Diabetic Kidney Disease
Diabetes causes blood glucose, or blood sugar, levels to rise too high. Over time, this can damage the kidneys. The kidneys clean blood. If they are damaged, waste and fluids build up in the blood instead of leaving the body. Kidney damage caused by diabetes is called diabetic nephropathy.
Nephropathy begins long before you have symptoms. People with diabetes should get regular screenings for kidney disease. Tests include a urine test to detect protein in your urine and a blood test to show how well your kidneys are working.
If the damage continues, your kidneys could fail. In fact, diabetes is the most common cause of kidney failure in the United States. People with kidney failure need either dialysis or a kidney transplant.
You can slow down kidney damage or keep it from getting worse. Controlling your blood sugar and blood pressure, taking your medicines and not eating too much protein can help.
Diabetic Kidney Disease Symptoms
There are often no symptoms with early diabetic nephropathy. As the kidney function worsens, symptoms may include:
- Nausea
- Weakness
- Itching (end-stage kidney disease) and extremely dry skin
- Drowsiness (end-stage kidney disease)
- Abnormalities in the hearts’ regular rhythm, because of increased potassium in the blood
- Muscle twitching
- Swelling of the hands, feet, and face
- Trouble sleeping or concentrating
- Poor appetite
As kidney damage progresses, the kidneys cannot remove the waste from the blood. The waste then builds up in the body and can reach poisonous levels, a condition known as uremia. People with uremia are often confused and occasionally become comatose.
Diabetic Kidney Disease Risk factors
The risk of diabetic nephropathy is greater if you have type 1 or type 2 diabetes. Several other factors may increase your risk of diabetic nephropathy, including:
- High blood sugar (hyperglycemia) that’s not well-controlled
- High blood pressure (hypertension) that’s not controlled
- Being a smoker
- High blood cholesterol
- A family history of diabetes and kidney disease
Diabetic Kidney Disease Risk Reduction
A person with diabetes can reduce their risk of diabetic nephropathy, or at least delay its onset, in a number of ways including:
- Strictly controlling blood sugar levels
- Making sure that blood pressure is well controlled
- Avoiding non-steroidal anti-inflammatory drugs (NSAIDs)
- Treating urinary tract infections promptly with antibiotics
- Drinking plenty of non-alcoholic fluids, preferably water
- Avoiding medical treatments that stress the kidneys, such as x-rays requiring the injection of contrast dyes
- Having regular tests to ensure the health of your kidneys.
Diabetic Kidney Disease Complications
Complications of diabetic kidney disease may develop gradually over months or years. They may include:
- Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema)
- A rise in potassium levels in your blood (hyperkalemia)
- Heart and blood vessel disease (cardiovascular disease), possibly leading to stroke
- Damage to the blood vessels of the retina (diabetic retinopathy)
- Anemia
- Foot sores, erectile dysfunction, diarrhea and other problems related to damaged nerves and blood vessels
- Pregnancy complications that carry risks for the mother and the developing fetus
- Irreversible damage to your kidneys (end-stage kidney disease), eventually need either dialysis or a kidney transplant for survival.
Diabetic Kidney Disease Diagnosis
Diabetic nephropathy is diagnosed using a number of tests including:
Urine tests – to check protein levels. An abnormally high level of protein in the urine is one of the first signs of diabetic nephropathy.
Blood pressure – regular checks for raised blood pressure are necessary. Elevated blood pressure is caused by diabetic nephropathy and also contributes to its progression.
Blood tests – to check the degree of kidney function.
Biopsy – a small tag of tissue is removed from the kidney, via a slender needle, and examined in a laboratory. This is usually only performed when there is doubt about whether kidney damage is due to diabetes or to another cause.
Kidney ultrasound – enables the size of the kidneys to be imaged and allows the arteries to the kidneys to be checked for narrowing that can cause decreased kidney function.
Diabetic Kidney Disease Prevention
To reduce your risk of developing diabetic kidney disease:
- Treat your diabetes. With effective treatment of diabetes, you may prevent or delay diabetic kidney disease.
