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.

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