HELP ON DIABETES

DIABETIC KIDNEY DISEASE

The kidneys function to remove excess salt and water and the waste chemicals made by the body. They work a little bit like a strainer—allowing salt, water, small pro­teins, and various chemicals (but not the large proteins and blood cells) to pass through into the kidney tubules. Later, many of these fi ltered chemicals as well as small proteins, salt, and water that the body still needs are reabsorbed by the kidney tubules, leaving behind the excess salt, water, and waste chemicals to form the urine.

Over many years, high glucose levels can injure the kidneys filtering mecha­nisms as well as the absorption mechanisms. The degree of injury can be assessed with two measurements:

• A protein called albumin in the urine 
• A chemical called creatinine in the blood 

  Normally, the amount of albumin in the first morning sample of urine is less than 30 mg per gram creatinine, but with kidney damage due to diabetes, this value can increase. When the value is in the 30 to 300 range, it is called microalbuminuria, and when it is more than 300, then the condition is called macroalbuminuria.

  Creatinine, on the other hand, is a chemical in the bloodstream that is released by muscles and removed from the body by the kidneys. The kidneys are quite effi cient at removing the creatinine, and the blood creatinine level does not go up until the kidney damage is significant.

Treatment

Treatment of diabetic kidney disease is directed at preventing further damage to the kidneys with the following interventions:

• Maintain good glucose control. 
• Control blood pressure. 
• Restrict protein intake: there is some evidence that kidney disease is made worse by a diet that is high in protein, so your doctor may recommend a low-protein diet. 
• Stop smoking. 
• Reduce weight: obesity is a risk factor for microalbuminuria, and it is possible that weight loss can reduce the protein loss. 
• Avoid medications that can cause further kidney damage. 

In severe kidney failure, when 80 to 90 percent of kidney function is lost, the kidneys can no longer remove the waste products and excess salt and water from the body. When this happens, the person with kidney failure will need dialysis, a medi­cal procedure for removing toxic waste products from the blood, and/or a kidney transplant.