Diabetes & Hypertension

Your Kidneys & Diabetes

Diabetes - The #1 Leading Cause of Kidney Failure

Diabetes is a chronic disease that affects blood sugar levels; there is no cure. There are several types of pre diabetic and diabetic stages that affect about 17 million people in US. Diabetes occurs when the body does not make enough insulin (a hormone that regulates the amount of sugar in the blood) or when the body cannot use normal amounts of insulin properly.

High blood sugar levels can cause problems in many parts of the body, including kidneys. The high blood sugar levels in diabetics cause kidney damage through a number of different mechanisms, all which results in scar formation within the kidneys. This results in a leakage of protein which is an important sign of diabetic gamage to the kidney.

Risks For Diabetes

Family history of diabetes
Over 40 years old
Overweight
Lack of regular exercise
Low HDL cholesterol or high triglycerides
Certain racial & ethnic groups (African Americans, Latinos, Asians, Native Americans)
Women with gestational diabetes or who had a baby with a birth weight of 9+ lbs.

Warning Signs of Diabetes

Frequent urination
Increased need for liquids
Extreme hunger
Unintentional weight loss
Unexplained fatigue
Irritability

What does diabetes do to the kidneys?

Diabetes injures small blood vessels in the kidneys. When the blood vessels in the kidneys are injured, kidneys cannot clean blood properly. This can cause the body to retain more water and salt than it should, leading to weight gain and ankle swelling. Protein may be present in the urine and waste materials can build up in the blood.

Diabetes may cause nerve damage, which can cause difficulty in emptying the bladder. The pressure that results from a full bladder can back up and injure the kidneys. An infection can occur if urine stays in the bladder for a long time; bacteria grows rapidly in urine with a high sugar level.

Diabetic kidney damage is also known as diabetic nephropathy. When the blood vessels to the kidney change, this affects the blood filtering units, glomeruli nephrons, of the kidney. The damage causes leakage of protein in the urine, a symptom of kidney failure. Protein in the urine can be detected by dipping an indicator strip into the urine. Presence of abnormal amounts of protein in the urine is called proteinuria.

What are the chances of developing kidney disease if you have diabetes?

Type I (juvenile onset) – 30% develop kidney disease

Type I diabetes is an autoimmune disease in which the immune system attacks the insulin producing cells in the pancreas. Over a period of time those cells are destroyed. It tends to develop during childhood and insulin shots are usually necessary. Treatment consists of a healthy diet, exercise, and insulin shots to replace the insulin that the body no longer produces. Most insulin-dependent diabetics test blood glucose levels several times per day in order to keep blood glucose or blood sugar levels within a safe range.

Type II (adult onset) – 5% to 10% develop kidney disease

Type II diabetes is the most common form of diabetes; 90% of diabetics fall into this category because a far greater number of the population has Type II diabetes. With Type II diabetes, glucose builds up in the blood. Although this was once called “adult onset diabetes”, the increasing number of adolescents and teenagers diagnosed with it renders the nomenclature inaccurate. Type II diabetes is not easily defined because it encompasses a range of different diseases. In some cases the pancreas overproduces insulin (insulin resistance) while in other cases, cells respond normally to insulin but the pancreas doesn’t produce enough insulin.

What Are the Signs & Symptoms that kidneys are starting to fail?

When the kidneys start to deteriorate, waste products including urea, protein and creatinine will accumulate in the body. Creatinine, a breakdown product of muscle, is usually an indicator for the degree of kidney failure. Creatinine rises as kidney failure progresses. When the blood creatinine level reaches more than 10 mg./dL, the patient has end stage kidney failure and needs dialysis.

What are the early signs of kidney disease for people with diabetes?

Protein in the urine
High blood pressure
Ankle and leg swelling, leg cramps
Going to the bathroom more at night
High levels of waste materials in the blood
Morning sickness, nausea and vomiting
Weakness, paleness and anemia
Itching
Less need for insulin or anti-diabetic pills

What can people with diabetes do to prevent kidney damage?

Maintain control of your blood sugar level
Have your blood pressure checked regularly (125/70 to 130/80)
Take all medications as directed by your doctor
Get 7 to 8 hours of sleep per night
Follow diabetic diet (restriction of protein, salt, potassium, phosphate and water)
Consult your renal dietician
Exercise regularly
Avoid NSAID (non-steroidal anti-inflammatory drugs)
Treat urinary tract infection promptly
Avoid alcohol and tobacco
See doctor as recommended

If diabetes has affected the kidneys, what can be done?

