What Are The Symptoms Of Diabetic Kidney Disease
You are unlikely to have symptoms with early diabetic kidney disease – for example, if you just have microalbuminuria . Symptoms tend to develop when the kidney disease progresses. The symptoms at first tend to be vague and nonspecific, such as feeling tired, having less energy than usual and just not feeling well. With more severe kidney disease, symptoms that may develop include:
- Difficulty thinking clearly.
- Needing to pass urine more often than usual.
- Being pale due to anaemia.
- Feeling sick .
As the kidney function declines, various other problems may develop – for example, anaemia and an imbalance of calcium, phosphate and other chemicals in the bloodstream. These can cause various symptoms, such as tiredness due to anaemia, and bone ‘thinning’ or fractures due to calcium and phosphate imbalance. End-stage kidney failure is eventually fatal unless treated.
Good Control Of Your Blood Glucose Level
Good control of your blood sugar level will help to delay the progression of the kidney disease and to reduce your risk of developing associated cardiovascular diseases, such as heart disease and stroke. Ideally, the aim is to maintain your HbA1c to less than 48 mmol/mol but this may not always be possible to achieve and the target level of HbA1c should be agreed on an individual basis between you and your doctor.
What Increases The Risk Of Developing 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:
- A poor control of your blood sugar levels.
- The length of time you have had diabetes.
- The more overweight you become.
- Having high blood pressure. The higher your blood pressure, the greater your risk.
- If you are male.
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.
If you have early diabetic kidney disease , the risk that the disease will become worse is increased with:
- The poorer the control of blood sugar levels. The greater your HbA1c level, the greater your risk.
- Having high blood pressure. The higher your blood pressure, the greater your risk.
- Smoking.
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Show Your Body Some Love
Whats the good news in all of this? You can manage or prevent CKD, diabetes, and heart disease all at once!
Look at these five tips to get started:
For People With Type 2 Diabetes
At the time the diabetes is first diagnosed, about 1 in 8 people have microalbuminuria and 1 in 50 have proteinuria. This is not because diabetic kidney disease happens straightaway 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 1 in 7 people and proteinuria in 1 in 20 people, within five years.
Diabetic kidney disease is much more common in Asian and black people with diabetes than in white people.
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Longer Life With A Kidney Transplant Than Without One
It should be noted that the average life expectancy of someone on dialysis is only five years. Research has tended to favor a transplant over long term kidney dialysis. Transplant patients generally live longer than dialysis patients.
You will go through a major surgery, with a long recovery period. There is a possibility of transplant rejection. However, after the organ transplant, you may have more energy, fewer diet restrictions, and an overall better quality of life. Patients have fewer complications to report.
If you obtain your kidney for transplant from a living donor, you can expect to live anywhere from 12 to 20 years. If your kidney came from a donor who is deceased, then you can expect to be around for the next 8 to 12 years. If you can manage to have a kidney transplant before you end up on dialysis, then you could live 10-15 years longer than someone on dialysis.
Its possible that you may have to be on dialysis for a time while waiting on an organ for transplant. They will need to locate a good match for you whether it is from a deceased donor or from a living donor. This is due to being on dialysis for a long time can shorten the life of a new kidney after the transplant. Still, a transplant is preferred in most cases over dialysis.
For more information and frequently asked questions on pre-emptive transplantation, go to:
Antihyperglycemic Medication Selection And Dosing In Ckd
Many antihyperglycemic medications need to have their dose adjusted in the presence of low renal function, and some are contraindicated in people with significant disease. See Figure 1 in Pharmacologic Glycemic Management of Type 2 Diabetes in Adults chapter, p. S88 and Appendix 7. Therapeutic Considerations for Renal Impairment.
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Diabetes Control In Patients With Established Ckd
Intensive management of diabetes, including concurrent control of glucose, lipids and blood pressure as well as diet and lifestyle modifications, can slow the progression of established DKD,,. Indeed, some data suggest such approaches can even reverse early glomerulopathy. For example, pancreatic transplantation, which restores normal glucose levels in patients with type 1 diabetes, is able to ameliorate the renal histological changes associated with diabetes. However, it takes at least 10 years to observe any regression, and metabolic control with standard therapy can seldom achieve that observed following pancreatic transplantation. Even with intensive management in the robust setting of clinical trials detailed below, many patients with diabetes still experience a progressive decline in renal function. This finding has led to the suggestion that, at best, current therapy simply delays the inevitable. Nonetheless, in the clinical setting, any delay in CKD has potentially profound effects on patient health.
