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Diabetes and Kidney Diabetes and Kidney ProblemsProblems

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What is Diabetes?

Diabetes is a condition in which there is too much sugar

(glucose) in the blood. Although sugar is needed to

provide energy for the body, when in excess, it causes

problem.

Persons with diabetes have excess sugar because they

lack or have deficient supply of insulin.

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Diabetes

“Mild Disease”

Serious consequences

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Diabetes Mellitus A Serious Disease

Leading cause of newcases of blindness 25 times more prone to eye problems

6 times higher risk forParalysis (stroke)

5 times more prone toKidney failure

20 times more prone tolower limb amputationNerve damage causes loss of sensation

2-3 times higher risk forheart attack

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Renal ArteryRenal Vein

Ureter

Renal Pelvis

Renal papillae

Renal cortex

Kidney

Ureter

AortaVena Cava

Renal ArteryRenal Vein

Kidney

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Kidney- What Is It? How Does It Work?

Kidneys are a pair of highly specialized organ with a complex

structure.

Each kidney contains thousands of small filtering units called “

Nephron”

Each nephron is made up of a cluster of small blood vessels

(Glomerulus) enclosed by a funnel shaped tubular structure

(“Bowman’s capsule” and “Loop of Henle”)

Glomerulus filters the fluid and waste products from the blood

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Kidney- What Is It? How Does It Work?

As the filtered water, soluble substances and waste products

pass through the long tubular structure, most of the water and

still useful substances are taken back

The remaining water with waste products is allowed to travel

through a long tube (ureter) from the kidney to the bladder

where it is stored as urine till it is excreted

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Kidney- How Is It Affected by Diabetes?

The sugar (glucose) in blood is filtered by the glomerulus. When

there is too much of it as in diabetes not all of it is taken back and

it remains in the tube

When blood sugar is high, sugar is passed in urine. Because it is

in high amount in urine it also retains more water so persons with

diabetes pass more urine

Initially the kidneys work hard to keep pace with increased load of

sugar

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Kidney- How Is It Affected by Diabetes?

As a result of many years of “toxically” high blood sugar the thin

walls of the blood vessels in the glomerulus and the filtering

membranes of the Bowman’s capsule themselves get damaged

When the filters are damaged , proteins that the body usually

saves are now lost in urine. Albumin is the most important protein

that is lost in the urine

With passing years of continued poor control the filtering

mechanism is further damaged and waste products accumulate in

the body – leading to kidney failure

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Poor control of diabetes for over 5 years can lead to diabetic

kidney disease

Inheritance also plays a role in determining the quickness and

degree of damage. This is the reason why some people are more

susceptible than others to diabetic kidney disease

Most people with diabetes also develop high blood pressure. This,

in turn, causes additional damage to the kidney which further

worsens high blood pressure setting another chain reaction

Kidney- How Is It Affected by Diabetes?

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Diabetes and the Kidneys Kidney disease caused by diabetes is called diabetes nephropathy

Because of great spare capacity, symptoms of kidney problems

don’t occur until the kidney has been severely damaged

Good control of diabetes prevents or delays kidney problems

Appropriate treatment at any stage can halt further progress of the

disease

It is important to detect the earliest signs of kidney problems

Early signs of diabetic kidney problems can be detected only by

laboratory examination of urine and blood

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Stages of the Diabetic Kidney Disease Stage 1 - Microalbuminuria

Small amount of the albumin is passed in the urine

Reversible with aggressive diabetes control and treatment

BP may start rising and must be treated aggressively

Stage 2 - Macroalbuminuria or Proteinuria Increasingly larger amounts of protein are passed

Toxic waste products start accumulating in the body, reflected by rise

in blood creatinine level

BP rises and must be treated aggressively

Often not reversible; further progression halted with good control

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Stage 3 - End stage renal disease or kidney failure

Here the amount of urine produced decreases substantially

Waste products accumulate to toxic levels

Blood pressure rises dangerously

Patients need regular dialysis for survival

Can be reversed or halted only with kidney transplant

Stages of the Diabetic Kidney Disease

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Why Monitoring Kidney Functions Is Important

In the first stage of kidney disease neither you nor your doctor

can tell that anything is wrong because there are no symptoms

It is important to have routine screening tests even when you feel

well

Presence of kidney disease further increases the risk for High blood pressure several folds

Coronary heart disease several folds

A urine test for microalbuminuria is the best way to detect early

kidney damage

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Monitoring Kidney Functions

Because diabetes may remain undetected for many years,

undertake the microalbuminuria test when you first learn

you have diabetes and every year thereafter

Expect to have more frequent and extensive testing of

kidney function if: Your diabetes is difficult to control

Your doctor has detected microalbuminuria in an earlier test

Your blood pressure is increasing

You have associated heart disease

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Monitoring Kidney Functions

Ensure that your doctor and diabetes care team monitor

Your blood pressure at each visit Test for kidney functions appropriately and as required

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Testing for Microalbuminuria

Although expensive the dipstick microalbuminuria test accurately

measures small amounts of albumin in the urine

Your doctor may ask you to collect all of your urine for 24 hours.

