Diabetes and Kidney Disease

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KEY POINTS

• When you have diabetes, high blood glucose can damage blood vessels in your kidneys so that they can’t work properly.
• Diabetic kidney disease may be treated with diet, medicine, or dialysis.
• Ask your healthcare provider how to keep your blood glucose and blood pressure in good control to help prevent or delay kidney disease.

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What is diabetic kidney disease?

The kidneys are inside your belly, on either side of your spine just above your waist. They make urine by removing waste products, extra salt and other minerals, and water from the blood through tiny blood vessels in the kidney.

Having diabetes means that there is too much glucose (sugar) in your blood. If blood glucose stays high for a long time, the tiny blood vessels may be damaged.

When the blood vessels in your kidneys are damaged, your kidneys can't get rid of wastes. They may make less urine, or no urine. Your body can't keep a healthy balance of water and minerals. The urine wastes build up in your blood and body and make you feel sick. This is called diabetic kidney disease (DKD).

What is the cause?

When you have diabetes, you are more likely to develop kidney disease if you do not keep good control of your blood glucose. You are also more likely to develop DKD if you:

• Have uncontrolled high blood pressure (When the force of blood flow is high, blood vessels are damaged over time.)
• Have a family history of DKD

What are the symptoms?

DKD usually takes many years to develop. In the early stages, you may not have any symptoms. As kidney disease gets worse, symptoms may include:

• Swelling, especially in your feet, ankles, and legs
• Feeling tired or weak
• Trouble sleeping at night
• Loss of appetite, often with weight loss
• Itchy, dry skin
• Changes in urination, such as urinating more often, less often, or not at all
• Muscle cramps or weakness
• Skin that is yellow or a darker color than is usual for you
• Nausea and vomiting
• Tingling in your hands or feet
• Confusion or trouble concentrating

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• Blood and urine tests
• Ultrasound scan, which uses sound waves to show pictures of the kidneys
• CT scan, which uses X-rays and a computer to show detailed pictures of the kidneys
• A biopsy, which is the removal of a small piece of tissue from your kidney

How is it treated?

Your provider may recommend working with a dietitian to help you plan meals that include the right foods. With the right diet, you may help keep DKD from getting worse. Follow your healthcare provider's advice about what foods you should eat.

Your healthcare provider may prescribe medicine to:

• Control your blood glucose. You may need 2 or more medicines to help control your blood glucose.
• Keep your blood pressure normal. Many people need 2 or more medicines to help control their blood pressure.
• Keep the balance of liquids and minerals in your body normal
• Treat other health conditions that cause kidney disease such as heart disease, lung disease, lupus, infections, or other kidney problems

It may take several weeks or months to find the best treatment for you.

Your healthcare provider may refer you to a kidney disease specialist. If your DKD becomes severe, you will need dialysis. Dialysis uses a machine to do the work of your kidneys. It removes waste products and extra water from your blood. Dialysis may help you live longer and improve your quality of life. Dialysis usually needs to be done several times a week.

If your health is good except for kidney failure, a kidney transplant may be an option. Talk with your healthcare provider about whether a transplant is an option for you.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. Take all medicines exactly as directed by your provider. In addition:

• Control your blood glucose. Keeping your blood glucose level in the proper range can delay blood vessel damage. Follow your healthcare provider's instructions for testing your blood and ask your provider what you should do if it is too high or too low.
• Control your blood pressure. Ask your healthcare provider what a healthy blood pressure should be for you. Check your blood pressure (or have it checked) as often as your provider advises.
• Eat a healthy diet. Ask your provider and dietician if there are any foods you need to avoid.
• Lose weight if you are overweight, and stay at a healthy weight. Weight loss can make it easier to control your blood glucose, blood pressure, and cholesterol.
• Exercise regularly according to your healthcare provider's instructions. Regular exercise can help you control your blood glucose and blood pressure, and help you keep a healthy weight.
• Ask your provider if there are medicines you need to avoid. For example, using ibuprofen, naproxen, or high doses of aspirin for a long time may damage your kidneys.
• Carry glucose tablets or gels with you and know how to take them properly in case of low blood glucose. To help prevent problems, tell your healthcare provider or pharmacist about all of the medicines, natural remedies, vitamins, and other supplements that you take.
• If taking your medicines is difficult for you, ask your healthcare provider or pharmacist if there is any way to simplify your medicine treatment plan.
• Get support. Talk with family and friends. Join a support group in your area.

Ask your provider:

• How and when you will get your test results
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

You can get more information from:

• The National Kidney Foundation
  855-653-2273
  https://www.kidney.org/atoz/content/diabetes
• American Diabetes Association
  1-800-342-2383
  http://www.diabetes.org/