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Diabetes Type 2
Kidney Disease |
Deterioration of kidney function is one of the many unhappy consequences of diabetes. Excellent dietary control and exercise should prevent most of the suffering and expense involved in kidney failure. The deterioration in the kidneys of diabetics takes place in and around the glomeruli, the blood-filtering units. Early in the disease, the filtering efficiency diminishes, and proteins in the blood are lost to the urine. Later, the kidneys lose their ability to remove waste products, such as creatinine and urea, from the blood. Symptoms related to kidney failure occur when kidney function has diminished to less than 25 percent of normal capacity. online auto insurance quote
Five Stages
There are five stages in the progression of diabetic kidney disease:
Stage I. The flow of blood through the kidneys - hyperfiltration - and the kidneys are larger than normal.
Stage II. The rate of filtration remains elevated or at near-normal levels, but the glomeruli begin to show damage. Small amounts of a blood protein known as albumin leak into the urine-- microalbuminuria. As the rate of albumin loss increases from 20 to 200 micrograms per minute, microalbuminuria becomes constant (normal losses of albumin are less than 5 micrograms per minute.) People with NIDDM and IDDM may remain in stage II for many years, especially if they have normal blood pressure and good control of their blood sugar levels.
Stage III. Macroalbuminuria -the loss of albumin and other proteins in the urine exceeds 200 micrograms per minute; now detected urine "dipstick methods." Some patients develop high blood pressure. The glomeruli suffer increased damage. The kidneys progressively lose the ability to filter waste, and blood levels of creatinine and urea-nitrogen rise.
Stage IV. Advanced l nephropathy ; the glomerular filtration rate decreases to less than 75 milliliters per minute, large amounts of protein pass into the urine, and high blood pressure almost always occurs. Levels of creatinine and urea-nitrogen in the blood rise further.
Stage V. The final stage is ESRD. The glomerular filtration rate drops to less than 10 milliliters per minute. Symptoms of kidney failure occur.
These stages describe the progression of kidney disease for most people with IDDM who develop ESRD. For people with IDDM, the average length of time required to progress from onset of kidney disease to stage IV is 17 years. The average length of time to progress to ESRD is 23 years. Progression to ESRD may occur more rapidly (5-10 years) in people with untreated high blood pressure. If proteinuria does not develop within 25 years, the risk of developing advanced kidney disease begins to decrease. Advancement to stages IV and V occurs less frequently in people with NIDDM than in people with IDDM. Nevertheless, about 60 percent of people with diabetes who develop ESRD have NIDDM.
Effects of High Blood Pressure
High blood pressure, or hypertension, is a major factor in the development of kidney problems in people with diabetes. Both a family history of hypertension and the presence of hypertension appear to increase chances of developing kidney disease. Hypertension accelerates the progress of kidney disease. Hypertension is a cause of kidney disease and a result of kidney disease - a dangerous spiral, involving rising blood pressure and progressive kidney damage.
Hypertension = Blood pressure exceeding 140 millimeters of mercury-systolic and 90 millimeters of mercury-diastolic.
Preventing and Slowing Kidney Disease
Blood Pressure Medicines
One class of drugs, angiotensin-converting enzyme (ACE) inhibitors (e.g.captopril) are effective in preventing progression to stages IV and V.1 ACE inhibitors have slowed deterioration even in diabetic patients who did not have high blood pressure.
Some, but not all, calcium channel blockers may be able to decrease proteinuria and damage to kidney tissue. Researchers are investigating whether combinations of calcium channel blockers and ACE inhibitors might be more effective than either treatment used alone. Patients with even mild hypertension or persistent microalbuminuria should consult a physician about the use of antihypertensive medicines.
Low-Protein Diets
A diet containing reduced amounts of protein may benefit people with kidney disease of diabetes. In people with diabetes, excessive consumption of protein may be harmful. Experts recommend that most patients with stage III or stage IV nephropathy consume moderate amounts of protein.
Intensive Management
Antihypertensive drugs and low-protein diets can slow kidney disease when significant nephropathy is present, as in stages III and IV. A third treatment, known as intensive management or glycemic control, has shown great promise for people with IDDM, especially for those with early stages of nephropathy. Intensive management is a treatment regimen that aims to keep blood glucose levels close to normal. The regimen includes frequently testing blood sugar, administering insulin on the basis of food intake and exercise, following a diet and exercise plan, and frequently consulting a health care team.
Good Care Makes a Difference
Have your doctor measure your glycohemoglobin regularly. The HbA1c test averages your level of blood sugar for the previous 1-3 months.
Have your blood pressure checked several times a year. If blood pressure is high ask your doctor about the benefits of ACE inhibitor.
Have your urine checked yearly for microalbumin and protein. If there is protein in your urine, have your blood checked for elevated amounts of waste products such as creatinine.
Reduce the amount of protein in your diet.
End-stage renal disease (ESRD)
According to the US National Kidney and Urologic Diseases Information Clearinghouse, each year in the United States, more than 50,000 people are diagnosed with end-stage renal disease (ESRD), a serious condition in which the kidneys fail to rid the body of wastes. ESRD is the final stage of a slow deterioration of the kidneys, a process known as nephropathy.
ESRD patients undergo either dialysis, which substitutes for some of the filtering functions of the kidneys, or transplantation to receive a healthy donor kidney. Most U.S. citizens who develop ESRD are eligible for federally funded care. In 1994, the Federal Government spent about $9.3 billion on care for patients with ESRD. High blood pressure and high levels of blood sugar increase the risk that a person with diabetes will progress to ESRD.
Alpha Nutrition Health Education Series List of Publications This discussion of diabetes is continued in the Book of Diabetes. You can order an eBook or printed text version separately or as part of a Nutritional Rescue Starter Pack Order Diabetes Rescue Starter Pack Now