Kidney failure is one of the two most feared complications of diabetes, blindness being the other. Both of these diabetes complications are preventable or can be slowed down if and when they occur.

About 5% of all Americans suffer from diabetic nephropathy. Persons with either type 1 or type 2 diabetes are susceptible to this condition. Diabetic nephropathy is not present at the time of diagnosis of people with type 1 diabetes. However, since persons with type 2 diabetes can go for years with the disease before being properly diagnosed, this allows nephropathy to sometimes be present at the time of diagnosis too.

High blood pressure, also called hypertension, is another frequent cause of kidney failure even if you don’t have diabetes. But when poor diabetes control and untreated high blood pressure join forces, kidney damage is almost a certainty.

In its early stages it’s completely silent. This makes it extremely important to screen all persons with diabetes for early evidence of kidney damage. Simple screening tests can be done by your doctor that involve nothing more than a random urine sample. This test is called a urine microalbumin study.

Damage to the kidneys causes protein to be spilled into the urine. Normally, kidneys don’t spill any protein at all into the urine. When protein is present in small quantity, the term is called microalbuminuria. When protein in the urine is relatively large in amount, doctors call that proteinuria. In diabetic kidney disease, microalbuminuria precedes proteinuria. The presence of microalbuminuria predicts future development of proteinuria, which ultimately predicts end stage kidney disease. Discovering microalbuminuria early allows you and your doctor to treat it and prevent or slow down further loss of kidney function.

If you have type 2 diabetes, you should get your urine microalbumin test done at the time of your diagnosis and once a year thereafter. Blood tests for kidney function (such as the BUN and creatinine level) are not as sensitive as this simple urine test for uncovering the early stages of diabetic kidney disease. If you have type 1 diabetes, it’s usually alright to wait five years after diabetes diagnosis before starting a yearly testing schedule, but some doctors may order it sooner.

If you have a positive microalbumin test, then more urine and blood tests will be done to measure the extent and severity of the problem. It’s important to know that just having a positive urine microalbumin test is not a guarantee that your kidneys are going to fail. That fate is largely in your hands.

Managing your diabetes well and keeping blood pressure under tight control will prevent or slow the progression of kidney disease in diabetics. Specifically, get your blood test called the hemoglobin A1C as low as possible (ideally below 7%) and then keep it there. The A1C test should be checked every 3 months. Then make sure your blood pressure stays below 120/80 (ideally below 115/75) by lowering salt intake, regular exercise, and medications if needed. Most experts now consider a blood pressure of 115/75 or lower as “ideal” for adults with diabetes. Lower blood pressure exposes the kidney’s filtering units to less wear and tear compared to higher readings. This helps to preserve their function. Never give up on your diabetes and blood pressure control. These are the best two defenses against ever going on a dialysis machine due to diabetes.

The type of blood pressure medication you take may make a big difference. Research has shown that the class of blood pressure pills called ACE inhibitors will actually protect kidneys from further damage and even prevent early kidney damage from happening. The names of all ACE inhibitors end with the term “-pril”, such as enalapril, captopril, fosinopril, or lisinopril. Dry cough is a common side effect of this class of medicines. Another class of blood pressure pills known as “ARB’s” works in a similar way, but they don’t cause a dry cough side effect. Their names end with the word “-artan”. Examples include losartan, irbesartan, and candesartan.

Research has shown that kidney damage from diabetes is related to low grade inflammation within the filtering units of the kidney. This discovery opens the door for further research to develop ways to block this process with anti-inflammatory or even antioxidant drugs.

Even if you must go on dialysis, diabetics on dialysis lead productive lives for years. For some, dialysis may only be a temporary step before a kidney transplant is performed.

This article originally featured in the Caller-Times, Corpus Christi, Texas. For current articles written by Steve check out http://www.caller.com where he is a featured columnist.

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This entry was posted on Sunday, August 23rd, 2009 at 11:25 am and is filed under Complications. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.