Diabetes and Kidney

Kidneys are remarkable organs. Inside are millions of tiny blood vessels that act as filters, and they job is to remove waste products from the blood.

10-21% people with diabetes have nephropathy. Approximately, 43% new cases of ESRD (end stare renal disease) are attributed to diabetes.

Why diabetes can cause kidney disease?

When our body digests the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells are too big to pass through the holes of the filter and hence, stay in the blood.

Diabetes can damage this system. High levels of blood sugar force the kidneys to filter too much blood. All this extra work is hard on the filters. After many years, they start to leak. Useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria. When kidney disease is diagnosed early (during microalbuminuria), there are several treatments which may keep disease from getting worse. Having larger amounts is called macroalbuminuria. If kidney disease is diagnosed later (during macroalbuminuria), it is known as end-stage renal disease or ESRD, which is a very serious stage. A person with ESRD needs to have a kidney transplant or get the blood filtered by a machine (dialysis). Not everyone with diabetes develop kidney disease. Factors that can influence kidney disease development include genetics, blood sugar control and blood pressure.

The better a person keeps diabetes and blood pressure under control, the lower the chance of getting kidney disease. Important treatments for kidney disease are tight control of blood glucose and blood pressure. Blood pressure has a dramatic effect on the rate at which the disease progresses. Even a mild rise in blood pressure can worsen the kidney disease.

Four ways of controlling Blood pressure are:-

• Losing weight,
• Eating less salt,
• Avoiding alcohol and tobacco and
• Regular exercise.

Low-protein diet needs to start when ESRD is confirmed. When these methods fail, certain medicines may be able to lower blood pressure. ACE inhibitors are generally recommended for most people with diabetes, high blood pressure and kidney disease. Once kidneys fail, dialysis is necessary. The person must choose whether to continue with dialysis or to get a kidney transplant.