Box : Clinical Criteria For The Diagnosis Of Ckd
One ore more of the following criteria must be present for more than 3 months and validated by repeat testing before a clinical diagnosis of chronic kidney disease can be made:
-
Estimated glomerular filtration rate of < 60 ml/min/1.73 m2
-
Urinary albumin/creatinine ratio of 30 mg g1
-
Urinary albumin excretion rate of 30 mg per day
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Treating Kidney Disease Safely The Sick
Several classes of medications used commonly in people with diabetes can reduce kidney function during periods of intercurrent illness, and should be discontinued when a person is unwell, in particular, when they develop significant intravascular volume contraction due to reduced oral intake or excessive losses due to vomiting or diarrhea. Diuretics can exacerbate intravascular volume contraction during periods of intercurrent illness. Blockers of the RAAS interfere with the kidney’s response to intravascular volume contraction, namely the ability of angiotensin II to contract the efferent arteriole to support glomerular filtration during these periods. Non-steroidal anti-inflammatories cause constriction of the afferent arterioles, which can further reduce blood flow into the glomerulus, especially in people who are volume contracted. For these reasons, all of these drugs can reduce kidney function during times of intercurrent illness. Consideration should be given to providing people with a sick-day medication list, instructing the patient to hold these medications if they feel that they are becoming dehydrated for any reason. A number of additional medications need to be dose-adjusted in people with renal dysfunction, and their usage and dosage should be re-evaluated during periods where kidney function changes .
Stages Of Kidney Failure
The five stages of chronic kidney disease are mainly based upon the Glomerular Filtration Rate, or GFR. The first stage is essentially no kidney damage, and the second stage is minimal damage. The following graph shows a detailed description of the five stages of chronic kidney disease:
| Stage of CKD | ||
| Less than 15 or on dialysis | End Stage Renal Disease or renal failure | Choices of dialysis or transplant, or both. |
Gestational diabetes and renal failure
Pregnancy puts a great strain on the body, and kidney disease for pregnant women with gestational diabetes can and does occur. Proteinuria in late pregnancy presents a problem. Women with diabetes prior to becoming pregnant who have intact renal function seem to have little problem. In other words, going into the pregnancy, they have no pre-existing kidney damage.
Those with diabetes prior to pregnancy who go into the pregnancy with already impaired renal function do not fare as well. They are at risk for decline of renal function during pregnancy that causes permanent damage. Preeclampsia with increased blood pressures further compensates the kidneys of the diabetic mother.
What is End Stage Renal Disease?
When a person enters stage 5 of renal disease, they have what is termed as End Stage Renal Disease or ESRD. The kidneys are severely damaged at this point. There is then a choice of dialysis or kidney transplant, or both.
What happens when you enter ESRD? Is there treatment?
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How Do Kidneys Work
On a hot summer day, when we drink a lot of water to keep ourselves hydrated, we feel the urge to go to the washroom, again and again. It is our kidneys that regulate the process. They are responsible for 4 major functions of a human body:
- Regulating the fluid levels,
- Monitoring the amount of waste removed or to be removed from the body,
- Keeping a track record of the passage of vitamins and minerals.
- Formulating the hormonal discretions and balancing in the body.
The primary function is to dispose of the waste products from the body. Eight liters of the total blood in the body pass through the kidneys between 20-25 times a day, which implies that kidneys filter 180 liters of blood in 24 hours. This is why kidneys need to function properly all day long.
The Burden Of Kidney Failure
Each year in the United States, more than 100,000 people are diagnosed with kidney failure, a serious condition in which the kidneys fail to rid the body of wastes. Kidney failure is the final stage of chronic kidney disease .
Diabetes is the most common cause of kidney failure, accounting for nearly 44 percent of new cases. Even when diabetes is controlled, the disease can lead to chronic kidney disease and kidney failure. Most people with diabetes do not develop chronic kidney disease that is severe enough to progress to kidney failure. Nearly 24 million people in the United States have diabetes, and nearly 200,000 people are living with kidney failure as a result of diabetes.
