The Kidneys in Diabetes
Siba Kallab, MD
Clinical associate, American University of Beirut (AUB)
Nephrologist, Keserwan Medical Center, affiliated with AUB
Head, dialysis unit, Tannourine Governmental Hospital
Why Are the Kidneys So Important?
The kidneys are very important organs in the human body. There are two kidneys, each located on either side of the spine at the lowest level of the rib cage. They have multi-functional activity:
- The kidneys filter out toxins, drugs and excess salts in the urine
- The kidneys adjust the water level balance according to water intake
- The kidneys play a major role in blood pressure regulation
- The kidneys get rid of excess acid resulting from cell
- The kidneys secrete an active form of vitamin D that promotes strong, healthy bones
- The kidneys secrete a hormone that controls the production of red blood cells
Diabetes and the kidney:
Having diabetes puts the patient at risk of other health problems, including heart attacks, strokes, vision loss, nerve damage, and kidney disease.
If you have diabetes it is very important to protect your kidneys from developing diabetic kidney disease, (or what healthcare providers call diabetic nephropathy) before the problem advances.
Are there any symptoms for diabetic nephropathy?
Usually not at the beginning of the disease. The patients who have the condition often produce normal or even high amounts of urine. Often people who have diabetic nephropathy also have high blood pressure.
How can we diagnose diabetic nephropathy?
When the kidneys are working normally, they prevent protein from leaking into the urine; so finding protein in the urine is a sign that the kidneys are in trouble. If there is a very large amount of protein in your urine, it means you have diabetic nephropathy.
The urine test is looking for a protein called “albumin”. You may be told that you have "microalbuminuria"
There is also a blood test to detect kidney failure
How can we protect our kidneys in diabetes?
Keep your blood sugar as close to normal as possible andyour blood pressure below 140/90, if possible andmake some lifestyle changes:
- Limit the amount of salt you eat
- If you smoke, quit!
- Lose weight if you are overweight
Some good news…
Many of the steps you need to take to protect your kidneys may actually help to prevent all other complications of diabetes.
You need a close follow up by your kidney doctor to monitor your kidney function and your blood pressure. Your doctor might adjust some medications if the urine protein levels have not improved.
Diabetes & Kidney Disease
Walid Aboujaoude, MD
Hypertension and Kidney Diseases Specialist
Head of Nephrology Division at MEIH
Diabetic nephropathy is kidney disease or damage that can occur in people with diabetes.
Causes, Incidence, And Risk Factors
Each kidney is made of hundreds of thousands of small units called nephrons that filter your blood and help remove waste from your body.
In people with diabetes, these nephrons thicken and slowly become scarred over time even before any symptoms begin.
The exact cause is unknown. However, kidney damage is more likely if there is poor control of diabetes and high blood pressure. Family history and ethnicity may also play a role.
Not everyone with diabetes develops this kidney problem.
People with diabetes who smoke and those with Type 1 diabetes that started before age 20 have a higher risk for kidney problems.
Often, symptoms can occur 5-10 years after the kidney damage had started.
People who have more severe kidney disease may have symptoms such as constant fatigue, general ill feeling, headache, nausea and vomiting, poor appetite, and swelling of the legs.
Signs And Tests
Your doctor can order tests to detect signs of kidney problems in the early stages. Once a year, you should have a urine test to look for a protein called albumin leaking into the urine Too much of this protein leaking is often a sign of kidney damage.
High blood pressure often goes along with diabetic nephropathy. You may have high blood pressure that begins quickly or is hard to control. Your doctor will also check your BUN and Serum creatinine every year.
In case of doubt, a kidney biopsy confirms the diagnosis.
In early stages, kidney damage can be slowed with treatment. Keeping your blood pressure under control (below 130/80) is one of the best ways to slow kidney damage.
Eating a low-fat diet, taking drugs to control blood cholesterol, and getting regular exercise can also help prevent or slow kidney damage.
You can also slow kidney damage by controlling your blood sugar levels, which you can do by:
- Eating a healthy diet
- Regularly taking insulin or other medicines your doctor prescribes.
- Knowing the basic steps for managing your blood sugar levels at home.
- Checking your blood sugar levels and keeping a record of them.
To protect your kidneys, remember the following:
- Tell your doctor about your diabetes before having an MRI, CT scan, or other imaging test in which you receive a contrast dye. These dyes can further damage the kidneys.
- Always talk to your health care provider before taking any drugs since some can damage the kidneys.
- Know the signs of urinary tract infections and get treated right away.
Diabetic kidney disease is a major cause of sickness and death in people with diabetes. It can lead to the need for dialysis or a kidney transplant.
Thus it is very important to consult your doctor about your diabetes and if there is any kidney involvement from it.
