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 >>
What Is Diabetic Nephropathy?
Diabetic nephropathy refers to kidney disease that occurs in people with diabetes. The kidneys help regulate the amount of fluids and salts in the body, which helps to control blood pressure and releases different types of hormones. Nephropathy is the term used when the kidneys start to incur damage, which can ultimately lead to kidney failure. In this article, we look at the link between diabetes and kidney failure. Contents of this article: What is diabetic nephropathy? Kidney problems are relatively common in people with diabetes. This is because diabetes affects the arteries in the body and the kidney filters blood from those arteries. It is estimated that around 40 percent of people who have type 2 diabetes develop nephropathy. People with either type 1 or type 2 diabetes can be affected by nephropathy. Diabetic nephropathy is a significant cause of long-term kidney disease and end-stage renal disease (ESRD), which is when the kidneys no longer work well enough to meet the needs of daily life. There are five stages of diabetic nephropathy, and ESRD is the last. Diabetic nephropathy is the most frequent cause of ESRD in the United States, with between 40 and 50 percent of all ESRD cases directly related to it. A person with ESRD will require dialysis. Causes Diabetic nephropathy is when the kidneys become leaky, allowing albumin (a protein made by the liver) to pass into the urine. The condition worsens as the level of albumin increases. Diabetic nephropathy develops slowly and is more common in people who have had diabetes for 20 years or more. Diabetic nephropathy is more likely to develop in people with diabetes who also have higher blood glucose levels. Doctors also believe that nephropathy is directly influenced by high blood pressure (hypertension), which may Continue reading >>
Stage 3 Of Chronic Kidney Disease
A person with stage 3 chronic kidney disease (CKD) has moderate kidney damage. This stage is broken up into two: a decrease in glomerular filtration rate (GFR) for Stage 3A is 45-59 mL/min and a decrease in GFR for Stage 3B is 30-44 mL/min. As kidney function declines waste products can build up in the blood causing a condition known as “uremia.” In stage 3 a person is more likely to develop complications of kidney disease such as high blood pressure, anemia (a shortage of red blood cells) and/or early bone disease. Symptoms of stage 3 CKD Symptoms may start to become present in stage 3: Fatigue Fluid retention, swelling (edema) of extremities and shortness of breath: Urination changes (foamy; dark orange, brown, tea-colored or red if it contains blood; and urinating more or less than normal) Kidney pain felt in their back Sleep problemsdue to muscle cramps or restless legs Seeing a doctor when you have stage 3 CKD As stage 3 progresses, a patient should see a nephrologist (a doctor who specializes in treating kidney disease). Nephrologists examine patients and perform lab tests so they can gather information about their condition to offer the best advice for treatment. The nephrologist’s goal is to help their patient keep their kidneys working as long as possible. Meeting a dietitian when you have stage 3 CKD Someone in stage 3 may also be referred to a dietitian. Because diet is such an important part of treatment, the dietitian will review a person’s lab work results and recommend a meal plan individualized for their needs. Eating a proper diet can help preserve kidney function and overall health. Diet and stage 3 CKD For stage 3 CKD, a healthy diet is likely to consist of: Eating high-quality protein foods to meet estimated daily protein goals Limiting potas Continue reading >>
The Stages In Diabetic Renal Disease. With Emphasis On The Stage Of Incipient Diabetic Nephropathy.
