels of creatinine and urea-nitrogen rise in the blood.

Stage 5 - This is the final stage of end-stage renal disease.   Symptoms of kidney failure occur.
 

HYPERTENSION (HIGH BLOOD PRESSURE

High blood pressure can be a cause, as well as a result of kidney disease.  As kidney disease progresses, changes in the kidneys lead to increased blood pressure.  Early detection and treatment of even a mild high blood pressure reading is essential forpeople with diabetes.
 
 

TREATMENT

A low-protein diet may benefit diabetics who have kidney disease.

Excessive consumption of protein can be harmful for people with diabetes.

Keeping the blood glucose levels as close to normal as possible is also a treatment for kidney disease.  An intensive treatment regimen includes frequent blood glucose testing, insulin injections, a diet and exercise plan, and seeing a doctor frequently.
 
 

DIALYSIS AND TRANSPLANTATION

BACKGROUND

Diabetes is the most common cause of end stage renal disease.  Kidney damage can occur even when drugs and diet are able to control the diabetes.  Most people with diabetes don't develop nephropathy.  There are about 15 million people in the U.S. with diabetes and about 50,000 people have end-stage renal disease as a result of diabetes.

End-stage renal disease patients undergo either dialysis, which substitutes of some of the kidney's
filtering functions, or a kidney transplant to receive a healthy donor kidney.  Most U.S. citizens who develop end-stage renal disease are eligible for federally funded care.  About $9.3 billion was spent by the Federal Government on patients with end-stage renal
disease in 1994.

African Americans and Native Americans develop diabetes, nephropathy and end-stage renal disease at rates higher than average.