Diabetes is the leading cause of kidney disease. Over a third of patients with diabetes will develop kidney disease related to diabetes, or diabetic nephropathy. Damage to the kidney occurs gradually and without symptoms over many years. For this reason, patients with diabetes must have routine tests in order to detect the onset of diabetic kidney disease.
Types of Testing
Testing includes monitoring the kidney function via a blood test and also checking for protein in the urine.
Your kidneys filter waste materials from your blood. One of these waste materials is a substance called “creatinine,” which originates from normal muscle function. Monitoring how much creatinine is in your body when you have your blood drawn can help us determine how well your kidneys are functioning. This is referred to as the eGFR, or glomerular filtration rate.
When your kidneys are damaged, they can’t filter the creatinine as well and the eGFR declines. Some decline in eGFR is expected as we age. However, the decline in diabetic kidney disease may be accelerated. In general, once the kidneys are damaged, they cannot be repaired.
Urine testing is an earlier way to see if you are developing diabetic kidney disease. In a normal functioning kidney, very little protein enters the urine. However, very early in diabetic kidney disease, a protein called “albumin” begins to leak into the urine and can be detected on a special urine test. An increasing amount of albumin in the urine indicates worsening damage to the kidneys.
How To Keep Your Kidneys Healthy
Now you may ask, “What can I do to keep my kidneys healthy if I have diabetes?” or “I have diabetic kidney disease, what can I do to slow down the damage?”
While there is not a specific cure for diabetic kidney disease, there are many interventions that you can do in cooperation with your healthcare team to slow the progression of the damage to your kidneys.
Control blood sugar
Most diabetic patients are familiar with the “A1C” blood test, which measures the average blood sugar for the last three months. The A1C target for most patients is < 7%, but your healthcare provider will direct you on your specific target.
Control blood pressure (BP)
For most patients, a reasonable target for BP is <130/80. Two types of medications, angiotensin-converting enzyme inhibitors (ACE I) and angiotensin receptor blockers (ARB), play a special role in slowing the progression of diabetic kidney disease. Also, limiting dietary sodium intake is important.
Other important tips to keeping your kidneys healthy include:
- Achieve and maintain a healthy body weight
- Limit alcohol intake
- Stop smoking
- Exercise regularly
- Avoid excessive protein intake
- Avoid nonsteroidal anti-inflammatory drugs (NSAIDs)
- Lipid control
If you have a Urine Albumin to Creatinine Ratio > 300 mg/gm, your healthcare provider may prescribe a medication from the group called sodium-glucose co-transport 2 inhibitors (SGLT2).
Here are important numbers to keep in mind.
- A1C: target < 7%.
- Urine Albumin to Creatinine Ratio: target < 30 mg/gm.
- eGFR: normal > 60 ml/min; track your trend.
- BP control: target <130/80.
At The Kidney and Hypertension Center, we provide consultation and ongoing care for the prevention and treatment of kidney-related diseases. Schedule your appointment today!
Written By: Dr. Mick Shaughnessy