Content-length: 16508 Content-Type: text/html; charset=UTF-8 JDF Educational Publication #15 - Diabetes and Kidney Disease

Juvenile Diabetes Foundation International
Educational Publications

Diabetes and Kidney Disease

Diabetes is one of the most common causes of kidney (renal) failure. The kidneys are the body's natural filtering and waste removal system. With every heartbeat, blood passes through a complex system of delicate filters within the kidneys. When these twin organs are damaged and are unable to do their job, kidney failure is the result.

Anyone with diabetes--whether Type I or Type II--is at high risk for developing kidney disease. For people with Type I diabetes, there is a 40 percent chance of renal problems twenty years after onset. Although current advances in diabetes control are diminishing that risk, kidney disease (or diabetic nephropathy) remains an extremely serious problem. Diabetic patients, as well as their physicians, should be aware of the signs of kidney damage, and should include a plan for kidney are within their overall diabetes program.

Diabetic Nephropathy

The filtering process in the kidney occurs in millions of tiny structures called glomeruli, which are made up of capillaries. As the blood flows through these capillaries, waste substances not needed by the body are filtered out into the urine and passed on to the bladder. Valuable proteins and glucose are retained.

Diabetes causes a change in the kidneys. It is now believed that, as a result of diabetes, the kidneys may start to overwork, possibly attempting to filter out excess sugar. Eventually the small blood vessels in the kidney become damaged. Scar-like material builds up on the capillary walls (called basement membranes) where most of the filtering process takes place.

This scarring and thickening of the basement membranes interferes with the filtering process. Wastes are not eliminated and can build up, while other valuable substances "leak" out into the urine. Kidney damage becomes renal failure when the kidneys almost completely stop cleaning wastes out of the blood. At this time, unless the disease is treated, wastes build up to poisonous levels and can cause death.

Treatments to Prevent Kidney Failure

Preventing kidney failure should be a goal of every person with diabetes. Because renal disease has so far proven to be irreversible in its later stages, medical researchers and physicians focus their attention on prevention in the earliest stages of the disease. When diabetic kidney disease is diagnosed, the measure outlined below have proven beneficial in some patients--slowing the progression to end stage renal disease.

Controlling Blood Sugar
Research has shown that kidney destruction is directly tied to the abnormal metabolic environment caused by high blood sugar. Keeping blood sugar levels as close to normal as possible may therefore slow or impede the destructive process--a compelling reason to make tight control a priority. Also, tight glycemic control helps control high blood pressure (hypertension).

Controlling High Blood Pressure (Hypertension)
Kidney scarring causes hypertension, and hypertension in turn speeds up the rate of kidney damage by weakening the blood vessels of the glomeruli (the kidney's filtering system). With a better understanding of this cycle, physicians now take a more aggressive position on controlling hypertension. From the first sign of kidney disease the following measures are prescribed:

Control Blood Sugar Control: Often this step alone greatly reduces hypertension.
Weight Loss: Obesity raises blood pressure. Maintaining ideal body weight is important for all diabetes control.
Exercise: Regular exercise has many beneficial effects on overall cardiac fitness, and helps to keep blood pressure down. An exercise program should, of course, be undertaken only after consultation with your doctor.
Low-Salt Diet: Salt makes your body retain water and raises blood pressure.
Hypertensive Medication: Many medications that lower high blood pressure are available.

Controlling Urinary Tract Infections
The direct connection between the urinary tract and the kidneys means germs are easily spread. Prompt treatment of any urinary tract infection is a must.

Symptoms of urinary tract infection are: pain or burning during urination, frequently feeling the need to urinate, cloudy urine, blood in urine, fever or lower back pain.

Controlling Diet

Low Protein Diet: Low protein diets have been suggested as treatment for people with chronic renal failure. Recent research supports the theory that high protein diets may speed up renal destruction.
Some studies have shown that low protein diets may reduce or even prevent glomerular damage and slow progressive renal failure. Physicians will assess the correct amount of protein for a person's body weight.
Low Phosphorus Diet: Many people with kidney disease suffer from secondary hyperparathyroiditis, a condition in which the body produces an excessive amount of the parathyroid hormone-causing inflammation and kidney damage. Restricting dietary phosphorus under the advice of a physician can prevent this condition.

Treatment Options for Failed Kidneys

There are two main classes of treatment for kidney failure--dialysis (using a substitute to cleanse the blood) and transplantation. Both treatment options usually relieve symptoms and extend life.

Dialysis
This is the most common treatment for kidney failure. There are three types of dialysis, each with its advantages and disadvantages.

Hemodialysis: the oldest and still the most widely used form, hemodialysis is a method in which a person is connected to a blood filtering machine (an "artificial kidney"). Blood drawn from the patient's arm is pumped through the machine's filtering system which removes wastes such as urea and returns the cleansed blood to the body. This treatment is required three times each week.
Hemodialysis is extremely effective. The disadvantage is that it is slow, taking four to five hours per session. Hemodialysis is done either in a treatment center or at home, with the help of a technician or trained family member. Even though home dialysis is more convenient (and less costly), it is generally recommended that people with diabetes use a treatment center, so that other related medical problems can be more closely monitored.

Peritoneal Dialysis: The peritoneum is a thin tissue that lines the inside of the abdomen. In peritoneal dialysis, a special solution (dialysate) is run through a tube into the peritoneum. As the peritoneum circulates blood, the dialysate draws out the accumulated wastes. After several hours, the fluid has absorbed the wastes, and is drained out. Peritoneal dialysis is done in a hospital.

Since dialysate contains sugar, people who were not insulin-dependent before dialysis, may need to take insulin with this treatment.
Chronic Ambulatory Peritoneal Dialysis (CAPD): This option enables people to do peritoneal dialysis at home or practically anywhere, as long as the place is clean. It requires pouring the dialysate fluid through a tube into the abdomen and leaving it in the abdomen for several hours. During this time, normal activities are continued.
CAPD gives people the freedom to manage their own dialysis. The danger of CAPD is that germs can enter the peritoneum through the tube and cause infection. However, new technologies are lowering the risk.

Transplantation
For some patients, surgery and a kidney transplant may be less intrusive than on-going dialysis. A kidney transplant, when successful, can mean a chance to live a more normal life.

The Right Donor: Finding a suitable donor present obvious difficulties. Most kidneys come from healthy people who died in accidents. The other source is a close relative who agrees to donate one kidney (people can survive with only one kidney). Either way, finding a close "match" in blood and tissue type is essential for successful "acceptance" of the new organ into the patient's body.
The Transplant: During the operation, a healthy kidney is placed into the patient's abdomen, and connected to blood vessels and a ureter into the bladder. Usually, the transplanted kidney immediately starts cleansing wastes and making urine.
Success Rates: The chances are 75 to 80 percent that the transplant will be successful and keep working for five to fifteen years.
Recurrence of Kidney Disease: For people with diabetes, the same process that damaged their original kidneys may damage the transplanted kidney; however, this can take many years, and good blood sugar control can slow the process of kidney destruction.
Other Risks: In order to reduce the risk of organ rejection, transplant recipients must take medications that suppress the immune system. When the immune system is suppressed, the body is less able to fight off other kinds of infections.

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