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Diabetes and the Kidneys


When the small vessels in the kidney are damaged by high blood sugars this is known as diabetic nephropathy.

The kidneys filter waste products from the body and pass them out in the urine. This detoxifies the body and regulates water balance.

If blood glucose values have been persistently high over many years the membranes of the kidney may become leaky and no longer able to filter waste products as efficiently from the body.

Tests which assess kidney function


Urine Test: Carried out ideally on an early morning sample of urine. Usually urine only contains smaller amounts of protein. If there are changes in the kidney function due to diabetes, more protein will be passed in the urine.

Blood Test: This measures how well the body is filtering out waste products for example estimated Glomerular Filtration Rate (eGFR) or Creatinine level.

Blood Pressure: Normal blood pressure protects the kidney. If there is already damage to the kidney it is important to maintain the blood pressure at normal level. High blood pressure will aggravate the kidney damage. Kidney damage consequently will increase blood pressure thus creating a vicious circle. Self Monitoring of blood pressure may be advantageous.

Screening and Monitoring


In the diabetes clinic you will be screened regularly to pick up early stages of diabetic kidney disease by urine and blood tests. If kidney damage is found, you will be given advice and treatment to protect the kidneys and prevent this getting worse.

Treatment


A slight increase in urinary protein may be reversible by maintaining good blood sugar and blood pressure readings. A tablet called an Ace inhibitor e.g Ramipril, Captopril, Enalapril or an Angiotensin Receptor Blocker (ARB) e.g. Valsartan, Candesartan, Irbesartan, Losartan can also slow down the process.

In a small number of cases, the kidney function can deteriorate and rarely dialysis may be necessary and kidney transplantation may be considered.

Screening and prevention are however the best strategy.


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