How Does Diabetes Cause Kidney Disease?

Diabetic nephropathy

Kidneys are remarkable organs. Inside them are millions of tiny blood vessels that act as filters. Their job is to remove waste products from the blood.

Nephropathy means kidney disease or damage. Diabetic nephropathy is damage to your kidneys caused by diabetes. In severe cases it can lead to kidney failure. But not everyone with diabetes has kidney damage.

Sometimes this filtering system breaks down. Diabetes can damage the kidneys and cause them to fail. Failing kidneys lose their ability to filter out waste products, resulting in kidney disease.

How Does Diabetes Cause Kidney Disease?

When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood.

Diabetes can damage this system. High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak and useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria.

When kidney disease is diagnosed early, during microalbuminuria, several treatments may keep kidney disease from getting worse. Having larger amounts of protein in the urine is called macroalbuminuria. When kidney disease is caught later during macroalbuminuria, end-stage renal disease, or ESRD, usually follows.

Diagnosing Diabetic Nephropathy

Screening for diabetic nephropathy should start within five years of a diagnosis of type 1 diabetes, or at the onset of puberty, whichever comes first. Screening for diabetic nephropathy in people with type 2 diabetes should take place within one year of diagnosis. All people with diabetes should then be screened annually, particularly after microalbuminuria has been detected.

Diabetic nephropathy and microalbuminuria are best diagnosed with a urine sample. It is important to avoid urine testing during an ongoing urinary tract infection or another acute illness, after strenuous exercise, or with uncontrolled high blood pressure or heart failure. Any of these conditions can cause blood and albumin to show up in the urine, resulting in an inaccurate measurement.

Treatment of Diabetic Nephropathy

The first line of defense against diabetic nephropathy is a healthy lifestyle, including a low-fat diet, light-to-moderate exercise regimen, smoking cessation, and avoiding excessive alcohol consumption in an effort to keep blood sugar levels in check and reduce blood pressure.

Albuminuria can be reversed by taking certain blood pressure medications, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers, which are particularly beneficial for both lowering blood pressure and protecting the kidneys in people with diabetes. A blood pressure under 130/80 mmHg should be targeted by people with diabetes. Reaching this goal often requires taking more than one blood pressure medication.

Another important factor in managing diabetic nephropathy is to keep blood sugars in check using insulin and possibly other medications as well. The target A1C level (a measure of average blood sugar levels during the last few months) for a patient with diabetic nephropathy is less than 7%.

Along with managing blood pressure and blood sugars, patients with diabetic nephropathy also benefit from lowering cholesterol and preventing obesity. There is some evidence that reducing protein in the diet will help prevent the progression of kidney disease. There is, however, some controversy regarding this theory.

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