Interactions Between Kidney Disease And Diabetes: Dangerous Liaisons
Abstract Background Type 2 diabetes mellitus (DM) globally affects 18–20 % of adults over the age of 65 years. Diabetic kidney disease (DKD) is one of the most frequent and dangerous complications of DM2, affecting about one-third of the patients with DM2. In addition to the pancreas, adipocytes, liver, and intestines, the kidneys also play an important role in glycemic control, particularly due to renal contribution to gluconeogenesis and tubular reabsorption of glucose. In this review article, based on a report of discussions from an interdisciplinary group of experts in the areas of endocrinology, diabetology and nephrology, we detail the relationship between diabetes and kidney disease, addressing the care in the diagnosis, the difficulties in achieving glycemic control and possible treatments that can be applied according to the different degrees of impairment. Glucose homeostasis is extremely altered in patients with DKD, who are exposed to a high risk of both hyperglycemia and hypoglycemia. Both high and low glycemic levels are associated with increased morbidity and shortened survival in this group of patients. Factors that are associated with an increased risk of hypoglycemia in DKD patients include decreased renal gluconeogenesis, deranged metabolic pathways (including altered metabolism of medications) and decreased insulin clearance. On the other hand, decrease glucose filtration and excretion, and inflammation-induce insulin resistance are predisposing factors to hyperglycemic episodes. Appropriate glycaemic monitoring and control tailored for diabetic patients is required to avoid hypoglycaemia and other glycaemic disarrays in patients with DM2 and kidney disease. Understanding the renal physiology and pathophysiology of DKD has become essential to all s Continue reading >>
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What Is Diabetic Nephropathy?
Diabetic nephropathy -- kidney disease that results from diabetes -- is the number one cause of kidney failure. Almost a third of people with diabetes develop diabetic nephropathy. People with diabetes and kidney disease do worse overall than people with kidney disease alone. This is because people with diabetes tend to have other long-standing medical conditions, like high blood pressure, high cholesterol, and blood vessel disease (atherosclerosis). People with diabetes also are more likely to have other kidney-related problems, such as bladder infections and nerve damage to the bladder. Kidney disease in type 1 diabetes is slightly different than in type 2 diabetes. In type 1 diabetes, kidney disease rarely begins in the first 10 years after diagnosis of diabetes. In type 2 diabetes, some patients already have kidney disease by the time they are diagnosed with diabetes. There are often no symptoms with early diabetic nephropathy. As the kidney function worsens, symptoms may include: Swelling of the hands, feet, and face Trouble sleeping or concentrating Poor appetite 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 As kidney damage progresses, your kidneys cannot remove the waste from your blood. The waste then builds up in your body and can reach poisonous levels, a condition known as uremia. People with uremia are often confused and occasionally become comatose. Certain blood tests that look for specific blood chemistry can be used to diagnose kidney damage. It also can be detected early by finding protein in the urine. Treatments are available that can help slow progression to kidney failure. That's why you should Continue reading >>
Diabetes - A Major Risk Factor For Kidney Disease
Diabetes mellitus, usually called diabetes, is a disease in which your body does not make enough insulin or cannot use normal amounts of insulin properly. Insulin is a hormone that regulates the amount of sugar in your blood. A high blood sugar level can cause problems in many parts of your body. The most common ones are Type 1 and Type 2. Type 1 diabetes usually occurs in children. It is also called juvenile onset diabetes mellitus or insulin-dependent diabetes mellitus. In this type, your pancreas does not make enough insulin and you have to take insulin injections for the rest of your life. Type 2 diabetes, which is more common, usually occurs in people over 40 and is called adult onset diabetes mellitus. It is also called non insulin-dependent diabetes mellitus. In Type 2, your pancreas makes insulin, but your body does not use it properly. The high blood sugar level often can be controlled by following a diet and/or taking medication, although some patients must take insulin. Type 2 diabetes is particularly prevalent among African Americans, American Indians, Latin Americans and Asian Americans. With diabetes, the small blood vessels in the body are injured. When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine. Also, waste materials will build up in your blood. Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that h Continue reading >>
Diabetes And Renal Failure: Everything You Need To Know
Unfortunately, renal failure or nephropathy (commonly referred to as kidney failure) 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, let’s see what Lydia had to say when she contacted TheDiabetesCouncil. Lydia’s story Lydia had received a laboratory result from her doctor that was very alarming to her. She had an excess amount of protein in her urine, usually an early sign of kidney damage. He informed Lydia that her kidneys were being affected by her diabetes, and she needed to work on self-managing her diabetes. He ordered some more tests to further look at her kidneys. Was Lydia headed to the kidney dialysis center? Her friend Tracey, whom she’d met in a diabetes support group had been the first person she knew who was on dialysis. Tracey seemed to have a very difficult life in and out of the dialysis center. Lydia was afraid to end up like Tracey. Lydia knew that she hadn’t been efficiently self-managing her diabetes. Her A1C had been greater than 8 percent a few times over the last few years. While most of the time she kept it around 7.5 percent, she was aware that her doctor wanted her to get it below 7 percent, and keep it there in Continue reading >>
