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Diabetes Complications: Kidneys

The kidney complication of long-standing diabetes-nephropathy-is due to small vessel disease. The kidneys are made of millions of filtering units. Long standing diabetes may affect capillaries of these filtering units. In the early state, small amount of protein may begin to leak (microalbuminuria Ch.4) intermittently into the urine. Later, the urinary protein loss is constant and considerable.

This urinary protein loss depletes the blood proteins, giving rise to swelling of the body. With the passage of time, the filtering units gradually close down, giving rise to kidney failure and high blood pressure. Repeated urinary tract infections aggravates kidney failure. The products of protein breakdown like urea and creatinine are mainly excreted by the kidneys. Hence, these waste products accumulate in blood when the kidney function deteriorates. With kidney failure, the patient often develops loss of appetite, nausea, vomiting, weakness, puffiness of face, sallow complexion and headaches.

Individual and familial predisposition and hypertension have a role in diabetic nephropathy. There is high risk of cardiovascular disease.

The daily dietary protein is restricted to 0.7 to 1 g per kg weight, care being taken that malnutrition does not develop. The intake of sodium is also restricted. The intake of fluids is adjusted according to the urine output. Tight control of blood pressure is essential, the drug of choice being ACE inhibitors. Statins and aspirin are also given.

The kidney threshold of glucose is elevated when the kidney function is impaired. Hence, glucose may not spill in urine although the blood glucose level is high. The insulin requirement often diminishes when the kidney function is compromised. Oral drugs like chlorpropamide and glibenclamide which are excreted by the kidney and metformin are best avoided when the kidney function is impaired; short acting glipizide and gliclazide are preferred. Drugs of meglitinde group are not excreted by kidneys, hence they are safe in diabetics with kidney disease.

Diabetics with end stage renal {about kidney) disease can be helped by dialysis or artificial filtration of blood. This can be carried out either with the help of a machine, popularly known as artificial kidney or by peritoneum, the lining of the abdomen.

Instructions of the dialysis unit regarding insulin and other medicines on the day of dialysis, should be followed. The ultimate answer to the problem of the end stage kidney disease is transplantation of the kidney. Kidney transplants can be carried out successfully in diabetics too. Simultaneous kidney and pancreatic transplants are carried out successfully in diabetics.

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Diabetes Complications: Kidneys