Vi Outlook And Future Perspectives
Tight metabolic and antihypertensive controls remain cornerstone interventions in the treatment of micro- and macrovascular complications in type 1 and type 2 diabetes. However, vascular diabetic complications, including diabetic nephropathy, remain a huge clinical problem despite implementation of overall intensified glycemic and antihypertensive control in these patients. Accordingly, there is an ongoing need for development of new therapeutic strategies in the treatment of kidney disease, which may imply that combined intervention is required toward various pathways of importance in the development of diabetic nephropathy.
What Increases My Chances Of Developing Diabetic Kidney Disease
Having diabetes for a longer time increases the chances that you will have kidney damage. If you have diabetes, you are more likely to develop kidney disease if your
- blood glucose is too high
- blood pressure is too high
African Americans, American Indians, and Hispanics/Latinos develop diabetes, kidney disease, and kidney failure at a higher rate than Caucasians.
You are also more likely to develop kidney disease if you have diabetes and
- have heart disease
- have a family history of kidney failure
How Do I Know If I Have Kidney Damage
Most people with early kidney damage do not have symptoms. The best way to find early kidney damage is to have a urine test once a year. This test checks for very small amounts of protein in the urine called albuminuria. It helps show kidney damage at an early stage in people with diabetes. Not everyone with kidney disease gets kidney failure. With the right treatment, you can prevent kidney disease from getting worse.
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What Are The Complications
The main complication of diabetic kidney disease is developing chronic kidney disease. Chronic kidney disease can progress even further to kidney failure. People with kidney failure need treatment with dialysis or a kidney transplant.
All people with diabetes are at risk of high blood pressure and cardiovascular disease . Having kidney disease also increases the risk of these problems. So having both diabetes and kidney disease means your risk is even higher.
Having diabetic kidney disease can also make other diabetes complications worse.
Glucose Control Influences Glomerular Filtration Rate And Its Prediction In Diabetic Subjects
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What Are The Kidneys
The kidneys are bean-shaped organs that are located near the middle of the back, just below the rib cage with one on each side of the spine.
Other key functions of the kidneys include the secretion of three important hormones:
- Erythropoietin which is released in response to hypoxia to stimulate the production of red blood cells in the bone marrow.
- Calcitriol the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body
- Renin an enzyme involved in the regulation of blood pressure
Age Distribution For Diabetic Nephropathy
Diabetic nephropathy rarely develops before 10 years duration of type 1 DM. The peak incidence is usually found in persons who have had diabetes for 10-20 years. The mean age of patients who reach end-stage kidney disease is about 60 years. Although in general, the incidence of diabetic kidney disease is higher among elderly persons who have had type 2 diabetes for a longer generation, the role of age in the development of diabetic kidney disease is unclear. In Pima Indians with type 2 diabetes, the onset of diabetes at a younger age was associated with a higher risk of progression to end-stage kidney disease.
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Diabetes And Renal Failure: Everything You Need To Know
Unfortunately, renal failure or nephropathy and unmanaged diabetes go hand in hand. In addition, 50 percent of people with diabetes will experience some form of kidney damage in their lifetime, even if they never experience kidney failure or end up on dialysis.
In this article, we will look at how renal failure and insufficiency can have an impact on people with diabetes, and how people with diabetes can avoid renal failure and dialysis. We will look at risk factors, causes, and symptoms, as we explore the relationship between renal failure, diabetes, and high blood glucose.
We will also look at what happens to a person with diabetes when their kidneys fail. We will discuss dialysis and kidney transplantation.
First, lets see what Lydia had to say when she contacted TheDiabetesCouncil.
What Is Diabetic Kidney Disease
Diabetes is the leading cause of kidney disease. About 1 out of 3 adults with diabetes has kidney disease.1
When your kidneys are damaged, they cant filter blood like they should, which can cause wastes to build up in your body. Kidney damage can also cause other health problems.
Kidney damage caused by diabetes usually occurs slowly, over many years. You can take steps to protect your kidneys and to prevent or delay kidney damage.
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Prevention & Treatment Of Kidney Disease
Kidney disease is closely linked to high blood sugar, high blood pressure and smoking. The best way to prevent or delay kidney damage is to:
- keep your blood sugar and blood pressure at target
- avoid smoking
- take your medications as prescribed
- have your blood cholesterol checked annually and keep it at target
- follow a healthy meal plan
- exercise regularly
- talk to your doctor about getting screened
If you’ve already been diagnosed with kidney damage or kidney disease, you;may need to limit certain foods to prevent waste products building up in your body. Your health-care team may suggest you limit protein foods or foods high in potassium, phosphate or sodium.; Controlling your blood pressure is also very important. You should see a registered dietitian for diet advice that is right for you.;
In advanced or “end-stage” kidney disease, dialysis may be needed to do the job of the kidneys.
