What is diabetic kidney disease?
Diabetic kidney disease (or diabetic nephropathy) is a complication of diabetes that affects kidney function. Close to 30-50% of people living with diabetes will develop diabetic kidney disease, and there are approximately five million people with diabetic kidney disease just in the United States. Despite improvement in medical care for patients with diabetes, those with diabetic-related kidney disease remain at increased risk of death.
Diabetes causes damage to the kidneys’ filtration system at the glomerular level. This damage causes leakiness of the kidney filter allowing leakage of protein into the urine. Prolonged leakiness of the kidney filter results in tissue scarring, progression of kidney damage, and functional decline.
How is diabetic kidney disease diagnosed?
Specific blood tests enable us, as physicians, to approximate the kidneys ability to filter blood – this also allows us to detect kidney damage. A diagnosis of diabetic kidney disease is presumed in a patient with kidney damage and the presence of protein in the urine. While blood and urine tests can suggest the presence of diabetic kidney disease, there are other diseases that may be confused with diabetic kidney disease, thus the definitive diagnosis or “gold standard” requires a kidney biopsy so that an expert renal pathologist can confirm the diagnosis from histological tissue evaluation.
What are the risk factors for diabetic kidney disease?
Risk factors associated with diabetic kidney disease include:
- Poorly controlled blood sugars
- Duration of diabetes
- Elevated blood pressure
- Oral contraceptive use
- Family history of diabetes
- Evidence of glomerular hyperfiltration
- Race (including African Americans, Mexican-Americans, or Pima Indian ancestry)
How is diabetic kidney disease treated?
Keeping your blood sugar level and blood pressure under control can slow or prevent diabetic kidney disease development. Some medications – particularly those that inhibit the angiotensin aldosterone system such as ACE inhibitors and angiotensin receptor blockers – can help slow down the progression of kidney damage. Failure of treatment most often results in decline of kidney function. Advanced kidney failure requires treatment with dialysis or kidney transplant.