The study on 24 hours urine collection is the most helpful in

detecting kidney problems

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Checking Your Blood Pressure

Rising blood pressure worsens microalbuminuria and early kidney

damage

If kidney damage is detected, it is important to treat even small

increases in blood pressure effectively

Your doctors may prescribe anti-hypertensive medications even if

your blood pressure has only risen within the high normal range

Along with good glucose control, early and effective treatment of

increased blood pressure is as important to delay or prevent

progression of diabetic kidney disease

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Steps to Control Kidney Damage

If the early signs of kidney disease are detected, you can

expect your doctor to suggest the following:

Improve your blood sugar control

Keeping HbA1c values below 7% can be reverse and prevent

further progress of kidney disease

Any reduction in HbA1c will help to reduce rate of progress

Take Insulin, if advised

Check for microalbuminuria and kidney function more often

Check your blood pressure more often, preferably at each visit

and monitor values. The normal values are 120/80 mmHg

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Steps to Control Kidney Damage

Take medication to treat high blood pressure

Review your dietary habits in consultation with your

dieticians to reduce protein content and perhaps salt

Quit smoking

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Quit Smoking!!

Smoking has been found to contribute significantly to increased

risk for high BP, diabetic heart, eye, nerve, and kidney disease

People with diabetes who smoke are more likely to have a

microalbuminuria – the first sign of diabetic kidney disease

(nephropathy)

Even for people with established kidney disease smoking is

harmful

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What is Dialysis?

Dialysis is done to help get rid of the waste substances

such as creatinine and urea from the blood. Dialysis can be

done in two ways haemodialysis or peritoneal dialysis. Hemodialysis - the patient's blood is passed from the artery through a

tube into a machine that filters out waste products. The cleansed

blood is then returned to the body through a vein.

Peritoneal dialysis - can be done at home; A special solution is run

through a tube into the abdomen where waste products from the body

pass through the lining of the abdomen called the peritoneum in to

the injected solution, which is then drained out after a specified time

period.

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When is Dialysis Necessary?

People who have lost more than 90% of the kidney’s filtering

capacity will need artificial filtrations to dispose of the waste

products that will otherwise accumulate in the blood

Dialysis is done to prevent coma and death from toxic effects of

the body’s accumulated waste products

Some people undergo a kidney transplant as an alternative to

continuing dialysis

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Complications of Chronic Kidney Failure

Hypoglycaemia can occur due to decreased excretion of insulin

Rapid progression to end-stage renal disease

Hyperkalemia - a dangerous state of abnormal amount of potassium

ions circulating in blood

High blood pressure

Worsening coronary artery disease (Heart problem)

Low protein in the body leading to accumulation of water and salt

and causing swelling of feet, puffiness of face etc

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Symptoms of Late Diabetic Nephropathy

Fatigue (tiredness)

Insomnia (loss of sleep)

Weakness

Nausea and Vomiting

Swelling on the face,hands and legs due to fluid retention (edema)

Weight gain because of fluid accumulation

Generalized itching

Unintentional weight loss

Loss of appetite

Repeated or unexplained hypoglycaemia in a previously poorly control diabetic

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Kidney Transplant

Kidney transplant is done for patients with end stage kidney

disease

Most people with kidney failure are treated with dialysis before

they are considered for a kidney transplant

The success is better when the kidney is from a live related donor

as compared to a transplant from a dead donor (cadaver)

Before the transplantation the patient needs to be carefully

assessed and treatment started for prevention of complications

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Kidney Transplant

After transplantation patients are given immunosuppressive drugs

to prevent rejection of the transplanted kidney

Better surgical techniques; Use of live related donor; Availability of

better immunosuppressant drugs and antibiotics; And good

diabetes and blood pressure control, have greatly increased the

success rate of kidney transplant

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Prevention Is Better Than Treatment

You can protect your kidneys from damage by: Ensuring regular usage of Insulin, if advised

Ensuring regular BP check- up and control

Ensuring regular urine check for microalbuminuria

Starting proper treatment at the first sign of microalbuminuria

Quitting Smoking

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