High blood glucose and high blood pressure both damage kidneys. The two kidneys are the body’s filtering system. Blood flows
through the blood vessels into the kidneys. From there, toxins and waste are removed and released via the kidneys, into the
urine. The relationship between diabetes and kidney disease is complex. Kidneys may become larger and overworked.
This leads to a disease called diabetic nephropathy.
Not all people with diabetes develop nephropathy. It is more likely to occur after puberty. In people who have had type 1
diabetes for 15 years or longer, it happens in about one in three people. Poor blood glucose control, high blood pressure,
and smoking or chewing tobacco also increase the risk of kidney failure.
Nephropathy develops slowly and quietly. There are no symptoms or signs until serious kidney damage has occurred. Symptoms
and signs may include:
Diabetic nephropathy does not cause an increased risk of kidney or bladder infection.
How is this detected?
Diabetic nephropathy can be detected at a very early stage, before it causes symptoms. This early phase is called incipient
nephropathy. There are very small amounts of the protein albumin in the urine (microalbuminuria). This may be found in a 24-hour
or overnight urine specimen. If nephropathy progresses, the amount of protein in the urine will increase bit by bit to the
stage of overt proteinuria. At this stage, protein can be detected using a routine protein dipstick in the urine.
What can be done?
Recent research has shown that having excellent blood glucose control can prevent diabetic nephropathy, or slow its progression
significantly. Certain drugs can also help prevent or slow it down. These drugs are called angiotensin converting enzyme
inhibitors (ACE inhibitors), or angiotensin II receptor blockers.
If nephropathy is not treated, it will develop into chronic renal failure. Eventually it will lead to end-stage renal failure.
In this condition, the person needs dialysis or a kidney transplant in order to live.
Advanced nephropathy is associated with a significant increased risk of macrovascular complications and early death due to
diabetes.
