Contributed by Rhea Bhargava, MD, Beth Israel Deaconess Medical Center, and Sylvia E. Rosas, MD,  Joslin Diabetes Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, in partnership with

The kidney is responsible for filtering the blood, maintaining salt-water balance and removing waste products. When it does not work properly, waste products accumulate and water retention can occur. People with diabetes can develop damage to the small vessels in their kidneys, leading most commonly to slow progression of disease that is asymptomatic, but sometimes leads to complete shutdown of the kidneys.

Identification: Unfortunately, kidney disease does not have any particular signs and symptoms but can be easily detected during a routine medical visit by 2 common tests. In the urine, a test for protein (signifying inability of the kidney to reabsorb all the protein) is usually the first identifiable sign of diabetic kidney disease. In addition, when you develop kidney disease, the serum creatinine, a waste product from muscle metabolism, rises but this happens later in the course of disease.

Risk Factors:

• Uncontrolled diabetes
• Obesity
• Uncontrolled blood pressure
• Family history of kidney disease
• Ethnicity- African-American, Pima Indian, Hispanic

Diagnosis: If you have diabetes type 1: it is recommended that your health care provider monitors the albumin, a type of protein, in your urine and the level of creatinine in the blood every year after 5 years of diagnosis. If you have diabetes type 2: your urine albumin and the level of creatinine in the blood should be checked every year from the time of diagnosis.

When people develop kidney disease, they usually have other complications of diabetes mellitus, particularly diabetic eye disease that may also require treatment.

Monitoring: The same test as the diagnosis will be used to monitor the disease.

Prevention:

• Adequate sugar control with a Hemoglobin A1c goal below 7 for most people
• Good blood pressure control. The goal is age dependent and should be discussed with your health care provider.
• Weight loss if you are overweight
• Quit smoking
• Low salt intake
• Regular Exercise

Treatment: The key treatment for diabetic kidney disease is prevention. This can be achieved by keeping glucose levels as close to normal as possible. Blood pressure control is equally important. High blood pressure in the setting of diabetic nephropathy can lead to rapid decline in kidney function. Stopping the protein leak in the urine is also an important aspect of management of diabetic nephropathy. Many drugs like ARB (Angiotensin Receptor Blocker) and ACEI (Angiotensin Converting Enzyme inhibitor) are used to lower the pressure in the kidney and subsequently lower protein leak. Making healthy choices in life remains key, so stop smoking if you do, lose weight, eat more fruits and vegetables and avoid high salt foods. It is recommended that patients with diabetes perform any physical activity for 30 minutes, 5 times a week as it helps to both maintain glucose and blood pressure control. Remember to follow with your healthcare provider regularly. You can achieve most of the above goals with the help of your primary care provider. However, you may be referred to a nephrologist, a kidney doctor, if there are concerns that you may have a disease other than diabetes, your disease is progressing in a manner atypical of diabetic disease or to initiate treatment with dialysis or transplantation.