Affecting up to 40% of type 1 and type 2 people with diabetes, diabetic nephropathy is one of the major causes of kidney disease among those beginning renal replacement therapy (such as dialysis).  It is a complication caused by high levels of glucose needing to be constantly filtered out by the kidneys which damages the organs over time. Proper kidney function screenings with your doctor are a must. Know the screening process and what questions to ask your doctor about keeping your kidneys healthy.
What do the kidneys do? These two bean-shaped, fist sized organs (situated just below the rib cage on each side of your spine) have the critical job of filtering your blood to remove waste and excess fluid. On a daily basis, your kidneys will filter out waste from 120 to 150 quarts of blood which leaves your body through the bladder as 1 to 2 quarts of urine. The kidneys help give stability to the composition of your blood. In addition to filtering your blood your kidneys help to:
- Keep your pH balance
- Regulate blood pressure
- Keep bones strong by making an active form of vitamin D and
- Assist in the creation of red blood cells by releasing a hormone called erythropoietin.
The kidneys are composed of about a million tiny sieves called nephrons. The nephrons contain a filter, the glomerulus, which allows fluid and waste to go through, but stops blood cells and large molecules (like proteins) from passing through. The filtered fluid then goes through the tubule, which removes waste through the urinary tract and returns needed minerals to the bloodstream.
How are the kidneys affected by diabetes? When your blood glucose levels are consistently high, your kidneys have to work more to filter the blood. This extra work load causes the filters in your kidney to start to leak. The larger molecules, like protein, that should be reabsorbed into the bloodstream are now able to pass through the kidney and are lost in the urine. Low levels of protein in the urine, microalbuminuria, is one of the first signs of diabetic nephropathy and is used as a point of diagnosis. Other symptoms include high blood pressure, swelling of the legs and ankles, more frequent urination at night, high levels of blood urea nitrogen and serum creatinine and a decreased need for insulin or other antidiabetic medications.
As kidney disease progresses, higher levels of protein are found in the urine (microalbuminuria). The kidneys can lose their filtering capabilities and waste products then build up to dangerous levels in the blood stream. A person in this situation may need to go on dialysis or consider a kidney transplant.
What should you be asking your doctor? Speak to your doctor about when you should been screening for diabetic nephropathy. The criteria will depend on what type of diabetes you have and when you were diagnosed with diabetes. If you have type 1 diabetes you should be tested five years after diagnosis. Those with type 2 diabetes should begin monitoring right away. For children, screenings should begin after age 10 and after the child has had had diabetes for 5 years. A simple dipstick test can pick up trace amounts of protein in the urine. Yearly blood work should also check for creatinine levels, which can indicate how well your kidneys are functioning.
What are your prevention and treatment options? A key plan for preventing diabetic nephropathy is to maintain your blood glucose levels as best you can. Dario can help you to better manage your diabetes by logging your readings automatically into charts and graphs to review with your doctor. Maintaining your blood pressure is also vital to helping keep your kidneys healthy. Your healthcare team may recommend ACE inhibitors as part of a treatment plan or may suggest limiting the amount of protein in your diet.
Not everyone with diabetes develops diabetic nephropathy. But awareness of the symptoms and disease progression are key so that you can make better healthcare decisions with about your long-term diabetes management goals.
*The information provided here is for informational purposes only and does not constitute medical advice. If you would like more information on these topics, please consult with your healthcare provider.