A Advanced Glycation Endproducts
1. The AGE system
When glucose and other reactive carbonyl compounds react nonenzymatically with proteins, lipids, or nucleic acids, Schiff bases and Amadori products are formed. Additional rearrangement and modification leads to the generation of diverse AGEs, such as carboxymethyl lysine , pentosidine, imidazolone, and pyrraline . AGEs interact with specific receptors . p60 , p90 , galectin-3 , the macrophage scavenger receptor type II , and CD36 regulate the uptake and clearance of AGEs . The best-characterized receptor is receptor for AGEs . Another molecule with AGE-binding and anti-AGE properties is the antimicrobial protein lysozyme . AGEs can also act in a receptor-independent way by cross-linking proteins . AGEs alter the structure and function of intra- and extracellular molecules, increase oxidative stress, and modulate cell activation, signal transduction, and the expression of cytokines and growth factors through receptor-dependent and receptor-independent pathways .
2. Expression of AGEs in the normal kidney
3. In vitro evidence for AGEs effects on renal cells
4. Experimental evidence for a role of AGEs in diabetic kidney disease
5. Clinical evidence for a role of AGEs in diabetic kidney disease
6. Agents with effects on AGEs in diabetic kidney disease
a. Glycated albumin antagonists
b. Inhibitors of AGE formation
c. AGE-receptor blockers
d. AGE-cross-link breakers
e. Aldose reductase inhibitors
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Diabetes Is The Leading Cause Of Chronic Kidney Disease
According to the Centers for Disease Control, over 17 million Americans have diabetes. Unfortunately, one-third does not realize they have the disease. Diabetes is the number one cause of chronic kidney disease . In 1999, almost 44% of patients who needed dialysis had diabetes as the underlying cause for their kidney disease. The numbers continue to rise today.
How diabetes damages the kidneys
Diabetes is a disease that affects the bodys ability to produce or use insulin. When the body turns the food eaten into energy , insulin is used to move this sugar into the cells. If someone produces little or no insulin, or if the body cannot use the insulin , the sugar remains in the bloodstream instead of going into the cells. Over time, high levels of sugar in the blood damage tiny blood vessels throughout the body including the filters of the kidneys. As more damage occurs to the kidneys, more fluid and waste remain in the bloodstream instead of being removed.
Symptoms of diabetes
The American Diabetes Association lists the symptoms of diabetes as:
- Frequent urination
- Blurry vision
Lack of an early diagnosis compounds the problem
Type 1 diabetes is typically diagnosed early because its symptoms are severe and rapid. A treatment plan can then be put in place and continued. Unfortunately, Type 2 diabetes often goes undiagnosed for many years because early symptoms are not severe.
Obesity is on the rise
High blood pressure can accompany Type 2 diabetes
Testing For Kidney Disease
Signs of kidney disease are not always noticed by those who have them. Routine screening for people at risk for kidney disease is important because early detection and treatment of kidney disease may slow its progression to kidney failure.
It is important for people with diabetes to have annual testing for kidney disease. This involves:
1. Urine testing to detect very small amounts of albumin. Albumin is a type of protein. Having a small amount of albumin in the urine is called microalbuminuria. This is a sign that the kidney’s filtering units have been damaged. This test is especially important if you are at increased risk for CKD because of diabetes, high blood pressure or a family history of these conditions.
2. GFR is the best measure of kidney function. GFR estimates your kidney’s filtering ability using the result of a simple blood test for a waste product called creatinine, and other factors like age, gender, and race. GFR is used to determine the stage of kidney disease, and treatment is based on the stage of kidney disease.
If you have diabetes, ask your health care professional to evaluate you for CKD. For more information, contact the National Kidney Foundation at 800.622.9010 or visit www.kidney.org
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Diabetic Disease In Arteries And Arterioles
Diabetes also causes scarring in the walls of arteries and arterioles in the kidneys and other tissues. Arterioles are the smallest arteries that connect to capillaries. Arteries and arterioles bring blood carrying oxygen to the tissues of the body. Sclerosis is scarring in the blood vessel wall that causes thickening of the wall and narrowing of the opening through which blood flows. Diabetes causes scarring of arteries and arterioles. When this happens, not enough oxygen reaches the tissue and injury results. This can injure many tissues. The heart, eyes, skin, nerves and kidneys can be affected.
Control Your Blood Pressure
Blood pressure is the force of your blood against the wall of your blood vessels. High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease.
Your health care team will also work with you to help you set and reach your blood pressure goal. The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask your health care team what your goal should be.