Diabetic Kidney Problems
If you have diabetes, your blood glucose, or blood sugar, levels are too high. Over time, this can damage your kidneys. Your kidneys clean your blood. If they are damaged, waste and fluids build up in your blood instead of leaving your body. Kidney damage from diabetes is called diabetic nephropathy. It 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. NIH: National Institute of Diabetes and Digestive and Kidney Diseases Continue reading >>
Diabetic Kidney Disease
Diabetic kidney disease is a complication that occurs in some people with diabetes. It can progress to kidney failure in some cases. Treatment aims to prevent or delay the progression of the disease. Also, it aims to reduce the risk of developing cardiovascular diseases such as heart attack and stroke which are much more common than average in people with this disease. To find out more about the kidneys and urine see also separate leaflet called The Kidneys and Urinary Tract. What is diabetic kidney disease? Diabetic kidney disease (diabetic nephropathy) is a complication that occurs in some people with diabetes. In this condition the filters of the kidneys, the glomeruli, become damaged. Because of this the kidneys 'leak' abnormal amounts of protein from the blood into the urine. The main protein that leaks out from the damaged kidneys is called albumin. In normal healthy kidneys only a tiny amount of albumin is found in the urine. A raised level of albumin in the urine is the typical first sign that the kidneys have become damaged by diabetes. Diabetic kidney disease is divided into two main categories, depending on how much albumin is lost through the kidneys: Microalbuminuria: in this condition, the amount of albumin that leaks into the urine is between 30 and 300 mg per day. It is sometimes called incipient nephropathy. Proteinuria: in this condition the amount of albumin that leaks into the urine is more than 300 mg per day. It is sometimes called macroalbuminuria or overt nephropathy. How does diabetic kidney disease develop and progress? A raised blood sugar (glucose) level that occurs in people with diabetes can cause a rise in the level of some chemicals within the kidney. These chemicals tend to make the glomeruli more 'leaky' which then allows albumin to lea Continue reading >>
Diabetic Nephropathy
Overview Diabetic nephropathy is a serious kidney-related complication of type 1 diabetes and type 2 diabetes. It is also called diabetic kidney disease. Up to 40 percent of people with diabetes eventually develop kidney disease. Diabetic nephropathy affects the ability of your kidneys to do their usual work of removing waste products and extra fluid from your body. The best way to prevent or delay diabetic nephropathy is by maintaining a healthy lifestyle and treating your diabetes and high blood pressure. Over many years, the condition slowly damages your kidneys' delicate filtering system. Early treatment may prevent or slow disease progression and reduce the chance of complications. Your kidney disease may progress to kidney failure, also called end-stage kidney disease. Kidney failure is a life-threatening condition. At this stage your treatment options are dialysis or a kidney transplant. Symptoms In the early stages of diabetic nephropathy, you may not notice any signs or symptoms. In later stages, the signs and symptoms include: Worsening blood pressure control Protein in the urine Swelling of feet, ankles, hands or eyes Increased need to urinate Less need for insulin or diabetes medicine Confusion or difficulty concentrating Loss of appetite Nausea and vomiting Persistent itching Fatigue When to see a doctor Make an appointment with your doctor if you have any signs or symptoms of kidney disease. If you have diabetes, visit your doctor yearly for a urine test that detects protein. This helps determine how well the kidneys are functioning. Causes Diabetic nephropathy results when diabetes damages blood vessels and other cells in your kidneys. How the kidneys work Your kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your Continue reading >>
When Diagnosed Early, Stopping Diabetic Kidney Disease May Be Possible
When Diagnosed Early, Stopping Diabetic Kidney Disease May Be Possible July 12, 2013 Dear Mayo Clinic: My father was recently diagnosed with diabetic kidney disease. Is there a chance this can be reversed, or will he have it for life? What changes, if any, should he be making to his diet? Answer: It is not uncommon for people who have diabetes to develop kidney problems. When diagnosed early, it may be possible to stop diabetic kidney disease and fix the damage. If the disease continues, however, the damage may not be reversible. Diabetic kidney disease, also called diabetic nephropathy, happens when diabetes damages blood vessels and other cells in the kidneys. This makes it hard for them to work as they should. In the early stages, diabetic kidney disease has no symptoms. That's why it is so important for people with diabetes to regularly have tests that check kidney function. In later stages of the disease, as kidney damage gets worse, signs and symptoms do appear. They may include ankle swelling, test findings that show protein in the urine, and high blood pressure. Over time, diabetic kidney disease can lead to end-stage kidney disease. If your father is in the early stages of diabetic kidney disease, there are several steps he can take to help protect his kidneys. First, it is critical to keep blood sugar as well controlled as possible. This not only helps the kidneys, but decreases the risk of other serious problems that can come from diabetes, such as blindness, heart attack and damage to the blood vessels and nerves. Keeping blood pressure under control also is important. High blood pressure can speed up the process of diabetic kidney disease and make kidney damage worse. In general, blood pressure of 140/90 in the doctor's office and 135/85 at home is a good g Continue reading >>
