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Diabetic Kidney Disease

diabetic nephropathy


The two kidneys lie to the sides of the upper abdomen 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. Each glomerulus and tubule make up a nephron. There are about one million nephrons in each kidney. The nephrons are the functional units of the kidney undertaking a massively task of cleansing the blood of impurities and maintaining normalcy.The 'cleaned' (filtered) blood from each kidney collects into a large vein - the renal vein - which takes the blood back towards the heart.

What are the main functions of the kidneys?

  • Filter out waste products from the bloodstream to be passed out in the urine.
  • Help control blood pressure.
  • Make a hormone called erythropoietin which stimulates the bone marrow to make red blood cells.
  • Help keep various salts and chemicals in the blood at the right level. For example, sodium, potassium, calcium, and phosphate.

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 (sugar) 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. 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.

Proteinuria is irreversible. If you develop proteinuria it usually marks the beginning of a gradual decline in kidney function towards end-stage kidney failure at sometime in the future.

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. Diabetic kidney disease is much more common in Asian and black people with diabetes than in white people.

What are the symptoms of diabetic kidney disease?

You are unlikely to have symptoms with early diabetic kidney disease. Symptoms tend to develop when the kidney disease progresses. The symptoms at first tend to be vague and nonspecific

  • Difficulty thinking clearly
  • A poor appetite
  • Weight loss
  • Dry, itchy skin
  • Muscle cramps
  • Swollen feet and ankles
  • Puffiness around the eyes
  • Needing to pass urine more often than usual
  • Anemia
  • 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 greater your HbA1c level, the greater your risk.)
  • The length of time you have had diabetes.
  • The more overweight you become.
  • Having high blood pressure.
  • If you are male.

What are the possible complications?

End-stage kidney failure

If this occurs then you would need kidney dialysis or a kidney transplant.

Cardiovascular diseases

All people with diabetes have an increased risk of developing cardiovascular diseases, such as heart disease, stroke and peripheral vascular disease. If you have diabetes and diabetic kidney disease, then your risk of developing cardiovascular diseases is increased further.

  • High blood pressure
  • Kidney disease has a tendency to increase blood pressure.

What is the treatment for diabetic kidney disease?

Treatments aim to:

  • Prevent or delay the disease progressing to kidney failure.
  • Reduce the risk of developing cardiovascular diseases such as heart disease and stroke.

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. A drug to lower your cholesterol level is commonly advised.

Tackle lifestyle risk factors, such as:

  • Stop smoking if you smoke.
  • Eat a healthy diet.
  • Keep your weight and waist in check.
  • Take regular physical activity.
  • Cut back if you drink a lot of alcohol.

What is the prognosis?

If you have microalbuminuria, this may clear away, especially with treatment.

If you have proteinuria, over time the disease tends to get worse and progress to end-stage kidney failure. However, the length of time this takes can vary and it may take years


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