Diabetes - A Major Risk Factor for Kidney Disease

Diabetes mellitus, usually called diabetes, is a disease in which your body does not make enough insulin or cannot use normal amounts of insulin properly. Insulin is a hormone that regulates the amount of sugar in your blood. A high blood sugar level can cause problems in many parts of your body.

The most common ones are Type 1 and Type 2. Type 1 diabetes is also called insulin-dependent diabetes mellitus. In this type, your pancreas does not make enough insulin and you have to take insulin injections for the rest of your life.

Type 2 diabetes, which is more common, usually occurs in people over 40 and is also called non-insulin-dependent diabetes mellitus. In Type 2, your pancreas makes insulin, but your body does not use it properly. The high blood sugar level often can be controlled by following a diet and/or taking medication, although some patients must take insulin. Type 2 diabetes is particularly prevalent among African Americans, American Indians, Latin Americans, and Asian Americans.

With diabetes, the small blood vessels in the body are injured. When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine. Also, waste materials will build up in your blood.

Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your 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 the urine that has a high sugar level.

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.

The earliest sign of diabetic kidney disease is increased excretion of albumin in the urine. This is present long before the usual tests done in your doctor's office show evidence of kidney disease, so it is important for you to have this test on a yearly basis. Weight gain and ankle swelling may occur. You will use the bathroom more at night. Your blood pressure may get too high. As a person with diabetes, you should have your blood, urine, and blood pressure checked at least once a year. This will lead to better control of your disease and early treatment of high blood pressure and kidney disease. Maintaining control of your diabetes can lower your risk of developing severe kidney disease.

As your kidneys fail, your blood urea nitrogen (BUN) levels will rise as well as the level of creatinine in your blood. You may also experience

• Nausea, vomiting, and/ or a loss of appetite
• Weakness and increasing fatigue
• Itching
• Muscle cramps (especially in your legs)
• Anemia (a low blood count)

You may find you need less insulin. This is because diseased kidneys cause less breakdown of insulin. If you develop any of these signs, call your doctor. 

Other signs of kidney disease in people with diabetes include:

• Albumin/protein in the urine
• High blood pressure
• Ankle and leg swelling, leg cramps
• Going to the bathroom more often at night
• High levels of BUN and creatinine in the blood
• Less need for insulin or antidiabetic medications
• Morning sickness, nausea, and vomiting
• Weakness, paleness, and anemia
• Itching

• Control your diabetes
• Control high blood pressure
• Get treatment for urinary tract infections
• Correct any problems in your urinary system
• Avoid any medicines that may damage the kidneys (especially over-the-counter pain medications)

The kidney doctor, called a nephrologist, will plan your treatment with you, your family and your dietitian. Two things to keep in mind for keeping your kidneys healthy are controlling high blood pressure in conjunction with an ACE inhibitor and following your renal diabetic diet. Restricting protein in your diet also might be helpful. You and your dietitian can plan your diet together.

End-stage renal failure, or kidney failure, occurs when your kidneys are no longer able to support you in a reasonably healthy state, and dialysis or transplantation is needed. This happens when your kidneys function at only 10 to 15 percent.

Three types of treatment can be used once your kidneys have failed: kidney transplantation, hemodialysis, and peritoneal dialysis. Learn more about treatment options for kidney failure.

Yes. Once you get a new kidney, you may need a higher dose of insulin. Your appetite will improve so your new kidney will break down insulin better than your injured one. You will use steroids to keep your body from rejecting your new kidney. If your new kidney fails, dialysis treatment can be started while you wait for another kidney. Learn more about kidney transplant.

Sometimes it is possible to perform a pancreas transplant along with a kidney transplant. Your doctor can advise you about this possibility.

Today, more and more research dollars are spent on diabetes research. Hopefully, the prevention and cure of diabetes are in the future. 

In the meantime, you can manage your diabetes better with:

• home monitoring of your blood glucose levels
• maintaining an awareness of controlling your blood pressure, and possibly monitoring your pressure at home
• following your special diet.

If you would like more information, please contact NKF Cares.

©2015 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.

Diabetes and Chronic Kidney Disease Basics: Part 1