Passing Kidney Stones
Dissolve Kidney Stones
Preventing Kidney Disease
Diabetes, particularly type 2 diabetes, has become so common that
diabetic kidney disease (nephropathy) has leaped ahead of high blood
pressure as the leading cause of kidney failure in much of the
world.
Kidney failure is a serious matter: The kidneys’ job is to filter
waste products and excess fluids from the blood circulating through
our bodies. If the kidneys fail, survival depends on either dialysis
(being hooked up to a machine to do the kidneys’ blood-filtering) or
a kidney transplant.
High blood glucose levels can damage blood vessels all over the
body, including the tiny blood vessels that do the kidneys’
filtering. When those tiny vessels are damaged, they can’t do the
job correctly. High blood pressure can result and make the problem
worse, damaging more blood vessels and speeding up the progression
of kidney disease. Both kidneys are affected.
Though 20-40 percent of those with diabetes develop kidney disease,
it can be slowed significantly if diagnosed early and treated.
Prescription for Kidney Health
Five principles should be followed by everyone with diabetes to help
prevent and treat kidney problems:
* Tight control of blood glucose levels (A1C less than 7 percent)
* Tight control of blood pressure: aim for lower than 130/80
* Control of lipids: LDL (“bad”) cholesterol should be less than 100
mg/dl, HDL (“good”) cholesterol should be above 50 mg/dl and
triglycerides should be less than 150 mg/dl
* No cigarette smoking
* Blood pressure-lowering drugs, such as ACE inhibitors or
angiotensin receptor blockers (ARBs), are effective in protecting
the kidney from damage if you have signs of diabetic kidney disease
The Earlier You Know, the Better
There are no symptoms in the early stages of diabetic kidney
disease. Symptoms of kidney failure—fatigue, nausea and fluid
retention—usually don’t occur until the late stages of kidney
disease because the kidney can still adequately filter the blood
even after extensive damage.
Usually the first sign that the kidneys’ filtration system is
damaged is an excess amount of protein in the urine, known as
microalbuminuria. This is not just an early sign of kidney disease,
but a well-established risk factor for cardiovascular disease, such
as heart attack and stroke.
Two tests one using urine and the other blood—must be performed
annually for early detection. The urine sample is used to screen for
microalbuminuria. The standard urine dipstick used in doctors’
offices does not measure this—a special machine is required instead.
The blood sample is used to measure the level of creatinine, a
substance normally present in the blood, which increases if your
kidneys are not functioning properly. The blood sample results are
then plugged into a formula that estimates your kidneys’ filtering
capacity. The most commonly used formula is called the MDRD
equation.
One cannot overemphasize how important it is to measure your blood
creatinine and to use the MDRD equation to estimate total kidney
filtering. The creatinine value alone can be misleading, as it must
be interpreted within the context of age and gender. Patients often
have more advanced kidney disease than their blood creatinine value
alone suggests.
For this reason, the National Kidney Foundation strongly urges all
physicians to use the MDRD equation; however, not all (besides
kidney specialists) routinely use it. An accurate estimate of your
kidney function is essential for your doctor to decide what, if
anything, needs to be done.
With aggressive treatment and yearly testing, we can greatly slow
the decline in kidney function and reduce the number of people
developing kidney failure.
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