Abstract Alterations in renal function and structure are found even at the onset of diabetes mellitus. Studies performed over the last decade now allow definition of a series of stages in the development of renal changes in diabetes. Such a classification may be useful both in clinical work and in research activities. Stage 1 is characterized by early hyperfunction and hypertrophy. These changes are found at diagnosis, before insulin treatment. Increased urinary albumin excretion, aggravated during physical exercise, is also a characteristic finding. Changes are at least partly reversible by insulin treatment. Stage 2 develops silently over many years and is characterized by morphologic lesions without signs of clinical disease. However, kidney function tests and morphometry on biopsy specimens reveal changes. The function is characterized by increased GFR. During good diabetes control, albumin excretion is normal; however, physical exercise unmasks changes in albuminuria not demonstrable in the resting situation. During poor diabetes control albumin excretion goes up both at rest and during exercise. A number of patients continue in stage 2 throughout their lives. Stage 3, incipient diabetic nephropathy, is the forerunner of overt diabetic nephropathy. Its main manifestation is abnormally elevated urinary albumin excretion, as measured by radioimmunoassay. A level higher than the values found in normal subjects but lower than in clinical disease is the main characteristic of this stage, which appeared to be between 15 and 300 micrograms/min in the baseline situation. A slow, gradual increase over the years is a prominent feature in this very decisive phase of renal disease in diabetes when blood pressure is rising. The increased rate in albumin excretion is higher in p 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 >>
Diabetic Nephropathy (kidney Disease)
Diabetic nephropathy refers to diabetic kidney disease (nehpro=kidneys, pathy=disease). In 2011, diabetes caused nearly 44% of kidney failure cases. This makes diabetic kidney disease the Number One complication of diabetes; one that is likely to affect almost every diabetic to some extent. In nearly half the cases of kidney disease, it could lead to kidney failure as well. Diabetes and Kidney Damage The kidneys filter nearly 200 quarts of our blood every day. Diabetes is a disease of excess sugar in our blood. Read these two sentences together and the link between diabetes and kidneys becomes obvious! Every single day of our lives, the kidneys perform these functions: Remove waste from our body (in the form of urine) Retain whatever proteins, vitamins and other nutrients we can still use Balance the fluids in the body Help maintain proper blood pressure by managing potassium and calcium levels Keep bones healthy Help make red blood cells. Diabetes damages the kidneys and the urinary system in three main ways: Damage to blood vessels in the kidneys: Too much sugar damages the filters in the kidneys Damage to nerves: Fine nerves in the hands, feet, etc. are corroded by the extra sugar in the blood Damage to the urinary tract: Nerves run from our bladder to our brain and let us know when the bladder is full and we need to go. Damage to these nerves could mean we don’t react when our bladder is full. Result: extra pressure on the kidneys. Retained urine can also allow urinary tract infections to grow and migrate back to the kidneys. Diabetes damage to blood vessels inside kidneys: The filtering units of the kidneys are called glomeruli (sing. – glomerulus). They have tiny blood vessels that are easily clogged and damaged by excess sugar in our blood. Damage to these ve Continue reading >>
Five Stages Of Diabetic Nephropathy | Understand Diabetic Nephropathy
Diabetic Nephropathy is the most common chronic complication of diabetes. Some patients can lose their ability to work Diabetic nephropathy has been divided into five stages. Diabetic Nephropathy is the most common chronic complication of diabetes, and it can worsen your illness and lead to metabolic disorder. It can even cause kidney failure if the treatment is not prompt. In such cases, some patients can lose their ability to work while it proves fatal for some others. Diabetic nephropathy has been divided into five stages, each having different recommendations for treatment. Stage 1: Renal or kidney functions are changed in this stage. The kidney increases in size, and it is accompanied by high filtration and priming rate. Patients need to strictly control their glucose in this stage. Stage 2: The structure of kidney is changed for worse and patients pass protein in their urine after intense physical activity. They are required to rest as much as possible in this stage. Stage 3: This stage comes after patients have suffered from diabetes for 5 to 15 years. Around 30 to 40 percent of patients would have advanced condition of proteinuria at this stage and their renal functions begin to decline. Stage 4: This stage is known as Clinical Diabetic Nephropathy whose characteristic is large amount of proteinuria, more than 3.5 grams daily, along with Edema and high blood pressure. Patients in this stage suffer from severe form of edema and their condition is not sensitive to diuretics. Stage 5: It is called uremia and patients condition is critical. They need to undergo dialysis and kidney transplant to sustain their life. The patients are always worried about their condition in this stage of the disease. The decision to take dialysis or not is always facing them even thoug Continue reading >>
