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Diabetes and Nephropathy (Kidney Complications)
What kidney problems can be caused by diabetes?
Kidney disease, or nephropathy, is a frequent complication of diabetes, both type 1
and type 2, and often ends in end-stage renal disease (kidney failure).
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Ten to 21% of all people with diabetes have nephropathy.
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Diabetes is the leading cause of end-stage renal disease. Diabetic nephropathy is a
progressive disease that takes several years to develop. Many tiny blood vessels in
the kidney act as filters to remove wastes, chemicals, and excess water from the blood.
In diabetic nephropathy, these blood vessels are damaged, become leaky, and protein
eventually spills into the urine (proteinuria). Eventually, the damaged filters are
destroyed, putting more stress on the remaining filters and eventually causing them
to become damaged. When the entire filtration system breaks down, the kidneys fail
to function, and this is called end-stage renal disease (ESRD). ESRD is a condition
where the patient requires dialysis or a kidney transplant in order to live.
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Approximately 43 percent of new cases of ESRD are attributed to diabetes.
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In 1999, 38,160 people with diabetes initiated treatment for end-stage renal disease,
and 114,478 people with diabetes underwent dialysis or kidney transplantation.
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ESRD incidence attributed to diabetes is increasing more rapidly than ESRD due to
other causes. From 1988 to 1991, diabetes accounted for 33.8 percent of new ESRD
cases, up from 23 percent of new cases in 1982. By 1999, this number reached 43 percent.
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In the United States, the incidence of reported ESRD in people with diabetes is more
than 4 times as high in African Americans, 4 to 6 times as high in Mexican Americans and
6 times as high in Native Americans than in the general population of diabetes patients.
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The risk of ESRD is 12 times as high in people with type 1 diabetes as in those
with type 2 diabetes.
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In patients with type 1 diabetes who develop persistent proteinuria (protein in the urine),
ESRD or death usually follows after about 5-10 years.
Can diabetes-related kidney problems be prevented?
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The key to preventing diabetes-related kidney problems begins with good control of blood
glucose levels, control of blood pressure and regular screening by a health care professional.
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The Diabetes Control and Complications Trial (DCCT), a 10-year study which ended in June
1993, proved among type 1 patients that improved blood glucose control can prevent the onset
and delay the progression of diabetic nephropathy. Therapy that keeps blood glucose levels
as close to normal as possible reduced damage to the kidneys by 35-56%. (New England Journal
of Medicine, September 30, 1993)
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Because a person with diabetes can develop nephropathy and not know it, a regular visit
with a health care professional is essential. Regular visits with a health care professional
can detect proteinuria early and possibly prevent ESRD.
Research has shown the efficacy of a class of antihypertensive drugs, ACE-inhibitors, in reducing
the progression of diabetic kidney disease.
What is needed?
In ideal circumstances, patients with diabetes will have their disease under good control
and be monitored frequently by a health care team knowledgeable in the care of diabetes.
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Health care team education is vital. Because people with diabetes have a multi-system
chronic disease they are best monitored and managed by health care professionals trained
with the latest information on diabetes to help ensure early detection and appropriate
treatment of the serious complications of the disease. A team approach to treating and
monitoring this disease serves the best interests of the patient.
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Patient education is critical. People with diabetes can reduce their risk for complications
if they are educated about their disease, learn and practice the skills necessary to better
control their blood glucose, blood pressure, and cholesterol levels, and receive regular
checkups from their health care team. Smokers should stop smoking, and overweight people
with diabetes should develop moderate diet and exercise regimens under the guidance of a
health care provider to help them achieve a healthier weight.
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It is recommended that patients who have had type 1 diabetes for more than five years have
an annual test for the presence of microalbinuria. All type 2 patients should have this
test at diagnosis.
Diabetes Dictionary
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