Ask the Doctor
Questions about kidney disease? Risk factors? Signs and symptoms? Are you concerned about yourself, a friend or family member? Ask Dr. Spry.
By Laura Byham-Gray, PhD, RD, CNSD
Keeping in good blood glucose control is important for lowering your risk for health complications. Glucose, often described as sugar, is made by the body, usually after eating, and serves as the fuel for every body cell. Diabetes mellitus, either type 1 or type 2, is the leading cause of kidney disease. When blood glucose levels stay high and uncontrolled over a period of time, blood flow to the kidneys is impaired, resulting in damage to the kidneys and their important functions. In addition, high blood glucose levels will lower the ability of the nerves to empty the bladder. The urine that stays in the bladder may then cause added pressure to build up, and may injure the kidneys.
In order to prevent or delay kidney disease from developing, you must be aware of its early and late stage signs and symptoms. The presence of albumin (a type of body protein) in the urine is the first sign of kidney disease, even before abnormalities in blood are found. Albumin in your urine may also be an early sign of changes in your blood. Other early signs of potential problems with kidney function include frequent trips to the bathroom and high blood pressure. Treatment at these early stages may lower the likelihood that kidney disease will progress to kidney failure. Later symptoms of kidney disease include edema (swelling of legs and ankles) and leg cramps. Changes in blood are found at this time, such as high levels of blood urea nitrogen (BUN is a substance your body makes when it uses protein) and lowering of the glomeruler filtration rate (GFR), which identifies your current level of kidney function. You may also feel tired and weak, which may be a sign of anemia (low red blood cell count). Other people may experience nausea and vomiting, or have itchy skin. Lastly, you may notice that you need less insulin or diabetes medication taken by mouth, since the diseased kidneys cannot break down or metabolize the insulin, and your body does not need as much.
The leading cause of death in the United States is heart disease; having both diabetes and kidney disease increases your risk. It is well known that high blood glucose levels that stay high over a period of time create changes in the blood vessels, leading eventually to heart disease. On the other hand, the relationship between kidney disease and heart disease is complex, and seems to be related to many factors, including anemia, malnutrition, or infections, as well as mineral and bone disorders.
Being involved in your treatment plan is essential! Checking your blood glucose levels at home and making sure that your hemoglobin A1C (a blood test that tells how well your blood glucose has been controlled over the last few months) is less than seven percent is first and foremost. Keeping in good glucose control is the best way to lower your risk of both kidney and heart disease. Follow-up with your primary care doctor or endocrinologist (a doctor specializing in diabetes) to make sure that you have your urine tested at least once a year to find any early changes in kidney function. You should also have your blood checked regularly for calcium, phosphorus and parathyroid hormone (bone hormone) to be sure that your bones are healthy. Other tests should include your total blood count (so that anemia can be treated early), as well as blood cholesterol type and level. Make sure you have your blood pressure checked often, and remember to take blood pressure medication if prescribed. Follow your diet for weight and blood glucose control, and get plenty of regular exercise. Avoid alcohol and cigarettes. If you have any of the symptoms identified above, you should see your doctor immediately.
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©2013 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. No one associated with the National Kidney Foundation will answer medical questions via e-mail. Please consult a physician for specific treatment recommendations.