Simply put, kidneys are made up of individual cells called nephrons that act as filters. Diabetes can damage the kidneys, causing the filter to break down and fail. As a result, they lose their ability to filter waste products that are excreted in the urine. Protein and red blood cells are usually too big to pass through the filter and stay in the system instead.

So, what are the fatal consequences of diabetes on the kidneys, and most importantly, why should you care?

Main Functions of kidneys

• Filter waste products to be excreted in urine
• Control blood pressure
• Produce a hormone called erythropoietin that helps the production of red blood cells
• Keeps the balance of electrolytes (e.g. sodium, potassium)

Diabetic Kidney Disease

This is a complication in diabetics that damages the filters of the kidneys (glomeruli). Due to this damage, the kidneys “leak” protein into the urine. A raised level of albumin (protein) in the urine is a sign that the kidneys are damaged by diabetes. It is divided into two main categories, depending on the albumin lost through the kidneys:

1. Microalbuminuria: The amount of albumin in the urine is between 30-300mg per day. (first sign that diabetic kidney disease develops).
2. Proteinuria: The amount of albumin leaking into the urine is more than 300mg per day. (marks the beginning of gradual decline of kidney function). Patients may have frothy urine.

Diabetic kidney disease can take years to progress but can occur more rapidly in people with poorly controlled blood glucose. The gradual decline in the kidney function may eventually progress to end-stage kidney failure. 1 in 5 individuals who need dialysis have diabetic kidney disease.

With severe kidney disease, it may result in uremia (build-up of urea) due to poor kidney function.

Symptoms

• Difficulty thinking clearly
• Poor appetite
• Weight loss
• Dry, itchy skin
• Cramps in muscles
• Swollen feet and ankles, puffy eyes (fluid retention)
• Pallor (due to anemia)

Diagnosis

• The raised level of the albumin is detected using a urine test.
• A blood test can be used to determine how well the kidneys are working. The level of creatinine is measured in the blood, and an estimate of kidney function is calculated, termed as “estimated glomerular filtration rate (eGFR).

Diabetic kidney disease can be made worse with poor blood glucose control, high blood pressure, and smoking.

Treatment 

• Renal dialysis
• Renal transplant

The goal is to prevent or delay the progression of kidney failure, and to reduce the risk of developing heart diseases and stroke

Complications

• End stage kidney failure / renal failure: develops approximately 8 in 100 people after 10 years.

[expand title=”References“]

Diabetic Kidney Disease. Patient. Accessed February 15, 2017.

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