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Diabetes And Kidney Failure
One of the causes of kidney failure is diabetes mellitus, a condition characterised by high blood glucose (sugar) levels. Over time, the high levels of sugar in the blood damage the millions of tiny filtering units within each kidney. There is no cure, and treatment must become ever more aggressive as the kidneys deteriorate towards failure. Treatment options include medications, dialysis and kidney transplant. On this page: The main job of the kidneys is to remove waste from the blood and return the cleaned blood back to the body. Kidney failure means the kidneys are no longer able to remove waste and maintain the level of fluid and salts that the body needs. One cause of kidney failure is diabetes mellitus, a condition characterised by high blood glucose (sugar) levels. Over time, the high levels of sugar in the blood damage the millions of tiny filtering units within each kidney. This eventually leads to kidney failure. Around 20 to 30 per cent of people with diabetes develop kidney disease (diabetic nephropathy), although not all of these will progress to kidney failure. A person with diabetes is susceptible to nephropathy whether they use insulin or not. The risk is related to the length of time the person has diabetes. There is no cure for diabetic nephropathy, and treatment is lifelong. Another name for the condition is diabetic glomerulosclerosis. People with diabetes are also at risk of other kidney problems, including narrowing of the arteries to the kidneys, called renal artery stenosis or renovascular disease. Symptoms of kidney failure For people with diabetes, kidney problems are usually picked up during a check-up by their doctor. Occasionally, a person can have type 2 diabetes without knowing it. This means their unchecked high blood sugar levels may be Continue reading >>
Kidney Disease Of Diabetes
Kidney Disease of Diabetes Facts* *Kidney Disease of Diabetes Facts Medically Edited by: Melissa Conrad Stöppler, MD Type 2 Diabetes Diagnosis, Treatment, Medication Medical Author: Melissa Conrad Stoppler, MD Medical Editor: Ruchi Mathur, MD, FRCP(C) Proper nutrition is essential for anyone living with diabetes. Control of blood glucose levels is only one goal of a healthy eating plan for people with diabetes. A diet for those with diabetes should also help achieve and maintain a normal body weight as well as prevent heart and vascular disease, which are frequent complications of diabetes. There is no prescribed diet plan for those with diabetes. Rather, eating plans are tailored to fit an individual's needs, schedules, and eating habits. A diabetes diet plan must also be balanced with the intake of insulin and oral diabetes medications. In general, the principles of a healthy diabetes diet are the same for everyone. Consumption of a variety of foods including whole grains, fruits, non-fat dairy products, beans, and lean meats or vegetarian substitutes, poultry and fish is recommended to achieve a healthy diet. Each year in the United States, more than 100,000 people are diagnosed with kidney failure, a serious condition in which the kidneys fail to rid the body of wastes. Kidney failure is the final stage of chronic kidney disease (CKD). Diabetes is the most common cause of kidney failure, accounting for nearly 44 percent of new cases. Even when diabetes is controlled, the disease can lead to chronic kidney disease and kidney failure. Most people with diabetes do not develop chronic kidney disease that is severe enough to progress to kidney failure. Nearly 24 million people in the United States have diabetes, and nearly 200,000 people are living with kidney failure a Continue reading >>
The Link Between Diabetes & Kidney Disease
How can diabetes affect the kidneys? People with diabetes need to watch their glucose levels and blood pressure, as over time high blood glucose levels and blood pressure can damage the tiny blood vessels in the filters of the kidneys. At this early stage, this damage causes small amounts of protein to be passed in the urine which is known as microalbumin. In a later stage, so much protein can be lost from the blood that water moves into the body tissues and causes swelling. After a number of years, the kidney filters can fail completely. Wouldn't I know if I had kidney damage? Not necessarily - there is actually a high chance you wouldn't know at all. There are no warning signs for chronic kidney disease and you could lose up to 90 per cent of your kidney function before you felt unwell. How can I find out if my kidneys are affected? Chronic kidney disease is common in people who have diabetes. The only way to know if you are affected is to have a yearly kidney health check by your doctor or diabetes specialist. The doctor or specialist will order a blood and urine test and will also check your blood pressure to determine if you have any signs of kidney damage. Although there is no cure for chronic kidney disease, early detection and treatment is extremely important to slow or halt the progression of the disease. If chronic kidney disease is not detected and treated early, kidney function may continue to worsen, progressing to end stage kidney disease. In order to survive, people with end stage kidney disease may need to have dialysis or a kidney transplant. Kidney disease can also worsen other serious diabetes complications such as eye disease, nerve damage and cardiovascular disease. For further information about your risk of developing chronic kidney disease talk to Continue reading >>
