Kidney

Dustin: Dr. Pond, I heard that diabetes affects the kidneys.

Dr. Pond: Yes, frequent urination and excessive thirst can be a sign of diabetes. This occurs when the kidneys respond to high blood glucose levels by letting the sugar go into the urine. When sugar goes into the urine, water from the blood also goes into the urine. This leads to an increase in the amount of urine which leads to frequent urination. The loss of water leads to an excessive thirst. However, diabetes can also damage the kidneys. If the kidneys fail to rid the body of wastes and extra water, a permanent condition known as end-stage renal disease (ESRD) occurs.

Dustin: When does end-stage renal disease occur?

Dr. Pond: ESRD develops when the function of the kidney drops below 10 to 15 percent, which is caused when the nephrons around the glomeruli are damaged by excessive sugar in the blood. A person can function with 50 percent of their kidneys working.

Dustin: So how often does end-stage renal disease occur?

Dr. Pond: Out of approximately 15 million people who are diagnosed with diabetes, 50,000 have ESRD. However, the incidence of diabetes and ESRD is higher in Native Americans and African Americans than in the rest of the population.

Dustin: How will I know if my mom is developing ESRD?

Dr. Pond: There are five stages that are known to occur in the progression of ESRD in people with diabetes.

Dustin: What causes the development of kidney problems in people diagnosed with diabetes?

Dr. Pond: One of the major factors is high blood pressure, which is also known as hypertension. High blood pressure can speed up the progression of kidney failure caused by ESRD. A rise in the blood pressure can also cause a spiral of events because high blood pressure increases the kidney damage and an increase in kidney damage leads to an increase in the blood pressure.

Dustin: Is there anything that can help to keep the kidneys from becoming damaged?

Dr. Pond: Blood pressure medicines can be prescribed by a physician to keep the blood pressure down. A low-protein diet may also be prescribed to reduce the progression of kidney failure. This is done so that the kidneys don't have to work so hard to filter out the excess protein. Too much protein in the urine can be a sign of poor kidney function, and excessive amounts of protein in the urine can be harmful. Besides a low-protein diet, a diet low in sodium, cholesterol, and potassium is also recommended.

Dustin: What are some other symptoms besides protein in the urine that can show kidney damage?

Dr. Pond: Well, when the kidneys stop working, the body retains the water and waste products because the kidneys are unable to filter them out of the blood properly. In addition, the hands and/or feet may swell from the build-up of wastes in the body, and a person may become tired or weak.

Dustin: When the kidneys reach the stage of ESRD, what can be done?

Dr. Pond: When the kidneys reach this stage, dialysis or a transplant may be needed.

Dustin: What exactly is dialysis?

Dr. Pond: It is a way to filter the blood. One form of dialysis is hemodialysis. In hemodialysis, the blood is sent through a machine that filters away the waste products and extra water. The clean blood is then returned to the body. This is usually done three times a week for approximately three to four hours. The other form of dialysis is peritoneal dialysis, which is done with a fluid known as dialysate. The fluid is placed in the abdomen to capture the waste products from the blood and then after a few hours the dialysate is drained away. This process is usually done four times a day.

Dustin: That all sounds pretty complicated. So is a transplant better?

Dr. Pond: Not necessarily, because the transplant is done to replace the damaged kidney with another healthy kidney. The donor usually has to be a relative because the kidney has to be a good match for the body. If the kidney is not a good match, then the immune system may not accept the new kidney and it will attack the transplanted kidney. Sometimes, special drugs can be used to help the immune system accept the new kidney.