Encyclopedia of Global Health

Diabetic Kidney Problems

Contributors: Jason Vassy

Edited by: Yawei Zhang
Book Title: Encyclopedia of Global Health
Chapter Title: "Diabetic Kidney Problems"
Pub. Date: 2008
Access Date: September 19, 2016
Publishing Company: SAGE Publications, Inc.
City: Thousand Oaks
Print ISBN: 9781412941860
Online ISBN: 9781412963855
DOI: http://dx.doi.org/10.4135/9781412963855.n355
Print page: 514
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This PDF has been generated from SAGE Knowledge. Please note that the pagination of
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Copyright 2008 by SAGE Publications, Inc.

Diabetes mellitus is the leading cause of kidney failure in the United States. Although the
early stages of diabetic kidney disease, or diabetic nephropathy, are subtle and often go
unnoticed, the disease can eventually result in end-stage renal disease (ESRD) requiring
kidney transplantation or dialysis therapy. This potentially deadly complication of diabetes
mellitus has grown to great public health significance, given the high cost of dialysis and the
shortage of organ donations.

The U.S. Centers for Disease Control and Prevention (CDC) reported that 300,000 new cases
of diabetic ESRD occurred in the United States in 2002. This absolute number continues to
grow, although the proportion of diabetics who get ESRD seems to be declining. Still, ESRD
treatment cost the United States Medicare system $25.2 billion in 2002. Diabetic nephropathy
can occur with both type 1 and 2 diabetes mellitus, although it may occur earlier in life in type
1 diabetics, because their disease generally begins in childhood. Certain ethnic and racial
groups are at greater risk for diabetic kidney disease, including African Americans and
Mexican Americans. Differences in risk may be due to socioeconomic or genetic factors.

Diabetic nephropathy is considered one of the microvascular complications of diabetes

mellitus, resulting from damage to small blood vessels including those in the kidneys. The
high glucose levels of diabetes damage the blood vessels and kidney tissue itself, causing a
gradual decline in kidney function. This microscopic damage can be seen by taking a biopsy
of the kidney, although this invasive procedure is often not necessary for the diagnosis of
diabetic nephropathy. The natural history of diabetic nephropathy is a gradual process that
begins with albuminuria, a condition in which the kidneys leak more protein into the urine than
normal, particularly the protein albumin. Normal urinary albumin excretion is less than 30
mg/day albuminuria between 30 and 300 mg/day and greater than 300 mg/day is called
microalbuminuria and macroalbuminuria (proteinuria), respectively. Microalbuminuria causes
no symptoms and may already be present at the time that diabetes mellitus is diagnosed.
Urinary albumin levels can be measured by using dipsticks tests on a single urine sample, by
analyzing a patient's urine after a 24-hour collection period, or by testing the urinary ratio of
albumin to creatinine, a waste product eliminated in the urine. With the worsening of kidney
disease, microalbuminuria may progress to macroalbuminuria, which may in turn progress to
an elevated creatinine level in the blood, representing the kidneys inability to adequately
remove this waste.

To track the progression of diabetic nephropathy, nephrologists, physicians who specialize in

the kidney, follow a patient's blood creatinine levels and glomerular filtration rate (GFR), a
measure of the kidneys function. Kidney function may decline such that survival is not
possible without kidney replacement therapy: dialysis or kidney transplant. About 2 percent of
diabetics per year progress from macroalbuminuria to increased creatinine levels or ESRD.
Once a person has macroalbuminuria, the median time to renal replacement therapy is 2.5
years.

The most effective way to prevent and treat diabetic nephropathy is through intensive
glycemic control, measured by a patient's blood glucose levels and hemoglobin A1c (HbA1c)
concentration. Treating high blood pressure in diabetics has also proven important to slow the
progression of diabetic nephropathy, and the angiotensin-converting enzyme (ACE) inhibitors
and angiotensin receptor blockers (ARB) are particularly effective drugs in decreasing diabetic
albuminuria. Dietary protein restriction may also slow the progression of kidney disease. A
patient who progresses to ESRD requires kidney transplantation or dialysis, a therapy
whereby the patient's blood is cycled through a machine to remove the wastes normally

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SAGE SAGE Reference
Copyright 2008 by SAGE Publications, Inc.

filtered by the kidneys. Neither treatment is without its complications: kidney transplantation
requires immunosuppressant drugs to prevent rejection of the new organ and dialysis is an
invasive procedure often performed three times a week.

Jason Vassy, Washington University in St. Louis

http://dx.doi.org/10.4135/9781412963855.n355
See Also:

Dialysis
Kidney Failure and Dialysis

Bibliography
A. I. Adler, et al., Development and Progression of Nephropathy in Type 2 Diabetes: The
United Kingdom Prospective Diabetes Study (UKPDS 64), Kidney International (v.63, 2003)
http://dx.doi.org/10.1046/j.1523-1755.2003.00712.x
U.S. Renal Data System, USRDS 2004 Annual Data Report: Atlas of End-Stage Renal
Disease in the United States, National Institutes of Health, National Institute of Diabetes and
Digestive and Kidney Diseases, Bethesda, MD, 2004, American Journal of Kidney Diseases
(v.45/Suppl 1, 2005).

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