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Diabetes and kidney disease

By Leana Huntley is an English trained foot health practitioner attached to ALMAWI Limited – The Holistic Clinic. E-mail your questions / concerns / comments to lhuntley@almawiclinic.com; or contact her at 662-1732 Tuesday - Saturday. Check for the Clinic at www.almawiclinic.com.

My cousin died from threefrom kidney failure. I wasn't privileged to meet him but he was the only relative that I'm aware of who had the disease; his wasn't diabetes related though.

Three years ago, though, I encountered what it's like to live with this disease through a customer who was coming to the clinic for treatment for Diabetic Neuropathy. His kidneys were failing terribly, and he was supposed to be on dialysis three times a week; however he only did it twice.

His constant complaint was that while he knew that the dialysis was his lifeline, it made him sick, extremely weak and he couldn't stand it. He would often say "I could barely see now (also due to complications of the diabetes); I can't drive again; I'm sure my wife has someone else; plus my feet swollen, painful and numb."

I often scolded this client reminding him that he still had life, therefore hope existed; but I always pondered on his situation wondering if it were me, would my reaction be much different.

He had an excellent support system with his wife and children being very dedicated; and thankfully being a successful businessman, he was able to facilitate his dialysis treatments although the expense was his constant cry.

The kidneys are extremely important organs. Millions of tiny blood vessels (capillaries) exist inside them that act as filters. The job of those vessels (filters) is to remove waste products from the blood. Sometimes this filtering system breaks down. Diabetes can damage the kidneys and cause them to fail. Failing kidneys lose their ability to filter out waste products, resulting in kidney disease.

How does diabetes contribute towards kidney disease?

When our bodies digest the protein we eat, the process creates waste products. As blood flows through the blood vessels (filters), small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood.

Diabetes can damage this system. High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak and useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria.

When kidney disease is diagnosed early (during microalbuminuria), several treatments may keep it from getting worse.When kidney disease is caught later (during macroalbuminuria), end-stage renal disease, or ESRD, usually follows.

In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail, which is very serious.

A person with failing or a failed kidney needs to have a kidney transplant or to have the blood filtered by machine (dialysis). Having a transplant means getting a donor that is a match, in most instances a parent, sibling, or your child. This means that this person would now function with only one kidney. Sometimes transplants are done and the person still doesn't survive, like happened with my little cousin.

Who gets kidney disease?

Not everyone with diabetes develops kidney disease. Factors that can influence kidney disease development include genetics, blood sugar levels and blood pressure controls. The better you control your diabetes and blood pressure, the lower the chance of getting kidney disease.

What are the symptoms?

The kidneys work hard to make up for the failing capillaries, so kidney disease produces no symptoms until almost all function is gone. Also, the symptoms are not specific. The first is often fluid build-up, including in the feet. Others include loss of sleep, poor appetite, upset stomach, weakness, and difficulty concentrating. It is critical to make regular visits to your doctor to check blood pressure, urine (for protein), blood (for waste products), and organs for other complications of diabetes.

How can I prevent it?

It can be prevented by keeping blood sugar in your target range. Research has shown that blood sugar control reduces the risk by one third in persons who are in the early stages, and by half in more severe cases. Other studies have suggested that tight control can reverse microalbuminuria.

Swelling of the Feet

It is quite common with kidney dysfunction to experience water retention in the feet. This is also a sign for persons who aren't aware of kidney problems, to check to see if there's a chance that the kidneys are failing.

Treatments for

kidney disease

Self-care

Important treatments for kidney disease are tight control of blood glucose and blood pressure. Blood pressure has a dramatic effect on the rate at which the disease progresses. Even a mild rise in blood pressure can quickly make kidney disease worsen. Four ways to lower your blood pressure are losing weight, eating less salt, avoiding alcohol and tobacco, and getting regular exercise.

Drugs

When these methods fail, certain medicines may be able to lower blood pressure. There are several kinds of blood pressure drugs, however, not all are good for people with diabetes. Some raise blood sugar levels or mask some of the symptoms of low blood sugar.

Diet

Another treatment some doctors use is a low-protein diet. Protein seems to increase how hard the kidneys must work. A low-protein diet can decrease protein loss in the urine, and increase protein levels in the blood. Never start a low-protein diet without talking to your health care team.

Dialysis/transplant

Once kidneys fail, dialysis is necessary. The person must choose whether to continue with dialysis or to get a kidney transplant. This choice should be made as a team effort. The team should include your doctor and diabetes educator, a nephrologist (kidney doctor), a kidney transplant surgeon, and a psychologist.

I trust this further heightens awareness that diabetes ought not to be taken lightly.

Your feet mirror your general health . . . cherish them!

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