RELATIONSHIP OF DIABETES MELLITUS TO KIDNEY DISEASE

Diabetes mellitus (commonly called diabetes) is, in fact, a major cause of kidney disease and
kidney failure. It is a disease in which the pancreas produces insufficient amounts of insulin, or in which
the body’s cells fail to respond appropriately to insulin.
Diabetic kidney disease, if uncontrolled, can result in kidney failure and the need for dialysis or
kidney transplantation. Persistently elevated blood pressure increases the risk, as do high blood sugar,
cholesterol, and triglyceride levels. Insulin is a hormone that helps the body’s cells to absorb glucose
(sugar). The body uses glucose as a prime source of energy. Diabetes Mellitus causes glucose levels to
build up in the blood and urine. This causes excessive urination, thirst, hunger, and problems with fat
and protein metabolism.
Risk Factors

All individuals with diabetes are at risk for kidney disease. Pima Indians with type 2 diabetes have a
particularly high risk of kidney disease and African-Americans with type 2 diabetes appear to have more
than four times the risk of kidney failure, compared with Caucasians. This may also be true for Native
Americans and Mexican-Americans.

Risk factors include:

 Family history of diabetic kidney disease

 Poor blood sugar control
 Hypertension
 Dietary factors (see Nutritional Considerations below)
Other possible risk factors include obesity, increasing age, duration of diabetes, and smoking.

Diagnosis

 The first steps are a medical history and a physical examination.

 Blood and urine testing will be performed.

Treatment

 Control of blood sugar is essential for preventing further kidney damage.

 If blood pressure is not controlled through diet and lifestyle changes (to below 130/80),
treatment with ACE inhibitors (e.g., lisinopril) or/and angiotensin receptor blockers (e.g.,
losartan) helps prevent worsening of kidney damage. Calcium channel blockers or diuretics may
be appropriate substitutes.
  Control of cholesterol and triglyceride levels is important.
 Weight loss is helpful, perhaps because of its beneficial effects on blood sugar, blood pressure,
and cholesterol.

Nutritional Considerations

Reducing saturated fat, cholesterol, and animal protein intake may reduce the risk for kidney damage.
Excessive intake of total protein and animal (not vegetable) protein has been shown to be a risk factor
for abnormal kidney function. In short-term studies, vegetarian diets and diets deriving protein primarily
from soy and other plant sources have improved kidney function. These diets also improve blood
pressure control, which further helps reduce the risk for kidney damage. In addition, dietary sodium
restriction is recommended.

How can diabetes mellitus affect the kidneys?

 Diabetes causes damage to the small blood vessels in the kidney. When these blood vessels are
injured, the kidneys cannot perform their function properly. Consequently, excess water and salt is
retained in the body. The excess fluid in the body can result in weight gain and swelling of the ankles.
In some cases it may take many years for someone with diabetes to develop kidney disease.
Sometimes, the filtering function of the kidneys is actually higher than normal, in the first few years of
developing diabetes. This process is known as hyper-filtration. This happens as the kidneys try to
respond to the excess glucose in the blood. Over time, however, this begins to affect the kidneys and
their filtering function begins to drop.
Generally, kidney damage rarely occurs within the first 10 years of diabetes. Sometimes, as
much as 25 years will pass before there are any signs of kidney failure. The risk of developing kidney
failure decreases, for most people who live with diabetes for more than 25 years, without any signs of
kidney damage. Diabetes is most common in adults over the age of 45 years. It is also more common in
women than in men and in people of African and Hispanic descent. Other risk factors for this disease are
obesity, physically inactivity, and having an immediate family member with diabetes. 

What are the symptoms of diabetes and kidney disease?

Due to low levels of insulin or the poor response to insulin caused by diabetes mellitus, the cells
are prevented from absorbing glucose. Consequently, there is a buildup of glucose in the blood.
When this blood (with excessive glucose) passes through the kidneys, these organs cannot
absorb all of the excess glucose. This excess glucose accompanied by water, goes into the urine and
causes frequent urination, in order to get rid of the additional water drawn into the urine.
This, in turn, triggers excessive thirst and hunger, to replace the water and the glucose lost in
urination. Additional symptoms of diabetes mellitus may include hypertension, blurred vision,
unexplained weight loss, irritability, weakness, fatigue, and nausea and vomiting.Diabetes is also a
contributing factor in many deaths from heart disease, kidney failure, and other conditions. This
condition should not be taken lightly.

Prevention is the best way to avoid the complications associated with diabetes and kidney disease. A
balanced lifestyle, healthy diet, regular exercise, and avoidance of harmful substances (such as tobacco
and drugs), will go a long way to preventing and slowing the effects of this terrible disease.

PHOEBE PEARL P. PADOLINA

BSNIV-9, GROUP 2