The kidneys have important functions to perform in our body. They detoxify the body from the dross accumulating in the metabolism, control the fluid and electrolyte balance, the amount and composition of the blood and the blood pressure. In addition, the kidney ensures that there are always enough red blood cells in the blood. The filtering task of the kidney is simplified in two steps: First, the blood is filtered in the so-called kidney bodies. Due to the fine pores of the kidney corpuscles, however, many other substances required by the body go along with the waste materials as well. Therefore, a second step follows, namely the recovery of valuable and vital substances for the body.
Causes and symptoms
In diabetics, persistent high blood sugar levels or genetic predisposition can lead to a change in the small blood vessels of the kidney. The filter performance of the kidney decreases more and more and thus the detoxification capacity. There is a so-called diabetic nephropathy. What benefits diabetic nephropathy?
- High blood pressure (hypertension)
- Bad glycemic control
- Long diabetes duration, genetic predisposition
- High protein intake, increased blood lipid levels
- To smoke cigarettes
Consequences of diabetic nephropathy
On average, every fifth diabetic develops renal damage varying in severity between 10 and 15 years after diagnosis. Left untreated, diabetic nephropathy can result in kidney failure in about one-third of those affected. Every year, around 8, 000 diabetic patients in Germany come to dialysis. Diabetes mellitus is the most common cause of chronic kidney failure. This should be avoided: Every diabetic should therefore also pay attention to his kidneys.
Diagnosis: Diabetic nephropathy
The diabetic does not notice himself if his kidneys are damaged over time because he feels no pain and the urine does not change. The first sign of incipient nephropathy is the smallest traces of protein in the urine, the so-called microalbuminuria (20-200 mg albumin / liter in morning urine). It is thus the most important factor for the early detection of diabetic kidney disease. Detection is possible early and easily using special test strips. Here, the first morning urine is tested on three days within a week. To diagnose nephropathy, at least two of the three morning urines require a concentration of> 20 mg albumin / liter. The next stage is characterized by a greater amount of protein in the urine, the so-called macroalbuminuria (micros: small, low, macros: large, much). Once a persistent macroalbuminuria (> 300 mg albumin / 24 h urine), the progression of kidney disease by appropriate drugs in most cases can only be contained, so is no longer reversible!
Therapy and treatment
Already at the stage of microalbuminuria, adequate therapeutic measures are needed to prevent the transition to the chronic - irreversible - form of kidney damage.
- Control and documentation of microalbuminuria (every 3-6 months) using special test strips! In type 1 diabetics from 5 years after diabetes manifestation, in type 2 diabetics, however, already from the diagnosis.
- In diabetic patients with kidney disease, the lowest possible blood pressure (120/80 mmHg) should be sought. Because: The lower the blood pressure, the better the kidney works. The so-called ACE inhibitors and the angiotensin II antagonists have proven to be effective here. Those affected not only benefit from slower progression of kidney disease, but also by reducing the frequency of strokes and heart attacks. The reason: high blood pressure is one of the most important risk factors for diseases and deaths in the heart and brain.
- Optimally adjust the blood sugar and check the long-term setting based on the HbA1c value (<6.5%).
- Restriction of protein intake (replacement of protein-rich, predominantly animal foods against low-protein, mainly vegetable foods).
- Lowering body weight is an important therapeutic measure. Even a slight weight loss can cause a significant improvement in blood pressure and metabolic adjustment.
- Also important: Pay attention to the risk of infection of the draining urinary tract, quit smoking and close ophthalmological inspections.
It is very possible to prevent or treat diabetic kidney damage by taking control measures (good glycemic control, optimal blood pressure, control of microalbumine) and adequate treatment. However, if kidney damage is noticed too late, it can not be undone and will inevitably result in kidney failure.