Diabetic Kidney Disease

diabetic kidney disease

The two kidneys lie to the sides of the upper abdomen (the loins), behind the intestines, and either side of the spine. A large artery - the renal artery - takes blood to each kidney. The artery divides into many tiny blood vessels (capillaries) throughout the kidney. In the outer part of the kidneys tiny blood vessels cluster together to form structures called glomeruli. Each glomerulus is like a filter. The structure of the glomerulus allows waste products and some water and salt to pass from the blood into a tiny channel called a tubule whilst keeping blood cells and protein in the bloodstream.

The liquid that remains at the end of each tubule is called urine. This drains into larger channels (collecting ducts) which drain into the renal pelvis (the inner part of the kidney). The urine then passes down a tube called a ureter which goes from each kidney to the bladder. Urine is stored in the bladder until it is passed out when we go to the toilet.

What are the main functions of the kidneys?

  • Filter out waste products.
  • Help control blood pressure.
  • Make a hormone called erythropoietin ('epo') which stimulates the bone marrow to make red blood cells.
  • Help keep various salts and chemicals in the blood at the right level.

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.

Diabetic kidney disease is divided into two main categories, depending on how much albumin is lost through the kidneys:

  • Microalbuminuria. This is when the amount of albumin that leaks into the urine is between 30 and 300 mg per day.
  • Proteinuria. This is when the amount of albumin that leaks into the urine is more than 300 mg per day.

How does diabetic kidney disease develop and progress?

A raised blood 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 leak into the urine. In addition, the raised blood glucose level may cause some proteins in the glomeruli to link together. These 'cross-linked' proteins can trigger a localised scarring process. This scarring process in the glomeruli is called glomerulosclerosis. As the condition becomes worse, scarred tissue (glomerulosclerosis) gradually replaces healthy kidney tissue. As a result, the kidneys become less and less able to do their job of filtering the blood. This gradual 'failing' of the kidneys may gradually progress to what is known as end-stage kidney failure.

How common is diabetic kidney disease?

Diabetic kidney disease is actually the most common cause of kidney failure. Around one in five people needing dialysis has diabetic kidney disease.

What are the symptoms of diabetic kidney disease?

You are unlikely to have symptoms with early diabetic kidney disease. With more severe kidney disease symptoms that may develop include:

  • Difficulty thinking clearly
  • A poor appetite
  • Weight loss
  • Dry, itchy skin
  • Muscle cramps
  • Fluid retention which causes swollen feet and ankles
  • Puffiness around the eyes
  • Needing to pass urine more often than usual
  • Being pale due to anaemia
  • Feeling sick

How is diabetic kidney disease diagnosed and assessed?

Diabetic kidney disease is diagnosed when the level of albumin in the urine is raised and there is no other obvious cause for this. Urine tests are part of the routine checks that are offered to people with diabetes from time to time.

A blood test can show how well the kidneys are working. The blood test measures a chemical called creatinine which is a breakdown product of muscle. This is normally cleared from the blood by the kidneys. If your kidneys are not working properly, the level of creatinine in the blood goes up.

What increases the risk of developing diabetic kidney disease?

  • A poor control of your blood sugar levels.
  • The length of time you have had diabetes.
  • The more overweight you become.
  • Having high blood pressure.
  • If you are male.

If you have early diabetic kidney disease (microalbuminuria), the risk that the disease will become worse is increased with:

  • The poorer the control of blood sugar levels.
  • Having high blood pressure.
  • Smoking.

What are the possible complications?

  • End-stage kidney failure
  • Cardiovascular diseases
  • High blood pressure

What is the treatment for diabetic kidney disease?

An angiotensin-converting enzyme inhibitor

There are several types and brands of this type of medication. Angiotensin-converting enzyme (ACE) inhibitors work by reducing the amount of a chemical called angiotensin II that you make in your bloodstream. This chemical tends to constrict (narrow) blood vessels.

An angiotensin-II receptor antagonist

There are several types and brands of this type of medication. Angiotensin-II receptor antagonists (AIIRAs) work in a similar way to ACE inhibitors. One may be used instead of an ACE inhibitor if you have problems or side-effects with taking an ACE inhibitor.

Good control of your blood glucose level

Good control of your blood pressure

Review of your medication

Certain medicines can affect the kidneys as a side-effect which can make diabetic kidney disease worse. For example, you should not take anti-inflammatory medicines unless advised to by a doctor.

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