Diabetic Kidney Disease
- Part 2 -

Prof JC Sanasam *

Kidney :: Pix - wikipedia.org

Occurrence and Progression of Diabetic Kidney Disease

When blood glucose (sugar) level rises in patients with diabetes it can cause a rise in the level of certain chemicals within the kidney. Such chemicals have tendency to make the glomeruli (the filter units in kidney) more ‘leaky’ which then allows albumin (a protein in the blood) to leak into the urine. Added to that, the raised blood glucose level may also cause all proteins in the glomeruli to link together. These cross-linked proteins can trigger a localized scarring process.

This scarring process in the glomeruli is medically called glomerulo-necrosis. This glomerulonecrosis, of course, does not occur in each and every diabetic patient and it usually takes several years to develop. As the condition continues to worsen, scarred tissue (glomerulonecrosis) gradually replaces the healthy kidney tissue. As a result, the kidneys become less and less able to do their job of filtering the blood to separate the toxic chemicals. This gradual ‘failing’ of the kidneys may gradually progress to what is known as end-stage kidney failure.

Microalbuminuria (albumin in urine in scarcely perceptible amount) is the first sign that diabetic kidney disease has developed. Over months or years, micro-albuminuria may go away (especially if treated), or persist at about the same level, or progress to proteinuria (frank presence of gross amount of leaked protein in the urine).

Once proteinuria has developed it is irreversible. If you have developed proteinuria it usually marks the beginning of a gradual decline in kidney function towards end-stage kidney failure at sometime in future.

Incidence of Diabetic Kidney Disease

The most common cause of kidney failure is diabetic kidney disease. Around one in five people needing dialysis (a wash-out treatment for kidney failure) is a person with diabetic kidney disease.

For people with Type 2 diabetes (the commoner type of diabetes which usually has its onset in adult age), at the time the diabetes is first diagnosed, about 12 in 100 people have microalbuminuria and 2 in 100 have proteinuria. This is not because diabetic kidney disease happens straight away in some cases but because many people with Type 2 diabetes do not have their diabetes diagnosed for quite some time after the disease had begun. Of those people who do not have any kidney problem when their diabetes is diagnosed, microalbuminuria develops in about 15 in 100 people, and proteinuria in 5 in 100 people, within five years.

Diagnosis and Assessment of Diabetic Kidney Disease

Diabetic kidney disease is diagnosed when the level of albumin in urine is raised and there is no other obvious cause for this. Urine tests are part of the routine checks that are offered to people with diabetes from time to time. Urine tests can detect presence of albumin in it, and measure how much is present in the urine.

A blood test can also show how well the kidneys are working. The blood test measures a chemical called creatinine which is a breakdown product of muscle. This is normally cleared from the blood by the kidneys. If your kidneys are not working properly, the level of creatinine in the blood goes up. An estimate of how well your kidneys are working can be made by taking into account the blood level of creatinine, your age and your sex. This estimate of kidney function is called the estimated glomerular filtration rate.

Risk Factors of Diabetic Kidney Disease

All people with diabetes have a risk of developing diabetic kidney disease. However, a large research trial showed that there are certain factors that increase the risk of developing this condition. These are:

o A poor control of your blood sugar levels.
o The length of time you have had diabetes.
o The more overweight you become.
o Having high blood pressure. The higher your blood pressure, the greater your risk.
o If you are male.
o Smoking

This means that having a good control of your blood glucose level, keeping your weight in check and treating high blood pressure will reduce your risk of developing diabetic kidney disease.

Possible Complications of Diabetic Kidney Disease

o End-stage kidney failure
o Cardiovascular disease such as heart disease, stroke and peripheral vascular (arterial and venous) disease
o High blood pressure

Treatment for Diabetic Kidney Disease

Treatment should aim to:
o Prevent or delay the disease progressing to kidney failure.
o Reduce the risk of developing cardiovascular diseases -heart stroke

Your physician would like to give some medications which would reduce your blood pressure related to kidney disorders. Good control of your blood glucose and blood pressure is a must. Avoidance of nephrotoxic drugs (drugs damaging kidney tissue) is essential. Many of the anti-inflammatory and pain-killer medicines are nephrotoxic.

A drug to lower your cholesterol level is also commonly advised to lower the risk of developing heart disease and/or heart stroke or attack.

Proper tackling of your life-style also will be required: stop smoking, eat a healthy diet, keep your weight and waist in check, take regular physical activity, cut back alcohol.

Concluded...