People with kidney failure undergo either dialysis, an artificial blood-cleaning process, or transplantation to receive a healthy kidney from a donor. Most U.S. citizens who develop kidney failure are eligible for federally funded care. In 2009, care for patients with kidney failure cost the United States nearly $42 billion.
People with diabetes should be screened regularly for kidney disease. The two key markers for kidney disease are eGFR and urine albumin.
Kidney disease is present when eGFR is less than 60 milliliters per minute.
The American Diabetes Association and the National Institutes of Health recommend that eGFR be calculated from serum creatinine at least once a year in all people with diabetes.
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Stages Of Kidney Disease
Early treatment can help slow down the progression of kidney disease. There are five stages of kidney disease. Stage 1 is the mildest stage and kidney functionality can be restored with treatment. Stage 5 is the most severe form of kidney failure. At stage 5, the kidney is no longer functional, and you will need to have dialysis or a kidney transplant.
Your glomerular filtration rate can be used to help your doctor determine the stage of your kidney disease. Knowing your stage is important because that will affect your treatment plan. To calculate your GFR, your doctor will use the results from a creatinine blood test along with your age, gender, and physique.
| Stage |
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Reach Your Blood Glucose Goals
Your health care professional will test your A1C. The A1C is a blood test that shows your average blood glucose level over the past 3 months. This is different from the blood glucose checks that you may do yourself. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months.
The A1C goal for many people with diabetes is below 7 percent. Ask your health care team what your goal should be. Reaching your goal numbers will help you protect your kidneys.
To reach your A1C goal, your health care professional may ask you to check your blood glucose levels. Work with your health care team to use the results to guide decisions about food, physical activity, and medicines. Ask your health care team how often you should check your blood glucose level.
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How Diabetes Causes Kidney Disease
Each kidney is made up of millions of tiny filters called nephrons. Over time, high blood sugar from diabetes can damage blood vessels in the kidneys as well as nephrons so they dont work as well as they should. Many people with diabetes also develop high blood pressure, which can damage kidneys too.
CKD takes a long time to develop and usually doesnt have any signs or symptoms in the early stages. You wont know you have CKD unless your doctor checks you for it.
Live Vs Deceased Donor
A live donor is preferred in all cases because of improved kidney graft functioning, among other things. It is definitely the preferred method for pre-emptive dialysis as mentioned above. Still, no matter how long a person has had to be on dialysis, they are better off with a transplant organ from a live donor.
Further reading:
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How Common Is Diabetic Kidney Disease
Although diabetic kidney disease is more common in people with type 1 diabetes, there are more people with type 2 diabetes and diabetic kidney disease. This is because type 2 diabetes is much more common than type 1 diabetes.
Diabetic kidney disease is actually the most common cause of kidney failure. Around one in five people needing dialysis have diabetic kidney disease.
Note: most people with diabetes do not need dialysis.
The Importance Of Control To Avoid Complications And Development Of Chronic Kidney Problem
Diabetes can be a lifelong condition that requires patients to develop new habits and abandon old ones. The good news is that diabetes can be controlled with a little bit of discipline. By managing your diabetes, you can continue enjoying life and potentially avoid complications like kidney disease, which can develop in patients with diabetes.
If diabetes is uncontrolled, the consequences can be serious. About 30% of patients with type 1 diabetes will develop kidney disease.1 The number increases to 40% in patients with type 2 diabetes.1 But the proper lifestyle, diet, and probiotics can help you keep your diabetes in check and help maintain proper kidney function.
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Recommendations For Nephropathy Screening In Diabetes
Patients with diabetes should be screened on an annual basis for nephropathy. In individuals with type 1 diabetes, screening for nephropathy should start 5 years after diagnosis of diabetes since the onset of diabetes itself is usually known. It typically takes about 5 years for microvascular complications to develop. In patients with type 2 diabetes, screening should begin at initial diagnosis since the exact onset of diabetes is often unknown .
Diabetic nephropathy can be detected by the measurement of urine albumin or serum creatinine, and both tests should be performed at minimum annually those with abnormal levels should have repeat tests done sooner. The first stage of nephropathy is usually the onset of elevated urine albumin which predicts the development of CKD and a gradual decline in glomerular filtration rate . Some individuals with CKD, however, do not develop elevated urine albumin initially. It is therefore important that individuals have both blood and urine screening tests performed. Using both modalities allows for identification of more cases of nephropathy than using either test alone.