Yes, diabetes can lead to kidney failure or “shut down” over time if left uncontrolled. High blood sugar from diabetes damages the small blood vessels in the kidneys, causing them to leak protein into the urine. This condition is called diabetic nephropathy. If diabetic nephropathy progresses, it can eventually lead to end stage renal disease (ESRD) where the kidneys fail completely. However, with proper management of blood sugar levels and blood pressure, the progression of kidney disease in diabetics can be slowed or prevented.
How Does Diabetes Affect the Kidneys?
In someone without diabetes, the kidneys act as filters to remove waste and excess fluid from the blood. They help regulate blood pressure, electrolyte balance, and red blood cell production.
In diabetes, high blood sugar causes damage to the small blood vessels and filters in the kidneys over time. Here’s how it happens:
– The high sugar content in the blood thickens the blood, making it harder to flow through the tiny blood vessels of the kidneys. This leads to damage and scarring of the vessels.
– Excess sugar also causes inflammation and dysfunction of the nephrons, which are the tiny filtering units inside the kidneys.
– Protein from the inflamed vessels starts to leak into the urine, a condition called albuminuria or proteinuria. This is one of the first signs of diabetic kidney disease.
– Over many years, as more nephrons are damaged by high blood sugar, the kidneys start to lose their filtering capacity. Waste builds up in the blood instead of being removed properly.
– High blood pressure, commonly associated with diabetes, also accelerates damage to the kidneys.
So in summary, the combination of high blood glucose, high blood pressure, inflammation, and blood vessel damage can gradually lead to loss of kidney function in diabetics.
What Are the Stages of Diabetic Kidney Disease?
Diabetic kidney disease typically progresses in five stages:
Stage 1: Kidney damage with normal GFR
This earliest stage is characterized by protein in the urine and very minor loss of kidney function. The glomerular filtration rate (GFR), which measures how efficiently the kidneys are filtering, is still normal at 90 mL/min or above. There are usually no symptoms at this point.
Stage 2: Kidney damage with mild decreased GFR
As kidney damage progresses, the GFR starts to decrease into the 60-89 mL/min range. More protein leaks into the urine. The creatinine level in the blood may start to rise slightly. Again, there are usually no symptoms in stage 2.
Stage 3: Moderate loss of kidney function
In stage 3, the GFR falls to 30-59 mL/min, indicating a moderate loss of kidney function. Protein in the urine increases further. Blood pressure may start to rise. As the kidneys become less efficient at filtering waste from the blood, symptoms like fatigue, nausea, and concentration issues may emerge in some people.
Stage 4: Severe loss of kidney function
At this stage, the GFR drops below 30 mL/min and the kidneys have lost about 80-90% of their function. Large amounts of protein spill into the urine. High blood pressure and fluid retention are likely. Symptoms like weakness, shortness of breath, and itching may occur. The blood creatinine level continues rising. Without treatment, kidney failure will occur within a few years in stage 4.
Stage 5: End stage renal disease (ESRD)
This is kidney failure where the GFR drops below 15 mL/min. The kidneys can no longer filter wastes from the blood effectively. Fluid retention, anemia, bone disease, and heart issues may develop. Dialysis or a kidney transplant are needed to sustain life at this point.
So in summary, diabetic kidney disease is a gradual decline in kidney function over 5 stages, from mild to severe. Careful management can slow progression and delay the onset of end stage kidney failure.
What Are the Risk Factors for Kidney Disease in Diabetics?
Certain risk factors increase a diabetic’s susceptibility to kidney damage:
– Poor blood sugar control over many years: This is the #1 risk factor, with higher A1C levels linked to faster kidney function decline.
– High blood pressure: Uncontrolled hypertension damages the kidneys.
– Longer duration of diabetes: The risk rises the longer someone has lived with diabetes.
– Presence of albumin/protein in the urine: This signals existing kidney damage.
– Older age: Kidney decline is more common as diabetics age.
– Smoking: Constricts blood vessels and accelerates kidney damage.
– Obesity: Excess weight strains the kidneys.
– Family history of kidney disease: Genetics may increase risk in some people.
– Ethnic background: African Americans, Hispanics, Pacific Islanders, and American Indians are at higher risk.
– Use of certain medications: NSAIDs, injected contrast dye, some antivirals, lithium, and others can impact kidney function if someone already has kidney disease.
The more risk factors present, the higher the likelihood of developing significant kidney damage from diabetes over time.
What Are the Symptoms of Kidney Failure from Diabetes?
In the early stages of diabetic kidney disease, symptoms may be absent since the kidneys can still adequately filter waste products from the blood.