Prevention & Treatment of Diabetic Nephropathy
Chadia Beaini Safa, MD
Head of Hemodialysis Unit, Bellevue Medical Center
Nephrologist, Bellevue Medical Center
The kidneys play an important role: they remove waste products from the body, balance the body’s fluids, release hormones that regulate blood pressure, produce the active form of vitamin D and control the production of red blood cells. Finding out that you have early diabetic nephropathy can alert you that your kidneys are in danger. It is important to take steps to protect your kidneys before the problem advances.
Diabetic nephropathy occurs in type 1 (formerly called insulin-dependent or juvenile onset) and type 2 (formerly called non-insulin-dependent or adult onset) diabetes mellitus, and in other secondary forms of diabetes mellitus, in which duration of diabetes is long enough and level of glycemia high enough to result in complications.
Diabetic kidney disease or diabetic nephropathy is defined by characteristic structural and functional changes. The major clinical manifestations of diabetic nephropathy are albuminuria and progressive chronic kidney disease, which can be slowed or prevented with optimal therapy.
Diabetic nephropathy usually causes no symptoms and people continue to produce normal amounts of urine. To detect diabetic nephropathy, tests that measure protein levels in the urine and blood tests to evaluate the level of kidney function should be done regularly. When the kidneys are working normally, they prevent proteins from leaking into the urine, so finding proteins in the urine is a sign that the kidneys are in trouble. The earliest clinical manifestation of renal involvement in diabetes is an increase in albumin excretion: moderately increased albuminuria or microalbuminuria (defined as urinary albumin excretion between 30 and 300 mg/day) or severely increased macroalbuminuria (defined as urinary albumin excretion above 300 mg/day). Moderately increased albuminuria precedes the development of severely increased albuminuria and it predicts the development of nephropathy. The onset of severely increased albuminuria is often followed by a slowly progressive decline in the renal function and, given enough time, end-stage renal disease in the absence of effective therapy. At an advanced stage of chronic kidney disease, uremic signs and symptoms can be present such as declining nutritional status, volume overload, fatigue and malaise, mild cognitive impairment, refractory acidosis, hyperkalemia, and hyperphosphatemia.
The first step in the prevention and treatment of diabetic nephropathy is proper glycemic control, which can partially reserve the glomerular hypertrophy and hyperfiltration, decrease protein excretion and slow the progression of renal function decline.
And while it is important to control blood sugar, it turns out that controlling blood pressure is at least as important. That’s because high blood sugar and high blood pressure work in concert to damage the blood vessels and organ systems.
Also, aggressive lipid lowering is an important part of the medical management of all diabetic patients since diabetes is considered a coronary heart disease equivalent.
In addition, changing the lifestyle has a big impact on the prevention and treatment of the diabetic nephropathy, the following measures are recommended:
Quit smoking, limit the amount of salt in the daily diet, reduce alcohol intake, eat more fruits and vegetables, lose weight if you carry excess weight, do regular aerobic exercise (walking, running) for 20 to 30 minutes most days of the week and do a protein restriction diet if overt kidney disease is present.
The optimal therapy of diabetic nephropathy continues to evolve and the best treatment is prevention before overt chronic kidney disease happens.
Diabetes and the Kidney
Sabine Karam, MD
Saint George Hospital University Medical Center
Clemenceau Medical Center
Assistant Professor of Clinical Medicine, University of Balamand
Diabetic kidney disease, or diabetic nephropathy, is a complication of type 1 or type 2 diabetes caused by damage to the kidneys’ filtering system.
The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from the blood. Severe damage to these blood vessels can lead to diabetic nephropathy. In this condition, the kidneys begin to leak and protein (albumin) passes into the urine.
Symptoms are usually late as kidney damage can begin 5 to 10 years before their onset. They include fatigue, nausea and vomiting, poor appetite, swelling of the legs and itchy skin.
In order to screen for diabetic kidney disease, a urine test that looks for albumin leaking into the urine should be ordered once a year in every diabetic patient in addition to a serum urea and creatinine levels.
Long-standing hyperglycemia is known to be a significant risk factor for the development of diabetic nephropathy. One cornerstone in the prevention and management of diabetic nephropathy is tight glycemic control.
Hypertension is another risk factor and control of hypertension has also been shown to be an important and powerful intervention in decreasing the progression of diabetic nephropathy. In general, blood pressure should be lower than 130/80 mmHg.
Kidney damage is also more likely if someone has type 1 diabetes that began before he was 20 years old, has family members who also have diabetes and kidney problems or smokes.
When kidney damage is caught in its early stages, it can be slowed with treatment. Once larger amounts of protein appear in the urine, kidney damage will slowly get worse. In advanced cases it can lead to the need for dialysis or a kidney transplant.