Diabetes strains the kidneys and increases their workload, which causes inflammatory changes. Over time, these changes can contribute to scarring and a worsening of kidney function. There are many ways that diabetes can affect the kidneys. Let's take a look at them, starting with proteinuria, which is the main way the kidneys are impacted by diabetes.
|Diabetes And Chronic Kidney Disease|
If you remember, proteinuria is the single most reliable predictor of worsening kidney function. In diabetes, doctors watch the protein levels in the urine closely. They will often order a special type of urine protein test called albumin, because it is a very good indicator of early kidney damage. Measured in milligrams (mg), a level less than 30 is considered normal.
If you have between 30 and 300 mg of albumin in the urine, your doctor will likely start treatment involving the use of certain medications and lifestyle changes. If you have more than 300 mg of albumin in your urine, referral to a nephrologist is strongly recommended. In addition, diabetes and proteinuria can affect the integrity of the blood vessels, increasing inflammation and the risk of atherosclerosis in the kidney, heart, and a number of other organs of the body.
High Blood Sugar, High Blood Pressure, and Obesity
In addition to proteinuria, high glucose (blood sugar) levels can also increase the stress and workload on the kidneys. This is why tight control of blood sugars is so important. Many people with diabetes, especially type 2, also have high blood pressure and are obese, both of which can also contribute to a worsening of kidney function.
The RAA System
Diabetic nephropathy affects the kidneys through the effects of the RAA system. The hormones in this system regulate blood pressure and are also responsible for increasing the inflammatory response in the kidneys. By increasing the activity of cytokines like TGF-beta, the RAA system can worsen proteinuria and increase scarring and fibrosis in the kidneys. This is why I believe that diabetes is an inflammatory condition, and the RAA system is an important contributor to this inflammatory process.
The Angiotensin Converting Enzyme (ACE) Gene
There is evidence that genes - or DNA - can influence how our bodies are affected by states like diabetes. A certain gene called the angiotensin converting enzyme, or ACE, may in part determine the degree to which the kidneys are affected. Variations in this gene may significantly contribute to the differences concerning the extent of kidney damage and proteinuria in different people with diabetes.
The ACE gene is being researched for other medical conditions, as well, not just those involving the kidneys. In the future, knowing one's genetic makeup will likely guide treatment for diabetic nephropathy and other medical conditions.
Standard Treatment Approaches
There are many things you can do to improve your kidney health as it relates to the impact diabetes has on it. Lifestyle changes - including weight loss, exercise, and dietary modification - are the most important. The focus here is on the standard treatment approaches used in the treatment of diabetic nephropathy, which will, in turn, support kidney health.
Tight Control of Blood Sugars
Diabetes is diagnosed when your fasting blood sugar (glucose) level is greater than 126 mg/dl as measured on two different occasions. If your blood sugars are high, your doctor will likely prescribe lifestyle changes as previously mentioned, and if needed, medications whose job is to help control your blood sugars. In certain cases, your doctor may need to prescribe insulin.
There are many different classes of medications used to treat diabetes. As with all medications, it is important to talk with your doctor about the correct dosing and possible side effects of each. If your blood sugar levels are still not controlled with lifestyle and medication changes, a consultation with an endocrinologist - a doctor who specializes in diabetes - is needed. To find out more, you can check out Diabetes And Chronic Kidney Disease.