- Manage high blood pressure or other medical conditions. If you have high blood pressure or other conditions that increase your risk of kidney disease, work with your doctor to control them. Ask your doctor about tests to look for signs of kidney damage.
- Follow instructions on over-the-counter medications. When using nonprescription pain relievers such as aspirin and ibuprofen (Advil, Motrin IB, others), follow the instructions on the package. For people with diabetic kidney disease, taking these types of pain relievers can lead to kidney damage.
- Maintain a healthy weight. If you’re at a healthy weight, work to maintain it by being physically active most days of the week. If you need to lose weight, talk with your doctor about weight-loss strategies, such as increasing daily physical activity and reducing calories.
- Don’t smoke. Cigarette smoking can damage your kidneys and make existing kidney damage worse. If you’re a smoker, talk to your doctor about strategies for quitting smoking. Support groups, counseling, and medications can all help you to stop.
Diabetic Kidney Disease Treatment
There is no cure for diabetic nephropathy. Treatment must become ever more aggressive as the kidneys deteriorate towards failure. Medical options include:
- Prevention – this is the best form of treatment and includes good control of blood glucose levels and blood pressure.
- Medications – including medications to reduce high blood pressure, particularly angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers to curb kidney damage.
- Dialysis – or artificial kidney treatment. End-stage kidney failure is the failure of the kidney to function at all. Dialysis involves either shunting the patient’s blood through a special machine (haemodialysis) that helps remove the wastes while preserving water and salts, or removing wastes through fluid introduced into the abdomen (peritoneal dialysis). Dialysis is required several times every week for the rest of the person’s life.
- Kidney transplant – a healthy donor kidney, obtained either from someone who has died or from a relative or friend, replaces the function of the diseased kidneys.
Diabetic Kidney Disease FAQs
What is diabetic kidney disease?
Diabetic kidney disease is a type of kidney disease caused by diabetes. Diabetes is the leading cause of kidney disease.
How Is Diabetic Nephropathy Treated?
There is no cure for diabetic nephropathy. Treatment must become ever more aggressive as the kidneys deteriorate towards failure. Medical options include:
- Prevention – this is the best form of treatment and includes good control of blood glucose levels and blood pressure.
- Medications – including medications to reduce high blood pressure, particularly angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers to curb kidney damage.
- Dialysis – or artificial kidney treatment. End-stage kidney failure is the failure of the kidney to function at all. Dialysis involves either shunting the patient’s blood through a special machine (haemodialysis) that helps remove the wastes while preserving water and salts, or removing wastes through fluid introduced into the abdomen (peritoneal dialysis). Dialysis is required several times every week for the rest of the person’s life.
- Kidney transplant – a healthy donor kidney, obtained either from someone who has died or from a relative or friend, replaces the function of the diseased kidneys.
How does diabetes cause damage to my kidneys?
Diabetes can harm the kidneys by causing damage to:
- Blood vessels inside your kidneys. The filtering units of the kidney are filled with tiny blood vessels. Over time, high sugar levels in the blood can cause these vessels to become narrow and clogged. Without enough blood, the kidneys become damaged and albumin (a type of protein) passes through these filters and ends up in the urine where it should not be.
- Nerves in your body. Diabetes can also cause damage to the nerves in your body. Nerves carry messages between your brain and all other parts of your body, including your bladder. They let your brain know when your bladder is full. But if the nerves of the bladder are damaged, you may not be able to feel when your bladder is full. The pressure from a full bladder can damage your kidneys.
- Urinary tract. If urine stays in your bladder for a long time, you may get a urinary tract infection. This is because of bacteria. Bacteria are tiny organisms like germs that can cause disease. They grow rapidly in urine with a high sugar level. Most often these infections affect the bladder, but they can sometimes spread to the kidneys.
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.
What are other names for diabetic kidney disease?
Diabetic kidney disease is also called DKD, chronic kidney disease, CKD, kidney disease of diabetes, or diabetic nephropathy.