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Diabetes and chronic kidney disease

Part of the series "All about diabetes"

How does diabetes affect my kidneys?

Diabetes is the number one cause of chronic kidney disease and end stage renal failure. Your kidneys are organs that filter waste and excess fluid from your blood. When there is too much sugar in your blood, the filters in your kidneys (called nephrons) become overworked.

Diabetes and chronic kidney disease

Tiny blood vessels transport blood that needs to be filtered into the nephrons. Excess blood sugar can damage these tiny vessels, as well as the nephrons themselves. Even though there are millions of nephrons, the healthy nephrons must work harder to make up for the ones that are damaged. Over time, the healthy nephrons will become overworked and damaged if your blood sugar remains high. Your kidneys may lose their ability to filter fluid and wastes and may no longer be able to keep you healthy.

I have diabetes. Are my kidneys already damaged?

Not necessarily. If your diabetes was diagnosed in the pre-diabetes stage (elevated blood sugar, but not high enough to be diabetes) and you took steps to control your glucose levels, your kidneys may be healthy. However, if your diabetes went undiagnosed for a long time, there is a chance your kidneys may be damaged.

Your doctor can perform a test to determine whether or not your kidneys are functioning properly. Chronic kidney disease (CKD) occurs over time. Many times people can have kidney disease and not realize it. This is because in the early stages of the disease, the symptoms are difficult to detect unless specific tests are performed.

An early diagnosis can prevent more damage from occurring. Your doctor may refer you to a physician who specializes in kidney diseases. This kidney doctor is called a nephrologist. The nephrologist can recommend treatments to help keep your kidneys working and continue to monitor your kidneys’ health.

I have diabetes. Does this mean I will eventually get a kidney disease?

Although diabetes is a leading cause for chronic kidney disease, being diabetic does not mean you will get CKD. An early diagnosis of diabetes can get you on a proper treatment program so your kidneys can continue to work effectively. If you have had diabetes for a while, following your treatment program is essential; not following your treatment plan can lead to problems like chronic kidney disease. Your doctor will monitor your health and adjust your treatment as needed.

I have diabetes. Does this mean I will need dialysis?

Not necessarily. Dialysis is a treatment for patients who have less than 10-20% of their kidney function. This is a stage of kidney disease called end stage renal disease (ESRD). Once kidney function drops to this level, your body will accumulate fluid and toxins. Dialysis removes those fluids and toxins, since your kidneys are no longer able. Some of the symptoms of ESRD include weight gain, decreased urination, fatigue, loss of appetite and vomiting.

If your doctor has determined you are in an early stage of kidney disease, you will be given a treatment plan to preserve as much of your kidney function as possible. This includes making sure you are not only receiving treatment for your kidneys, but making sure your diabetes is under control. High levels of blood sugar will continue to damage your kidneys. Once your diabetes is under control through medication and/or diet, your kidneys can continue to work without extra stress.

Are kidney stones and kidney disease the same thing?

No. Kidney stones are an accumulation of minerals in the kidney. When certain wastes are not dissolved into urine, they can form small crystals in the kidney. Over time, these crystals can form small stones. Frequent kidney stones, however, can cause kidney problems.

Can my doctor figure out how much kidney damage I have?

The National Kidney Foundation has created a guideline to help doctors determine the different stages of kidney disease. This guideline is based on a patient’s glomerular filtration rate, or GFR.

The GFR is a formula that uses your creatinine level, your age, race and gender to measure how fast your nephrons are filtering wastes. Creatinine is a waste product formed when your muscles work. Your GFR can help your doctor determine how much kidney function you have. 

For example, if you have a GFR of 59 that means that your kidneys are working at about 59% of normal. If you know your creatinine level, you can find a GFR calculator on the DaVita website to figure out your GFR. Knowing your GFR level can help you and your doctor treat kidney disease. You can even track your GFR using the DaVita GFR calculator. The rate at which your GFR changes over time will show whether your kidneys disease is progressing, and if so, how quickly.

These guidelines use the GFR calculation to divide kidney disease into stages. Each stage has suggested tests and treatments. 

Stages of chronic kidney disease

Stage

Description

GFR

Stage 1

Kidney damage with normal or high GFR

GFR > 90

Stage 2

Mild CKD

GFR = 60-90

Stage 3

Moderate CKD

GFR = 30-60

Stage 4

Severe CKD

GFR = 15-30

Stage 5

Kidney failure—dialysis or transplantation needed

GFR < 15

There is no cure for chronic kidney disease, but some kidney damage will stay at the same level, and some will progress and get worse, at different rates. In many cases, treatment and lifestyle changes can help slow the progression of kidney disease and you can remain healthier for longer. Stage 5 CKD is often referred to as ESRD or end stage renal disease. People with early stages of CKD are often unaware that there is anything wrong with their kidneys since they do such a good job of compensating. 

When should I visit a nephrologist?

You should see a nephrologist when your doctor refers you to one. Your doctor is aware that diabetes can damage your kidneys, and may test your creatinine levels regularly. Your doctor may also test your blood urea nitrogen (BUN) level. These tests measure the amount of waste and toxins that remain in your blood. If your creatinine and BUN levels are very high, this could be a sign that your kidneys are not working as well as they should. Talk to your doctor to make sure your levels are checked regularly and your GFR is calculated. According to the National Institutes of Health you should see a nephrologist once your GFR is at 30. 

A nephrologist will conduct more in-depth tests and monitor your kidney function. The nephrologist will make changes to your treatment plan if function gets worse. Talk to your doctor if you feel you should see a nephrologist.

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