Diabetic Nephropathy Overview
Diabetic nephropathy is kidney disease that develops as a result of diabetes mellitus (DM). According to the American Diabetes Association, diabetes affects approximately 9.3 percent of the U.S. population (29.1 million people as of 2012). This disease damages many organs, including the eyes, nerves, blood vessels, heart, and kidneys. Diabetes is the most common cause of kidney failure in the United States and accounts for over one-third of all patients who are on dialysis. Diabetes mellitus is a disorder in which the body is unable to metabolize carbohydrates (e.g., food starches, sugars, cellulose) properly. The disease is characterized by excessive amounts of sugar in the blood (hyperglycemia) and urine; inadequate production and/or utilization of insulin; and by thirst, hunger, and loss of weight. Diabetics who require daily insulin shots to maintain life have insulin-dependent diabetes mellitus, or type 1 diabetes . In this type of diabetes, the pancreas secretes little or no insulin and the blood sugar level remains high, unless treated. Type 1 diabetes usually occurs in children and young adults, but it may occur at any age. In the past, this condition was also called juvenile onset diabetes. Onset of type 1 diabetes is abrupt. The patient becomes very sick and requires immediate insulin therapy. Approximately 3 million people in the United States have type 1 diabetes and each year, about 30, 000 people are diagnosed with the condition. Non-insulin-dependent diabetes, or type 2 diabetes , differs from type 1 in that the main problem is a peripheral resistance to the action of the insulin. DM 2 usually occurs in adults over the age of 40 who are overweight and have a family history of the disease. Some patients can manage their diabetes with weight loss and chang 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 >>
Diabetic Nephropathy
Diabetic nephropathy is a type of progressive kidney disease that may occur in people who have diabetes. It affects people with type 1 and type 2 diabetes, and risk increases with the duration of the disease and other risk factors like high blood pressure and a family history of kidney disease. Over 40 percent of cases of kidney failure are caused by diabetes, and it’s estimated that approximately 180,000 people are living with kidney failure caused by complications of diabetes. Diabetes is also the most common cause of end-stage renal disease (ESRD). ESRD is the fifth and final stage of diabetic nephropathy. Diabetic nephropathy progresses slowly. With early treatment, you can slow or even stop the progression of the disease. Not everyone who develops diabetic nephropathy will progress to kidney failure or ESRD, and having diabetes does not mean you will develop diabetic nephropathy. The early stages of kidney damage often do not cause noticeable symptoms. You may not experience any symptoms until you are in the late stages of chronic kidney disease. Symptoms of ESRD may include: fatigue general overall unwell feeling loss of appetite headache itchy and dry skin nausea or vomiting swelling of your arms and legs Each of your kidneys has about one million nephrons. Nephrons are small structures that filter waste from your blood. Diabetes can cause the nephrons to thicken and scar, which make them less able to filter waste and remove fluid from the body. This causes them to leak a type of protein called albumin into your urine. Albumin can be measured to help diagnose and determine the progression of diabetic nephropathy. The exact reason this occurs in people with diabetes is unknown, but high blood sugar levels and high blood pressure are thought to contribute to diab Continue reading >>
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 And Kidney Disease (stages 1-4)
What is diabetes? Diabetes happens when your body does not make enough insulin or cannot use insulin properly. Insulin is a hormone. It controls how much sugar is in your blood. A high level of sugar in your blood can cause problems in many parts of your body, including your heart, kidneys, eyes, and brain. Over time, this can lead to kidney disease and kidney failure. There are two main types of diabetes. Type 1 diabetes generally begins when people are young. In this case, the body does not make enough insulin. Type 2 diabetes is usually found in adults over 40, but is becoming more common in younger people. It is usually associated with being overweight and tends to run in families. In type 2 diabetes, the body makes insulin, but cannot use it well. What is chronic kidney disease (CKD)? Your kidneys are important because they keep the rest of your body in balance. They: Remove waste products from the body Balance the body’s fluids Help keep blood pressure under control Keep bones healthy Help make red blood cells. When you have kidney disease, it means that the kidneys have been damaged. Kidneys can get damaged from a disease like diabetes. Once your kidneys are damaged, they cannot filter your blood nor do other jobs as well as they should. When diabetes is not well controlled, the sugar level in your blood goes up. This is called hyperglycemia. Hyperglycemia (high blood sugar) can cause damage to many parts of your body, especially the kidneys, heart, blood vessels, eyes, feet, nerves. 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 kid Continue reading >>
Diabetic Nephropathy
