Protect Your Kidneys
Your guide to understanding and preventing kidney disease
The Pathway to Problems
Uncontrolled blood glucose damages the small blood vessels in the kidneys, says Ian de Boer, MD, MS, associate professor of medicine in the Division of Nephrology at the University of Washington and an investigator at the Kidney Research Institute. “High glucose levels in the blood have a direct effect on kidney cells, leading to damage, inflammation, and scarring that leads to kidney disease.”
As the blood glucose increases, the entrance to the kidneys’ filtering units dilates, allowing more blood to enter. The downside: At the same time, the “exit vessel” constricts. “Therefore, the pressure goes up [in the kidneys] and you have initial hyperfiltration,” says Michael Flessner, MD, PhD, program director in the Division of Kidney, Urologic, and Hematologic Diseases at the National Institute of Diabetes and Digestive and Kidney Diseases. “But then that damages the filtration units and ultimately causes destruction of those units.” Damaged kidneys are less and less able to rid the body of waste and may eventually fail. For that, dialysis or a kidney transplant are the only treatments.
- "High blood pressure can damage the kidneys and can lead to more rapid loss of kidney function," says de Boer. That’s why it’s absolutely critical people with kidney damage maintain strict blood pressure control.
- People with diabetes and advanced kidney disease can’t use metformin because of the risk of lactic acidosis, a buildup of lactic acid in the bloodstream.
Screenings are like spotlights that can illuminate early signs of disease so it can be treated. Important kidney health tests:
- Urinary Albumin Test
- Estimated Glomerular Filtration Rate Test
According to the American Diabetes Association’s 2016 Standards of Care, here’s how often you should have both of these tests done:
After five years of diabetes, test yearly. With high blood pressure, test yearly, regardless of how long you’ve had diabetes.
At diagnosis and every year after
How can I protect my kidneys?
- Control blood glucose to near normal levels.
- Keep blood pressure at or under 140/90 mmHg.
- Stop smoking—it can interfere with your blood pressure medications.**
I have evidence of diabetic kidney disease. Now what?
Your health care provider may:
- Give you strict blood pressure targets.
- Ask you to alter your protein intake.
- Prescribe medications that can help slow the progression of kidney disease such as ACE inhibitors or angiotensin II receptor blockers (but not both).
Dialysis or a kidney transplant is necessary.