Diabetic Kidney Disease
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. About 1 out of 4 adults with diabetes has kidney disease.1 The main job of the kidneys is to filter wastes and extra water out of your blood to make urine. Your kidneys also help control blood pressure and make hormones that your body needs to stay healthy. When your kidneys are damaged, they can’t 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. 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. How does diabetes cause kidney disease? High blood glucose, also called blood sugar, can damage the blood vessels in your kidneys. When the blood vessels are damaged, they don’t work as well. Many people with diabetes also develop high blood pressure, which can also damage your kidneys. Learn more about high blood pressure and kidney disease. 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 smoke don’t follow your di Continue reading >>
High Blood Pressure And Diabetic Kidney Disease
High Blood Pressure and Diabetic Kidney Disease High blood pressure (hypertension) is one of the principal causes of diabetic kidney disease and kidney failure. When blood pressure is high, there is a large amount of tension inside the blood vessels that leads to damage. These vessels may close off completely which can cause a heart attack, stroke, or kidney failure. High blood sugar and high cholesterol can also damage blood vessels. Thus people with diabetes who also have hypertension are at especially high risk for blood vessel damage. It usually takes years for blood vessels to completely close off and damage to blood vessels can be slowed down or reversed with treatment. Diagnosis of high blood pressure can only be done by having your blood pressure measured by a person trained in taking blood pressures. Usually, there are no symptoms that can tell you that you have high blood pressure. In diabetic patients the blood pressure is considered high if it is greater than 130/80. Your blood pressureshould be measured on multiple occasions as blood pressures vary normally throughout the day and it is normal to have occasional high pressures. Blood pressure should be taken after you have rested for 5 minutes and may be taken sitting or standing. Your healthcare providers may ask you to check your blood pressure at home and record the readings as part of your blood pressure management. There are multiple ways to control your blood pressure. The first step is lifestyle changes. Most patients will also need one or several medications to achieve good blood pressure control. Your diet and lifestyle can directly affect blood pressure. For example, too much salt, alcohol, or caffeine intake leads to your body increase your blood pressure. Your weight also affects your blood pres Continue reading >>
Kidney Disease And Diabetes
One of the more common long-term complications of diabetes is kidney damage. Also known as diabetic nephropathy or diabetic kidney disease (DKD), this condition is a result of vascular abnormalities that accompany diabetes and increases mortality risk. Furthermore, diabetes mellitus is a main risk factor forend-stage renal disease (ESRD), the most advanced stage of kidney disease. Kidney disease means the kidneys cant filter blood and make urine like they should. Chronic kidney disease occurs slowly over many years and usually cannot be reversed. Early kidney disease, sometimes called renal insufficiency, may have no signs or symptoms You may not feel any different until the disease is advanced but the damage is still being done. Blood tests to check kidney filtration rate and urine tests to check for protein in your urine are the only ways to find out if you have kidney disease at this stage. Its important to be tested for kidney disease if you have diabetes so it can be detected early and treated to slow progression of the damage. Keeping your blood sugar and blood pressure under control in your target range is very important to slow kidney disease. Losing weight, getting regular exercise and not smoking are great ways to help control blood sugar and blood pressure. Kidney failure, or End-stage renal disease (ESRD) Kidney failure means damage to the kidneys has progressed to the point that they are not doing a good job of filtering wastes such as urea and creatinine from the blood so it can be excreted in the urine. The waste buildup can make you sick and you may have these symptoms: swelling of the ankles, face or belly, vomiting, loss of appetite, fatigue, weakness, confusion and headaches. Treatments for kidney failure may include: hemodialysis, peritoneal dialysi Continue reading >>
Diabetes Is The Leading Cause Of Chronic Kidney Disease
Diabetes Is the Leading Cause of Chronic Kidney Disease 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 (CKD) . 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. Diabetes is a disease that affects the bodys ability to produce or use insulin. When the body turns the food eaten into energy (also called sugar or glucose ), 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 (insulin resistant), 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. The American Diabetes Association lists the symptoms of diabetes as: Lack of an early diagnosis compounds the problem Type 1 diabetes (also known as juvenile diabetes or insulin-dependent 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. It is estimated that by the time someone is diagnosed with Type 2 diabetes, the disease has been present for four to seven years. Since diabetes may have been present for some time, the chances for kidney damage increase. Type 2 diabetes (also known as adult Continue reading >>
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