If you have any signs of kidney disease, contact your doctor. With blood and urine tests, your doctor can tell how your kidneys are working and will order the best treatment for you. Together you can work to keep your kidneys working as long as possible.

W hat treatments are available for end stage kidney failure?

Treatments available for end stage kidney failure are hemodialysis, peritoneal dialysis and kidney transplantation.

What are some concerns, if I'm diabetic with kidney disease?

Medication

Vitamins, calcium, anti-hypertensives and diuretics may be added as kidney failure advances. Sugar control may appear easier in some patients with advancing renal failure. Close monitoring is needed to adjust the doses of anti-diabetic medicine. Long acting oral anti-diabetic medication used in normal kidney function may not be suitable for diabetic patients with kidney failure.

Infection

As kidney function decreases, the body will be very susceptible to infections.

Monitoring Of Sugar Level

You can check your own sugar level daily by doing a finger prick test using a blood glucose meter to read your daily glucose level. Blood glucose levels will tell the doctor how well the patient is controlling his or her blood sugar level. Your doctor may also order blood test for HbA1c. This will let the doctor know how well the blood sugar level has been controlled over the last three months.

Dental Appointments

If you have dental appointments, do inform your dentist that you are diabetic, so that he can give you a dose of antibiotics before under going any dental work. Do not forget to inform your dialysis nurse that you have dental appointment. Heparin during haemodialysis may be reduced to prevent any bleeding during the dental work.

What else can I do as a diabetic with end stage renal failur on dialysis?

Take care of your personal hygiene; shower every day.
Take care of the fistula arm, to prevent any infection and blockage.
Check on toes and feet daily as taught by your diabetic nurse.
Check your eyesight.
Follow up with your various doctors regularly and do not miss appointments.
If there's broken skin, clean and dress the wound then monitor the wound. If it does not heal, you must go to the doctor for treatment.

Your Kidneys and Hypertension

Hypertension - The #2 Leading Cause of Kidney Failure

High blood pressure, hypertension, is a condition that occurs when increased resistance to blood flow through small blood vessels, arterioles, forces the heart to work harder. When the heart has to pump harder, the blood travels through the arteries at a pressure that can damage the inside walls of blood vessels. High blood pressure affects some 50 million Americans, its incidence increases with age, and it is more common among African Americans and older women. High blood pressure can lead to heart, brain, kidney, and eye damage, and left untreated, it increases the likelihood of stroke and congestive heart failure. These risks are significantly reduced with proper treatment.

Why is blood pressure important?

Without pressure in your blood vessels, your blood could not circulate through your body bringing to your vital organs the oxygen and food they need to keep functioning.

What does high blood pressure mean?

The harder it is for the blood to flow through your blood vessels, the greater the strain on your heart. If the pressure in your arteries increases to 140/90 (or more) and stays there, you have high blood pressure, also called hypertension.

What factors contribute to high blood pressure?

Factors might include heredity, age, race, obesity and sensitivity to salt. Other factors are heavy alcohol consumption, the use of birth control pills and the lack of adequate exercise.

How can I tell if my blood pressure is high?

There may be no symptoms. The only way to be sure that you have high blood pressure is to have your blood pressure measured. It is important to have it checked at least once a year by a qualified health professional.

What should I do if I'm diagnosed with high blood pressure?

Have your blood pressure checked regularly
Know what your weight should be and keep it at that level or below
Do not use excessive salt in cooking or at meals; avoid salty foods
Eat a low-fat diet recommended by your physician
Do not smoke cigarettes
Take your medicine exactly as prescribed; don't run out of pills even for a single day
Follow your doctor's advice about exercise
Live a normal life in every other way
Keep your appointments with the doctor, so that your blood pressure program can be monitored and necessary adjustments made

What is the connection between kidneys and high blood pressure?

High blood pressure is thought to be due to a subtle abnormality of kidney function. When uncontrolled, very high blood pressure is up to 20 times more likely to result in kidney failure. High blood pressure is not something to take lightly. On the average, individuals with uncontrolled high blood pressure are three times as likely to develop angina and heart attacks, six times as likely to develop heart failure, and seven times as likely to have a stroke as individuals with controlled high blood pressure. In addition, people with kidney disease due to diabetes who control their blood pressure are half as likely to lose kidney function.

If you have any questions, call Kidney Foundation of Greater Cincinnati at 513.961.8105.