Medicines that lower blood pressure can also help slow kidney damage. Two types of blood pressure medicines, ACE inhibitors and ARBs, play a special role in protecting your kidneys. Each has been found to slow kidney damage in people with diabetes who have high blood pressure and DKD. The names of these medicines end in pril or sartan. ACE inhibitors and ARBs are not safe for women who are pregnant.
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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.
Diabetes And The Kidneys
The kidneys filter waste products from the body and pass them out in the urine. This gets rid of toxins in the body and regulates its water balance.
If blood glucose levels have been persistently high over many years, the filters in the kidney may become leaky and no longer able to filter waste products as efficiently from the body.
When the small blood vessels in the kidney are damaged by high blood glucose this is known as diabetic nephropathy. Other factors contributing to the damage are high blood pressure and smoking.
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The Basics About Kidney Disease
Based on the description of what happens to your kidneys, you might expect it to be obvious when your kidneys start to malfunction. But this actually isnt the case! Renal insufficiency, or early kidney disease, often has no symptoms. Its good to be aware of this because even if you dont feel any different, damage is being done.
Because you cant physically feel the difference right off the bat, its important for diabetics to be tested for kidney disease. This is done with blood tests to evaluate kidney filtration rate and urine tests that check for protein.
The earlier you detect any signs of kidney disease, the better because then you can treat it and slow the progression of the damage. You can slow your kidney disease down by keeping your blood sugar and blood pressure in your target range. Some ways to do this include the following:
- Losing weight if you need to
- Getting regular exercise
- Not smoking
B Growth Hormone And Insulin
1. The GH/IGF system
2. Expression of GH/IGFs in the normal kidney
The GH/IGF system is expressed in the normal kidney, i.e., GHR and GHBP, IGF-I and IGF-II, the respective IGF-IR and IGF-II/man-6-PR, and all six specific IGFBPs . All three GHR isoforms have been discovered in human kidney . In rat kidney, GHR mRNA was detected most abundantly in the proximal tubule, less in the medullary thick ascending limb, and not at all in the glomerulus , whereas IGF-IR mRNA was concentrated in the medullary thick ascending limb, the distal nephron and collecting duct, and in the glomerulus, with the lowest levels in the proximal tubules . IGF-I staining was confined to a few collecting ducts . The renal glomerulus is a site of both action and synthesis of IGF-I. Mouse glomerular mesangial cells synthesize and release IGF-I , and specific IGF-I receptors are present in cultured glomerular endothelial, epithelial, and mesangial cells , suggesting an autocrine and paracrine action of IGF-I in the kidney.
3. In vitro evidence for GH/IGF effects on renal cells
4. Experimental evidence for a role of GH/IGFs in diabetic kidney disease
5. Clinical evidence for a role of GH/IGFs in diabetic kidney disease
6. Agents with effects on the GH/IGF system in diabetic kidney disease
a. Long-acting somatostatin analogs
b. GHR antagonists
c. IGF-I receptor antagonists
e. AGE inhibition
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How Diabetes Can Damage Kidneys
Diabetes is the leading cause of CKD: Approximately 1 in 3 people who have diabetes also have kidney disease, according to the Centers for Disease Control and Prevention . People with diabetes often have elevated levels of sugar in the blood, which can cause damage to many tissues in the body over time, including in the kidneys.
The working units of the kidneys, called nephrons, contain networks of tiny blood vessels that filter waste products from the blood.
When sugar is high in the blood, the sugars can bind to different proteins in the nephrons and change the structure of those proteins, says Staci Leisman, MD, a nephrologist and associate professor of medicine and medical education at Icahn School of Medicine at Mount Sinai in New York City. This can make the nephrons less effective at filtering and lead to protein in your urine a key sign of CKD.
Lowering blood sugar levels, which is the number one goal of diabetes management and treatment, can help prevent or slow kidney damage.
What Happens To The Kidneys In Diabetes
The main function of the kidneys is to filter waste products and excess water from the bloodstream so that they can be excreted in the form of urine. This is carried out by a system of tubes and blood vessels known as nephrons. Inside the nephrons are tiny blood vessels called capillaries and tiny urine-collecting tubes. One of the major structures in the nephron is a group of blood vessels known as the glomerulus, which acts as a filter.
Having high blood glucose levels can interfere with the function of the glomerulus. The filtering function of the kidneys doesnt work properly and proteins start to leak from the blood into the urine.
High blood glucose levels can also cause scarring of the glomerulus . As the scarring gets worse, the kidneys stop being able to filter waste products from the blood.
When enough glomeruli have been damaged, kidney failure results.
People who have diabetic nephropathy also often have high blood pressure. High blood pressure can further contribute to kidney damage.
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