As kidney function declines, symptoms may include:
– Fatigue, lack of energy
– Trouble concentrating, “brain fog”
– Poor appetite, nausea, metallic taste
– Muscle cramps, numbness, tingling
– Swelling in hands and feet (edema)
– Puffiness around eyes, especially in mornings
– Dry, itchy skin
– Need to urinate more or less frequently
– Foamy or tea-colored urine
– Shortness of breath
– High blood pressure
Once the kidneys fail completely (ESRD), symptoms may be severe and require emergency treatment. These can include:
– Nausea and vomiting
– Confusion
– Fatigue so severe it interferes with daily activities
– Chest pain
– Seizures or coma
– Fluid buildup leading to pulmonary edema and difficulty breathing
– Abnormal heart rhythms and sudden death if potassium levels get too high
Diabetic kidney disease develops slowly, but can suddenly worsen and become life-threatening if blood sugars are very poorly controlled. Seeking medical care for symptoms of kidney failure allows steps to be taken to protect remaining kidney function.
Can Kidney Decline from Diabetes Be Reversed?
Unfortunately, diabetic kidney damage cannot be reversed once it occurs. The damaged nephrons in the kidneys cannot regain normal function.
However, progression of kidney disease can be slowed or stabilized with optimal diabetes treatment and blood pressure control. The goals are to:
– Keep A1C level at or below 7% to prevent further kidney damage.
– Lower blood pressure below 130/80 mm Hg to reduce pressure inside the kidney vessels.
– Use ACE inhibitors or ARBs to dilate blood vessels and reduce proteinuria.
– Take steps to lower cholesterol and maintain a healthy weight.
– Correct any electrolyte imbalances.
– Avoid nephrotoxic drugs, dehydration, and infections that could worsen kidney function.
– Monitor kidney function closely with urine and blood tests.
While kidney decline cannot be reversed, following the doctor’s treatment plan carefully may delay or prevent end stage kidney failure for many years. Kidneys can continue working at 20-25% capacity before requiring dialysis or transplantation.
Some research has looked at whether certain diabetes drugs like SGLT2 inhibitors may help regenerate nephrons and restore a small degree of kidney function. More studies are needed to determine if functional improvement is possible.
Can Kidney Failure from Diabetes Be Prevented?
The best way to prevent diabetic kidney failure is to proactively manage diabetes before kidney damage sets in.
Steps to help prevent kidney disease include:
– Getting A1C down below 7% or as close to normal as possible. This greatly reduces risk of developing kidney disease.
– Checking for protein in the urine at every doctor visit if diabetic. Protein indicates existing kidney damage that requires additional treatment.
– Controlling blood pressure aggressively, below 130/80 mm Hg. Use ACE inhibitors or ARBs as first choice medications.
– Taking all prescribed diabetes medications consistently.
– Following the recommended diet and exercise program from your diabetes educator or nutritionist. Losing weight if overweight.
– Not smoking or drinking excessive alcohol, which damage kidneys.
– Getting lab tests for kidney function per doctor’s orders to detect problems early.
– Seeing both an endocrinologist and nephrologist (kidney specialist) regularly for coordinated care.
– Avoiding use of NSAIDs like ibuprofen which can worsen kidney function.
– Drinking adequate fluids daily to stay hydrated.
– Avoiding excess consumption vitamin supplements like vitamin C, which can stress the kidneys at high doses.
– Being careful not to let blood sugars drop too low from diabetes meds, which can also damage kidneys.
While no prevention strategy is 100% effective, closely monitoring diabetes and kidney function greatly reduces the likelihood of experiencing complete kidney shutdown in the future.
What Are the Treatment Options for Kidney Failure from Diabetes?
If the kidneys eventually progress to end stage despite prevention efforts, treatment options include:
Hemodialysis
This is a procedure where blood is filtered through an artificial kidney machine, removing wastes and excess fluid. It requires having access created via a catheter or surgically-placed port. Hemodialysis is typically done 3 days per week at a dialysis center or hospital.
Peritoneal dialysis
In peritoneal dialysis, the inside lining of the abdomen acts as a natural filter. Dialysis solution is infused into the abdominal cavity and absorbs waste products, then drained out. It can be done at home continuously or intermittently.
Kidney transplant
This involves surgically placing a healthy donor kidney into the body. The transplanted kidney takes over filtering function from the failed kidneys. Transplants can come from living donors or cadavers. They may last 10-20 years on average.
Conservative management
Some patients choose not to undergo dialysis or transplant. Conservative treatment focuses on minimizing symptoms through diet, fluid intake monitoring, medications, and careful lab testing. Life expectancy is limited without replacement kidney function.
Most nephrologists recommend starting dialysis before kidney function deteriorates beyond 10-15% capacity. Doing so helps maintain nutrition and avoids fluid overload. Family support is extremely helpful in managing treatments. Many patients with kidney failure from diabetes live active and fulfilling lives with proper management.
Conclusion
In summary, diabetes is one of the leading causes of chronic kidney disease that can gradually progress to total kidney failure. Sustained high blood sugar and blood pressure damage the kidney’s filtering units over time. While kidney damage cannot be reversed, progression can be slowed with vigilant diabetes control and medical care. Preventing kidney disease is always preferable to treating it.
With careful monitoring and coordinated treatment from endocrinologists and nephrologists, many diabetics avoid severe kidney failure. Newer therapies also offer hope. Catching kidney disease early is key, before extensive scarring occurs. Anyone with diabetes should have their kidney function checked regularly to avoid serious complications.