What You Need to Know About Diabetic Kidney Disease

Diabetic kidney disease or diabetic nephropathy (CKD) is a common complication of diabetes and one of the leading causes of chronic kidney disease and end-stage kidney disease in the western world. In 2018, It was the most common diagnosis for the initiation of renal replacement therapy in the United States accounting for 47% of the cases.[1]  About 30 percent of patients with Type 1 diabetes and 10 to 40 percent of those with Type 2 diabetes eventually will suffer from kidney failure.[2]

Diabetic kidney disease occurs because diabetes damages blood vessels and other cells in the kidneys that filter waste from blood. This can lead to kidney damage and high blood pressure. The latter can cause further kidney damage because it increases pressure in the kidneys’ delicate filtering system.[3]

Also, diabetes may cause damage to nerves in your body, which can cause difficulty in emptying your bladder. The pressure resulting from a full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that has a high sugar level.

Diabetic nephropathy can lead to kidney failure, called end-stage kidney disease, which is a life-threatening condition. Treatment options for kidney failure are dialysis or a kidney transplant.[4]

How long before diabetic kidney disease has an impact

The National Kidney Foundation says that almost all Type I diabetes patients will develop some evidence of functional change in the kidneys within two to five years of the diagnosis. About 30 to 40% progress to more serious kidney disease, usually within about 10 to 30 years. Type II (adult-onset or non-insulin-dependent) diabetes has a less well-defined course. The understanding is that it follows a similar course, except that it occurs at an older age.[5]

Stages of diabetic kidney disease [6]^,[7]

There are five stages of diabetic kidney disease:

Typically, there are no symptoms in the early stages of diabetic kidney disease. Blood and urine samples can identify a specific protein called microalbumin in urine. If you have albuminuria, you may notice foamy urine. Two factors to consider as the disease progresses are:

·         Glomerular filtration rate (GFR): The GFR measures creatinine, a kidney waste product, in your blood.

·         Urine albumin-creatinine ratio (uACR): UACR indicates the amount of the albumin in your urine. Kidney damage often presents as having a urine albumin-creatinine ratio (uACR) of 30 or more for at least 3months

Stage 1: People with stage 1 have an estimated eGFR of 90 or higher and kidney damage (e.g., uACR 30 or higher) for 3 months or more. During stage 1, diabetic kidney disease symptoms include some damage to your kidneys. but they still are functioning.  Your urine has a little bit of protein in it.

Stage 2: eGFR 60-89 and kidney damage (e.g. uACR 30 or higher) for 3 months or more.  Your kidneys still are working well but symptoms of diabetic kidney disease may include some signs of damage with increased amounts of protein in the urine.

Stage 3

a:  Mild to moderate loss of kidney function (eGFR 45-59 for 3 months or more). Symptoms may start to appear.

·         urinating (peeing) more often or less often than usual

·         itchy and/or dry skin

·         feeling tired

·         nausea

·         loss of appetite

·         weight loss without trying to lose weight

b: Moderate to severe loss of kidney function (eGFR 30-44 for 3 months or more). Symptoms:

• more or less frequent urination
• itchy or dry skin
• fatigue
• difficulty concentrating
• swelling or numbness in your arms, feet, ankles, legs
• sore or cramping muscles
• shortness of breath
• loss of appetite
• nausea and/or vomiting

Stage 4: Severe loss of kidney function (eGFR 15-29 for 3 months or more). You also have a high risk of heart disease. In addition to the symptoms of earlier stages, stage 4 diabetic kidney disease symptoms may include:

• breath that smells fishy or like ammonia
• trouble sleeping

Stage 5: End-stage kidney failure (eGFR less than 15 for 3 months or more) or you are on dialysis. Diabetic kidney disease symptoms in addition to those present in earlier stage include:

• confusion
• seizures, in extreme cases

Once kidneys are affected it may be possible to prevent or delay the progression of kidney disease. Since high blood pressure is one of the major factors that can indicate which diabetics will develop serious kidney disease, if you have high blood pressure, it is important to take blood pressure medicine as prescribed.  Your doctor may also recommend that you follow a low-protein diet since this will reduce the amount of work your kidneys must do.  Also, continue to follow your diabetic diet and to take all your prescribed medicines. [8]

Steps to prevent diabetic kidney disease

To slow or prevent diabetic-kidney disease, following these guidelines from the CDC[9]

·         Get tested yearly

·         Meet blood sugar targets as often as you can.

·         Get your A1C level tested at least twice a year, but ideally up to 4 times per year.

·         Control your blood pressure

Other recommended lifestyle changes to manage blood glucose and blood pressure, which will help to keep kidneys health include:

·         Stop smoking.

·         Follow a diabetes meal plan prescribed by a dietician and limit salt and sodium

·         Get active

·         Stay at or get to a healthy weight.

·         Get enough sleep. Aim for 7 to 8 hours of sleep each night

·         Take all your prescribed medications

·         Limit alcohol consumption

·         Stay in your target cholesterol range

You also want to see your health care team regularly to ensure you are on the right track managing your diabetes and to check for diabetic kidney disease and other diabetes complications.

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