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Guide to Diabetes

Diabetic Nephropathy / Kidney problems 

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If diabetes is not controlled properly or you have poor diabetic control it can lead to complications with other parts of your body. Diabetes can affect the blood circulation throughout the body. Chronic Kidney Disease (CKD)
 

 





 Did you know that an Asian person with Diabetes is Ten (10x) times more likely to get kidney failure than a white person? (www.kidneyresearch.org.uk)


In understanding how diabetes can affect the kidneys, we will look at how the kidneys work. The kidneys act as sieves to get rid of the body’s waste products from the blood in your body. They filter the blood to make urine which allows the body to get rid of excess water, waste products and salt. They also help control blood pressure.
Kidney problems can arise if the blood vessels that supply the kidneys are damaged.
 

How can diabetes affect the kidney?


Diabetic Nephropathy is damage to both kidneys caused by diabetes. It can occur in patient whose diabetes is treated with diet, tablets or insulin. It does not usually occur until a person has had diabetes for about 10 years, but since some people can have had diabetes for a long time without knowing, it can appear much sooner after diagnosis. About one in four (1/4) people with diabetes will get diabetic nephropathy. Some people are more likely to be affected than others. 
It tends to run in families, especially in those with a family history of high blood pressure.
 

How is it detected? 


Diabetic Nephropathy is detected with urine tests carried out in diabetic clinics. The tests are used to identify protein in the urine. Sometimes blood tests are done to show that the kidneys are not working as they should. Although this could be due to diabetic nephropathy, it can also mean that the kidneys a have been damaged by something else eg. Infection, kidney stones.
Without treatment diabetic nephropathy tends to get worse but the rate at which it does so varies from person to person. First the kidneys leak more protein into the urine which may cause swelling oedema, initially of the ankles. As this happens the blood pressure rises. As high blood pressure itself can damage the kidneys, it also increases the risk of other diabetic complications e.g. Diabetic Retinopathy (eye disease), stroke and heart attack.

 

Treatment 


Kidney problems can be treated successfully in many cases it is available at all stages of diabetic nephropathy, but in general the earlier it is started the more effective it is. 

 

Early diabetic nephropathy (microalbuminuria) 


People with Type 1 Diabetes Insulin dependant diabetes, are treated with tablets called ACE inhibitors reduces the amount of protein leaking into the urine and as least slows down the rate at which the kidneys fail. 


General treatment for diabetic nephropathy


  • Treatment of high blood pressure
  • Control of diabetes 
  • Correct other factors which increase the risk of a heart attack ie cholesterol, high blood pressure
  • correct other risk factors for heart attack and stroke and gangrene.


Treating high blood pressure


  • If you are over weight, try to lose some. 
  • Reduce your salt intake
  • Don’t drink too much alcohol
  • Stop smoking
  • Take regular physical exercise

Control of diabetes

 

Remember that improving diabetic control will probably help prevent further kidney damage. It will also help prevent other diabetic complications e.g. blindness from diabetic eye damage and damage to the nerves which can lead to foot ulcers. Good blood glucose control is very important in preventing narrowing of large arteries (blood vessels), which cause heart attacks, strokes and gangrene of the legs. The Diabetes Team will help you improve control.
People with diabetes are at risk of narrowing of large blood vessels. Besides good control of blood pressure and diabetes, it is important to stop smoking if you smoke and to have the blood fat cholesterol level checked regularly. 
 

Detect and treat any other diabetic complications

 

People who have diabetic nephropathy often have some diabetic eye damage (Retinopathy) and damage to the nerves (Neuropathy) as well.  It is very important that you are seen regularly in the clinics.
 

What happens when the kidneys become so damaged?


Eventually the kidneys may become so damaged that they are unable to do their job properly. This is called renal failure. The diabetic treatment often has to be changed. Metformin tablets must not be given to people with renal failure, so different treatment may be prescribed. 

There is a build up of waste products in the blood which causes:

  • Feeling unwell with nausea (feeling sick) and itching.

  • Tiredness due to anaemia

  • Breathlessness.- As more fluid builds up it can get into the lungs.

  • Bone pain may occur as calcium is lost from the bones.

  • People often notice that their diabetic control changes, sometimes becoming easier to manage, but often with more frequent hypoglycaemia (low blood sugars).The diabetic treatment often has to be changed. Metformin tablets must not be given to people with renal failure, so different treatment may be prescribed.

  •  The dose of other tablets or insulin may need to be reduced.

  •  The kidneys can be severely damaged by this disease and people with diabetic nephropathy may eventually need dialysis or a kidney transplant.


Ref: Diabetic Nephropathy by Dr Sue Carr and Dr Robert Gregory

 USEFUL LINKS

 

  • EastMidlandsRenalNetwork www.emrn.org.uk
     

  • Kidney Research UK www.kidneyresearchuk.org
     

  • The Kidney Organisation www.kidney.org.uk
     

  • The British Kidney Patient Association- www.britishkidney-pa.co.uk
     

  • British Renal Association www.britishrenal.org
     

  • Transplantation Informationwww.uktransplant.org.uk