Diabetic Kidneys - This discussion focuses on kidney disease as a complication of diabetes
Dr. Harold Gunatillake FRCS - Health Writer
Diabetes is a very serious disease, one has to remember and a strict discipline needs to be exercised if you wish to live like the non-diabetics and enjoy a comparable life style. People having diabetes type 1 (juvenile type) have to be more careful from the time it’s diagnosed, whilst the majority who suffer late onset diabetes (type 11), in their sixties and after, need to adhere to a strict disciplined life style, too.
Twenty-six million Americans have chronic kidney disease, which has a number of causes — most often diabetes and high blood pressure. As the kidneys begin to fail, the body’s waste products build up in the bloodstream, leading to anemia, nerve damage, heart disease and other ailments.
People having diabetes run the risk of getting complications than most others, such complications as skin infections, vascular disease leading to amputations of limbs, hypertension, heart disease, stroke, cancer and kidney disease, among others. These complications are avoidable through a planned discipline.
Blood pressure needs to be watched weekly, whether you suffer from high blood pressure, or otherwise. Purchase your own blood pressure apparatus.
There are no early signs of kidney failure, and you need to check your kidney functions through blood and urine examination, annually. This is crucial that everyone with diabetes- and their doctors- watch for signs of kidney problems.
"Unfortunately, many people having diabetes don't realize that they have kidney disease," says Robert Stanton, MD, chief of nephrology at the Joslin Diabetes Center Clinic and associate professor of medicine at Harvard Medical School. "The obvious symptoms don't appear until the kidneys are failing." This complication is also called diabetic nephropathy and can lead to kidney failure
The obvious signs of kidney problems appear after there has been significant damage to the kidneys. They may include foamy urine, weight gain, water retention, loss of appetite, and feeling unwell. Anyone with those symptoms needs to see a doctor right away.
You need to understand your disease by reading books on diabetes and questioning your doctor, when you visit him regarding your specific problems. Some patients are too intimidated to ask questions or request a clarification.
They may regard all medical matters to be the doctor’s purview. Or they may be fatalists who assume whatever will be, will be. In Sri Lanka the common talk among most lay people is that the specialists may not like you’re asking questions, and in most situations get angry.
Though diabetes is a serious chronic illness, you could be the master and the doctor and take charge the control and lead quite a normal healthy life.
There is good news: Simple tests can monitor kidney function and detect early diabetic kidney disease. Treating early disease can make a huge difference. Medications, dietary changes, and good control of glucose levels and blood pressure can slow down or prevent kidney damage.
Studies have shown that strict control of your blood sugar can delay the onset of kidney disease. Your doctor may put you on insulin injections for easier and better control of your blood sugar. Control with tablets lowering blood sugar may not be sufficient when kidney damage is detected.
The kidneys filter the blood. They get rid of wastes (creatinine, urea, urates, chlorides (Cl), excess potassium (K) and Sodium (Na) in the body through urine, while the cleaned blood is sent back into the body.
In people with diabetes, the kidneys may be damaged so they don't filter blood as well. Small amounts of protein start to leak into the urine. This is referred to as micro-albuminuria. Blood pressure goes up, further stressing the kidneys, and larger amounts of protein are found in the urine. As these changes occur, the kidneys lose even more ability to filter the blood and waste products start to build up in the blood.
High blood glucose levels -- the defining symptom of diabetescan damage cells in the kidneys over time. Diabetes may be associated with other causes of kidney damage too, says Janet B. McGill, MD, an endocrinologist and professor of medicine at the Washington University School of Medicine, St. Louis.
Urine tests for protein, creatinine, and albumin.
Creatinine/ albumin ratio in the urine is also tested- normal below2.5mg.mmol)
Certain drugs and dyes are toxic to the kidneys and should be avoided by people with kidney disease. The drugs include painkillers like acetaminophen, aspirin and ibuprofen; laxatives and antacids that contain magnesium and aluminum (Mylanta and Milk of Magnesia); ulcer drugs like Tagamet and Zantac; decongestants like Sudafed; enemas that contain phosphorus (Fleet); and Alka-Seltzer, which is high in salt. Contrast dyes used for certain tests, like angiograms and some M.R.I.’s, can also be harmful to kidney patients.
¶ When kidney disease progresses, patients can develop symptoms like changes in urination; swelling in the legs, ankles, feet, hands or face; fatigue;skin rashes and itching; a metallic taste in the mouth; nausea and vomiting; shortness of breath; feeling cold even when it is warm; dizziness and trouble concentrating; and back or leg pain. If any of these occur, they should be brought to a doctor’s attention without delay.
Treatment for Diabetes and Kidney Damage
Keep Your Blood Pressure in Balance
Your comments and problems on the subject are most welcome.
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