Diabetes is the single leading cause
of kidney failure in the United States.
Diabetes is a disease that affects
the body’s ability to produce
or respond to insulin, a hormone that
allows blood glucose (blood sugar)
to enter the cells of the body and
be used for energy. Nephropathy, also
called diabetic kidney disease, is
a condition that affects one-third
or more of people who have had Type
1 (juvenile) diabetes for at least
20 years. About 10 to 40 percent of
people with Type 2 (adult onset) diabetes
also have kidney disease.
the United States diabetes is more common
among certain ethnic groups, including:
African-Americans, Hispanics, Pacific Islanders
and Native Americans. The disease is extremely
prevalent in the African-American community.
Approximately 13 percent of all African-Americans
have diabetes and one-third of this group
are unaware that they have the disease.
African-Americans suffer from kidney failure
about four times more often than other ethnic
for diabetic kidney disease focuses on slowing
the progression to kidney failure. Controlling
high blood pressure and blood sugar levels,
participating in a doctor-supervised exercise
and weight loss program and eating a special
diet can help.
kidney failure develops, the kidneys lose
their ability to remove waste products from
the body. The first signs of nephropathy
are small amounts of protein in the urine
and elevated levels of creatinine (a waste
product) in the blood. Unfortunately, most
people do not experience symptoms until
their kidneys have lost much of their ability
kidneys function at only five to ten percent
of their capacity, they can no longer process
most of the waste in the body and cannot
sustain a person’s life. This condition
is called end-stage renal disease. Treatment
options include either kidney dialysis or
transplantation. In most cases, renal transplantation
is often preferred for a better quality
Are you at
Risk for Diabetes?
is a major risk factor for kidney disease.
There are 18.2 million Americans with diabetes
– and nearly one-third of them (5.2
million people) do not know it. African-Americans,
Latinos, Native Americans, Asian Americans
and Pacific Islanders are at higher risk
for developing diabetes.
does diabetes affect the kidneys?
can affect the kidneys in a number of ways
but one of the most important complications
is diabetic nephropathy. This is a kidney
condition that occurs only in people with
diabetes mellitus and results in progressive
damage to the small filtering units of the
eventually leads to large amounts of protein
in the urine, high blood pressure and declining
kidney function. Even when drugs and diet
are able to control diabetes, the disease
can lead to nephropathy and kidney failure.
is the most common cause of kidney failure
in New Zealand. About 20% of people who
need dialysis (artificial kidney treatment)
or kidney transplantation have diabetic
the signs of diabetic kidney disease?
is possible for individuals to have serious
kidney damage without being aware of it.
There may be no specific symptoms of diabetic
kidney disease until the kidneys fail completely.
signs or risk factors include:
(a type of protein) in the urine
related to kidney failure usually occur
only in late stages of the disease, when
kidney function has diminished. For many
years before that point, kidney disease
of diabetics exists as a silent process.
to the kidneys is reflected in the amount
of protein in the urine. Initially, the
amount of protein is very small, but gradually,
over a number of years, the amount of protein
in the urine increases.
does diabetes damage the kidneys?
can cause damage to blood vessels and nerves
and can prompt an increase in urine and
to blood vessels: Even with the
use of injected insulin, people who have
had diabetes for some time often suffer
from damage to the small blood vessels of
the body. The delicate blood vessels in
the filters of the kidney (the glomeruli)
may be damaged. In the early stage, this
damage is demonstrated by small amounts
of protein in the urine.
at a later stage, so much protein is lost
from the blood that water from the blood
moves into the body tissues and causes swelling
(oedema). After a number of years, the kidneys'
filters can become so damaged by diabetes
that the kidneys fail completely. Because
smoking also damages the blood vessels,
it worsens the complications of diabetes.
People with diabetes should try to stop
smoking completely or never start.
to nerves: Diabetes can also damage
the nerves in many parts of the body. When
the bladder is affected, it may be difficult
to pass urine. If urine builds up in the
bladder, the pressure can cause it to flow
back into the kidneys and cause scarring
to kidney tissue.
Urine of people with diabetes has a high
sugar content. This encourages growth of
bacteria and kidney.
may occur. People with diabetes must take
special care to ensure any infections are
and good diet will help to prevent kidney
Who can get
nephropathy is a long-term complication
of diabetes but only 20-30% of people with
diabetes will develop it. It is not entirely
understood why only a small number of people
with diabetes develop diabetic nephropathy.
However, a number of factors appear to increase
the risk of kidney disease.
- high blood pressure
- high blood
glucose levels (particularly in the
early stages of diabetes)
- family history
of high blood pressure.
It is important
to realise that these are only risk factors
and it is possible to have no risk factors
and still develop kidney problems. Conversely,
there are some people with all the risk
factors who do not develop kidney problems.
if the kidneys fail?
a person's kidneys are about to fail, they
might experience symptoms such as tiredness,
nausea and vomiting. They may also find
that they need less insulin than usual.
When the kidneys fail, wastes and fluids
will accumulate in the body and dialysis
treatments or a kidney transplant is needed.
survival of kidneys transplanted into diabetes
patients is about the same as survival of
transplants in people without diabetes.
Dialysis for people with diabetes also works
well. Even so, people with diabetes who
receive transplants or dialysis may experience
more medical problems and death because
of other complications of the diabetes,
such as damage to the heart, eyes, and nerves.
people with diabetic kidney failure will
be suitable for a combined kidney and pancreas
transplant. If successful, they will regain
normal kidney function and will have normal
blood sugar levels, meaning they can stop
Why is high
blood pressure a factor?
blood pressure, or hypertension, is a major
factor in the development of kidney problems
in people with diabetes. Both a family history
of, and the presence of high blood pressure,
appear to increase chances of developing
kidney disease. High blood pressure also
accelerates the progress of kidney disease
where it already exists.
blood pressure is usually defined as blood
pressure exceeding 140/90. The first number
is the systolic pressure, the second number
the diastolic. The terms systolic and diastolic
refer to pressure in the arteries during
contraction of the heart (systolic) and
between heartbeats (diastolic).
can be seen not only as a cause of kidney
disease, but also as a result of damage
created by the disease. Early detection
and treatment of even mild hypertension
is essential for people with diabetes.
can kidney disease be slowed or prevented?
tests can help to detect kidney damage at
an early stage. There are also treatments
which may help to delay kidney failure.
It is usually necessary to start these treatments
as soon as your doctor notices any of the
early signs or risk factors. Therefore,
you should stay in close touch with your
doctor if you have diabetes.
help prevent kidney damage
that your diabetic control is excellent
- follow your doctor's advice regarding
insulin injections, medicines, diet,
exercise and monitoring your blood sugar.
control high blood pressure - have your
blood pressure checked several times
a year and preferably monitor it yourself
at home. If blood pressure is high,
follow your doctor's plan for keeping
it at normal levels. Drugs used to lower
blood pressure (anti-hypertensive drugs)
can slow the progression of kidney disease
make correct food choices - it is important
to consult a doctor or dietitian to
determine a suitable diet.
smoking or don't start smoking.
have urine infections treated immediately
control blood cholesterol and triglyceride
levels with diet and medication if necessary
drink alcohol in moderation only.
aim to achieve and maintain your weight
within the correct range for your height
your urine, blood and blood pressure
checked regularly by your doctor.
ask your doctor to inform you of new
developments in the treatment of diabetes.