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Kidney disease (nephropathy) is a possible complication of diabetes. It is also known by other names including Kimmelstiel-Wilson disease; Diabetic glomerulosclerosis; and Diabetic kidney disease. Kidney diseases in a person with diabetes may result into many more complications including hypoglycemia (from decreased excretion of insulin), rapidly progressing chronic kidney failure, end-stage kidney disease, hyperkalemia, severe hypertension, complications of hemodialysis, complications of kidney transplant, coexistence of other diabetes complications, peritonitis (if peritoneal dialysis used), and increased infections.
Researches and studies have not been able to establish fully the exact reasons leading to kidney disease in the persons with diabetes - a number of factors lead to this including heredity, food habits, and other medical conditions like high blood pressure. High blood pressure combined with diabetes accelerates kidney disease.
Both types of diabetes - type 1 diabetes as well as type 2 type of diabetes. Diabetic conditions result into poor processing of foods by the body. Foods are converted into carbohydrates and than glucose - the simple sugar that is the main source of energy for body's cell. In order to enter glucose, the body requires insulin, a hormone generated in the pancreas. If the generation of insulin or/and its utilization by the body is impaired, problems arises in the utilization of glucose by the cells of the body and blood glucose level rises. This creates condition of diabetes which may lead to kidney disease if it remains poorly treated and/or managed.
around 1 in 20 persons having diabetes suffer from type 1 diabetes that occurs in children and young adults. In this type of diabetes, the body produces little insulin or no insulin, and people affected with this type of diabetes require insulin injection or other insulin therapy to manage their diabetes. People with type 1 diabetes are more prone to acquire kidney disease, and statistics indicate that around 40% of persons may suffer from some sort of kidney disease over a period of time. Most of the persons with diabetes (around 95%) suffer from type 2 diabetes. IF this type of diabetes remains untreated and/or poorly treated, kidney disease may arise.
Kidney disease develop over a period of time and may remain undiagnosed for a long time and symptoms may surface suddenly when the disease has advanced. Kidney disease in persons with diabetes develops in five stages:
- Stage 1: The flow of blood through kidney (through the glomeruli) registers an increase and kidney become larger than normal. Many persons may remain in stage 1 indefinetely while others may move to State 2.
- Stage 2: The blood filtered through kidney (through glomeruli) remains at an increased level or at almost normal level but the glomeruli begins to show signs of damage. At this stage, small quantity of a blood protein called albumin starts leaking into the urine, a condition known as microalbuminuria. The condition of microalbuminuria remains undetected at the early stages. However, when the the rate of albumin loss increases from 20 to 200 micrograms per minute (normal rate being less than 5 micrograms per minute), it becomes detectable through tests. People with type 1 as well as type 2 diabetes may remain in this condition for years if the blood pressure and blood glucose levels are treated and managed well.
- Stage III: In this stage (also called dipstick-positive proteinuria or clinical albuminuria or overt diabetic nephropathy), the loss of albumin and other proteins in the urine exceeds 200 micrograms per minute. The glomeruli continues to suffer damage and the kidney's effectiveness to filter waste becomes more impaired and the level of blood creatinine and urea-nitrogen rises. Like earlier stages, this stage may also continue for many years without developing into Stage IV.
- Stage IV: This stage is also called "advanced clinical nephropathy", and large quantity of protein passes into the urine combined generally with high blood pressure. Blood creatinine and urea-nitrogen levels rise still further.
- Stage V: This is the final stage of kidney disease and may lead to kidney failure.
- Low protein diet helps in preventing or delaying the onset of kidney disease.
- High blood pressure requires proper treatment as continued high blood pressure accelerates the onset of kidney disease.
- Blood glucose level should be monitored and properly treated.