Author: Vecihi Batuman, MD, FASN; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Diabetic nephropathy is a clinical syndrome characterized by the following [ 1 ] : Persistent albuminuria (>300 mg/d or >200 g/min) that is confirmed on at least 2 occasions 3-6 months apart Progressive decline in the glomerular filtration rate (GFR) Elevated arterial blood pressure (see Workup) Proteinuria was first recognized in diabetes mellitus in the late 18th century. In the 1930s, Kimmelstiel and Wilson described the classic lesions of nodular glomerulosclerosis in diabetes associated with proteinuria and hypertension. (See Pathophysiology.) By the 1950s, kidney disease was clearly recognized as a common complication of diabetes, with as many as 50% of patients with diabetes of more than 20 years having this complication. (See Epidemiology.) Currently, diabetic nephropathy is the leading cause of chronic kidney disease in the United States and other Western societies. It is also one of the most significant long-term complications in terms of morbidity and mortality for individual patients with diabetes. Diabetes is responsible for 30-40% of all end-stage renal disease (ESRD) cases in the United States. (See Prognosis.) Generally, diabetic nephropathy is considered after a routine urinalysis and screening for microalbuminuria in the setting of diabetes. Patients may have physical findings associated with long-standing diabetes mellitus. (See Clinical Presentation.) Good evidence suggests that early treatment delays or prevents the onset of diabetic nephropathy or diabetic kidney disease. This has consistently been shown in both type1 and type 2 diabetes mellitus. (See Treatment and Management). Regular outpatient follow-up is key in managing diabetic nephropathy successfully. ( Continue reading >>
Diabetic Nephropathy
Diabetic nephropathy (diabetic kidney disease) (DN)[1] is the chronic loss of kidney function occurring in those with diabetes mellitus. It is a serious complication, affecting around one-quarter of adult diabetics in the United States. It usually is slowly progressive over years. [2] Pathophysiologic abnormalities in DN begin with long-standing poorly controlled blood glucose levels. This is followed by multiple changes in the filtration units of the kidneys, the nephrons. (There are normally about 3/4-1 1/2 million nephrons in each adult kidney).[3] Initially, there is constriction of the efferent arterioles and dilation of afferent arterioles, with resulting glomerular capillary hypertension and hyperfiltration; this gradually changes to hypofiltration over time.[4] Concurrently, there are changes within the glomerulus itself: these include a thickening of the basement membrane, a widening of the slit membranes of the podocytes, an increase in the number of mesangial cells, and an increase in mesangial matrix. This matrix invades the glomerular capillaries and produces deposits called Kimmelstiel-Wilson nodules. The mesangial cells and matrix can progressively expand and consume the entire glomerulus, shutting off filtration.[5] The status of DN may be monitored by measuring two values: the amount of protein in the urine - proteinuria; and a blood test called the serum creatinine. The amount of the proteinuria is a reflection of the degree of damage to any still-functioning glomeruli. The value of the serum creatinine can be used to calculate the estimated glomerular filtration rate (eGFR), which reflects the percentage of glomeruli which are no longer filtering the blood.[citation needed] Treatment with an angiotensin converting enzyme inhibitor (ACEI) or angiotensi Continue reading >>
Treating Elderly People With Diabetes And Stages 3 And 4 Chronic Kidney Disease
Correspondence: Prof. Giovanni Gambaro, Divisione di Nefrologia, Dipartimento di Scienze Biomediche e Chirurgiche, Università di Verona, Ospedale Maggiore, P.le Stefani 1, 37126 Verona, Italy. Phone: +39-045-8122521; Fax: +39-045-915176; E-mail [email protected] Abstract Dedicated European and US clinical guidelines for type 2 diabetes in the elderly have been released, but they do not specifically address the issue of advanced chronic kidney disease (CKD) in older patients with diabetes. General clinical guidelines have been published on the treatment of patients with diabetic nephropathy (DN), but these address the issue of how to prevent progression and treat advanced DN without distinguishing between different age groups. Elderly patients with diabetes and stages 3 to 4 CKD have particular needs that differ from those of younger patients with the same conditions. This is mainly due to their frailty and shorter life expectancy. Differently tailored therapeutic strategies are needed, which may have less stringent targets; and the use of common drugs should be critically evaluated. The management agenda (metabolic control, low-protein diet, controlling BP, preventing progression of advanced DN, preventing cardiovascular outcomes) for these patients is discussed in light of the limits and perspectives of current guidelines. Intensive, simultaneous management of all items on the agenda may not be feasible for a proportion of older patients, and clinicians may have to give priority to reducing some risk factors rather than others, choosing between different therapies. In 2004, the European Diabetes Working Party for Older People launched its “Clinical Guidelines for Type 2 Diabetes Mellitus” specifically dedicated to the elderly (the European Diabetes & Aging Continue reading >>
