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How diabetes affects your kidneys

By Jenilee Matz, M.P.H., Staff Writer, myOptumHealth

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Your kidneys act somewhat like the colander you use in the kitchen. They strain out waste and keep the useful substances in your body.

When these vital organs do not work well, there can be serious health consequences. Diabetes and kidney failure are tightly linked. In fact, diabetes is the leading cause of chronic kidney disease. Some degree of diabetic nephropathy (kidney disease caused by diabetes) occurs in one out of every three people with diabetes.

Kidney basics

Healthy people have two kidneys. The kidneys filter out waste. Your kidneys also make red blood cells, regulate blood pressure and help balance fluids and minerals in the body.

Blood flows through the kidneys, passing through millions of tiny filters called glomeruli. The waste products are filtered out and substances your body needs, like protein, are reserved.

Diabetes and kidney disease

People with diabetes are at-risk for kidney disease. Poorly managed diabetes leads to high blood sugar. This harms blood vessels all through the body, including the small blood vessels in the glomeruli. Over time this damages the kidney's ability to filter properly.

At first, when damaged, the glomeruli will start to leak. Small amounts of protein will be lost through urine instead of staying in the blood. This is called microalbuminuria, the earliest stage of kidney disease. Treatment in this stage may be able to stop the disease from becoming worse.

If left untreated, over many years, macroalbuminuria develops. This is when large amounts of protein are lost through the urine. A diagnosis of macroalbuminuria may mean that kidney failure (end-stage renal disease or ESRD) is likely.

Kidney failure occurs when the kidneys completely lose their filtering ability and harmful waste builds up in the blood. There are only two options to treat kidney failure:

1. Kidney transplant.
2. Dialysis. Dialysis is a treatment that filters out the waste products. There are two main types of dialysis. Hemodialysis uses a machine that works like an artificial kidney. Peritoneal dialysis uses the lining of your abdomen as a filter. Depending on the type of dialysis, you'll either need treatment every day or a few times each week.

Other ways diabetes harms the kidneys

• Nerve damage often occurs in people with diabetes. Your nerves tell your brain when your bladder is full. When nerves are damaged, there may be a delay in sending this message to your brain. A full bladder may put pressure on the kidneys and lead to kidney damage over time.
• Urinary tract infection. Holding urine in your bladder for too long can cause a urinary tract infection. If left untreated, the infection could spread from the bladder to the kidneys.
• High blood pressure. Many people with diabetes also have high blood pressure. High blood pressure also damages the blood vessels in a similar manner as high blood sugar. The one-two punch of high blood pressure and high blood sugar can speed up the harm to the kidneys' filtering system.

A "silent" disease

Often, kidney disease comes on without any warning signs. Make sure to go to all your diabetes-related checkups. Your doctor will check your urine for protein and measure your blood pressure.

If you do have symptoms, you may already have serious kidney damage. Symptoms also vary greatly between people. Some may include:

• Fluid build-up
• Loss of appetite
• Nausea
• Weakness

How to reduce your risks

Controlling your blood sugar is the biggest step in cutting your kidney disease risk. Other prevention tips include:

• Eat a nutritious diet that's rich in fruits, vegetables, whole grains, lean protein and low-fat or nonfat dairy. Limit foods high in saturated fat, trans-fat, sodium and added sugars.
• Exercise for 30 to 60 minutes most days of the week. Talk to your doctor first before you start or increase your activity level.
• Take all medications as directed, especially those that treat diabetes, high blood pressure and cholesterol.
• Keep your blood pressure in check.
• Do not drink alcohol or smoke. If you do, quit.

View the original How diabetes affects your kidneys article on myOptumHealth.com 

SOURCES:

• National Diabetes Information Clearinghouse. Prevent diabetes problems: keep your kidneys healthy. Accessed: 07/20/2009

• National Kidney Foundation. Diabetes and chronic kidney disease. Accessed: 07/20/2009

• Whaley-Connell AT, Sowers JR, McFarlane SI, et al. Diabetes mellitus in CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition and Examination Survey (NHANES) 1999-2004. American Journal of Kidney Diseases. 2008;51(4 Suppl 2):S21-S29. Accessed: 07/21/2009

• American Diabetes Association. Kidney disease (nephropathy). Accessed: 07/20/2009