Kidney Symptoms and Complications of Diabetes

Diabetic nephropathy is a common complication of diabetes. But exactly what is it? This is when your kidney can no longer function properly because of damage caused by high sugar levels. Protein can show up in the urine years before other symptoms of kidney damage. And high blood pressure often goes along with diabetic kidney damage.

As times goes by, the injury may lead to chronic kidney failure, which, after an average of 2-6 years can in turn develop into end-stage renal disease. Diabetes is the most common cause of end stage kidney disease in America. The risks are higher in people with diabetes whose glucose levels are poorly controlled. And poorly controlled high blood pressure significantly hastens kidney damage.

Symptoms are what the person experiences to suggest there may be a health problem

You will not experience any symptoms at all with early stage diabetic nephropathy. Symptoms appear after much damage is done, and may be a result of kidney failure or spilling high amounts of protein in the urine.

Symptoms may include:
• Fatigue
• Foamy appearance or excessive frothing of the urine
• Frequent hiccups
• General ill feeling
• Generalized itching
• Headache
• Nausea and vomiting
• Poor appetite
• Swelling of the legs
• Swelling, usually around the eyes in the mornings; general body swelling may occur with late-stage disease
• Unintentional weight gain (from fluid build up)

Signs and tests

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So, if there are no symptoms, how do you prevent this serious complication? The answer should come as no surprise - blood sugar and blood pressure control and regular doctor visits. The first laboratory abnormality that indicates kidney damage is a positive microalbuminuria test. This result often means you have at least some damage to the kidney from diabetes. Damage at this stage may be reversible through diet, exercise and/or medications.

Most often, your doctor will suspect kidney damage when a routine urine test shows too much protein in the urine (proteinuria) of someone with diabetes. This test may also show glucose in the urine, especially if blood sugar is poorly controlled.High blood pressure may be present or develop rapidly as a result of kidney damage. It may be difficult to control. Labs such as Serum creatinine and BUN increase as kidney damage gets worse.

TREATMENT

How is diabetic nephropathy treated, and what are the goals? The answer is, treatment of diabetic kidney disease is intended to slow the progression of kidney damage and control complications. The main treatment is keeping blood pressure under control (to levels less than 130/80.) If possible, a type of blood pressure medicine, either ACE inhibitors or angiotensin receptor blockers (ARBs), should be used since these drugs slow down the kidney damage. Many studies have suggested that a combination of these two types of drugs may be best.

You must recognize and acknowledge that uncontrolled high blood pressure is an enemy of your health. The most effective method of slowing kidney damage from diabetes is to control your high blood pressure, control lipid levels, maintain a healthy weight, and have regular physical activity.

Blood glucose levels should be closely monitored and controlled. This may slow the progression of the disease especially in the very early stages. You can change your diet to help control your blood sugar. See: Diet for people with diabetes

Medications to manage diabetes include glucose-lowering pills and insulin injections. Blood glucose must be monitored and the dose of insulin adjusted as needed. As kidney failure gets worse, less insulin is put out, so smaller doses may be needed to control glucose levels.


End stage kidney disease

So, what is end-stage kidney disease? End-stage kidney disease is a complete or near complete failure of the kidneys. In this condition, the kidney fails to get rid of wastes, concentrate urine, and regulate electrolytes. Also called End-stage renal disease (ESRD), this means that the kidney is only able to do 10% of its normal function; with wastes and fluids building up, without dialysis or kidney transplantation, complications are multiple and severe, and death will occur.

In the U.S., more than 400,000 people are on long-term dialysis and more than 20,000 have a functioning transplanted kidney. The most common cause of ESRD in the U.S. is diabetes. ESRD almost always follows chronic kidney failure, which may exist for 10-20 years or more before progressing to become ESRD.

Symptoms- In addition to those associated with chronic liver disease, symptoms of ESRD can include:
• Greatly decreased urine output
• No urine output
• Easy bruising or bleeding
• May have blood in the vomit or stools
• Decreased alertness
o drowsiness, somnolence, lethargy
o confusion, delirium
o coma
• Muscle twitching or cramps
• Seizures
• Increased skin pigmentation
• Skin may appear yellow or brown
• Nail abnormalities
• Decreased sensation in the hands, feet, or other areas

Treatment for End Stage Renal Disease

The only treatments for ESRD are dialysis or kidney transplantation. The physical condition of the person and other factors determines which of these is used. Other treatments of chronic kidney failure may continue but are unlikely to work for ESRD without dialysis or transplantation. Current therapy includes aggressive treatment of high blood pressure with an ACE inhibitor or an angiotensin receptor blocker.

Blood transfusions and medications such as iron and erythropoietin may be needed to control anemia. Fluids may be restricted to an amount nearly equal to the volume of urine produced.

Dietary restrictions may slow the build-up of wastes in the bloodstream and control associated symptoms such as nausea and vomiting. Restrictions include a low- protein diet, with high carbohydrate levels to make up for the lost calories. Salt, potassium, phosphorus, and other electrolytes may be restricted.

Expectations (prognosis)
Even after dialysis or transplantation, people with End Stage Renal Disease and diabetes tend to do worse than those without diabetes.

LINK to Retinopathy, neuropathyGraphicSee Eye Complications of Diabetes