Diabetic Kidney Disease
Diabetes is the most common cause of Kidney Failure. However, it's also true that most people with diabetes don't go on to have end-stage kidney disease (ESRD). There are many things you can do to control your diabetes and minimize your risk of kidney failure including stopping smoking and keeping blood pressure under control. A federal study called the Diabetes Control and Complications Trial proved in 1993 that intensive management of diabetes can reduce the risk of kidney disease by 50 percent.
Intensive Management (called Tight Control) means frequent testing of blood sugar, calculating insulin intake on the basis of diet and exercise, following a diet and exercise plan, and talking often with a health care team whose members are skilled at treating diabetes.
What Are The Stages ?
Stage I - The flow of blood through the kidneys increases and the kidneys get bigger. People can stay in this stage indefinitely or advance to Stage II after many years.
Stage II - Small amounts of blood protein known as albumin leak into the urine. This is called microalbuminuria.
Stage III - The loss of albumin and other proteins speeds up. Some patients develop high blood pressure. The kidneys continue to lose the ability to filter waste. Many people are first diagnosed with kidney disease at this stage.
Stage IV - In this stage large amounts of urine are passed through the kidneys and high blood pressure almost always occurs.
Stage V- The ability of the kidneys to filter waste almost stops. Kidney dialysis or transplants are treatment options.
Diagnosis Of CKD
People with diabetes should be screened regularly for kidney disease. The two key markers for kidney disease are eGFR and urine albumin.
- eGFR. eGFR stands for estimated glomerular filtration rate. Each kidney contains about 1 million tiny filters made up of blood vessels. These filters are called glomeruli. Kidney function can be checked by estimating how much blood the glomeruli filter in a minute. The calculation of eGFR is based on the amount of creatinine, a waste product, found in a blood sample. As the level of creatinine goes up, the eGFR goes down.
Kidney disease is present when eGFR is less than 60 milliliters per minute. The American Diabetes Association (ADA) and the National Institutes of Health (NIH) recommend that eGFR be calculated from serum creatinine at least once a year in all people with diabetes.
- Urine albumin. Urine albumin is measured by comparing the amount of albumin to the amount of creatinine in a single urine sample. When the kidneys are healthy, the urine will contain large amounts of creatinine but almost no albumin. Even a small increase in the ratio of albumin to creatinine is a sign of kidney damage.
Kidney disease is present when urine contains more than 30 milligrams of albumin per gram of creatinine, with or without decreased eGFR.
The ADA and the NIH recommend annual assessment of urine albumin excretion to assess kidney damage in all people with type 2 diabetes and people who have had type 1 diabetes for 5 years or more.
If kidney disease is detected, it should be addressed as part of a comprehensive approach to the treatment of diabetes.
Ways To Prevent Diabetes Kidney Problems
You can prevent diabetes kidney problems through the following means:
- Keep your blood glucose levels under control. Talk to your doctor about your HbA1c test and what your goal should be.
- Keep your blood pressure under control (130/85 mmHg or lower).
- Have your kidneys checked at least once a year by having your urine tested for small amounts of protein.
- Talk to your doctor about being placed on an ACE inhibitor to protect your kidneys.
- Have any other kidney tests that your doctor recommends.
- See your doctor right away if you think you have a bladder or kidney infection.
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