What is DKD?
Diabetic kidney disease, also called diabetic nephropathy, is a type of kidney disease caused by diabetes. Over time, diabetes can damage the kidneys and cause them to stop working properly. The main functions of the kidneys are to remove waste from the blood and regulate fluid levels in the body. When kidneys are damaged from diabetes, waste builds up in the blood and fluid levels become unbalanced. This puts extra strain on the heart and blood vessels. DKD is one of the leading causes of kidney failure in the United States.
Risk Factors for Developing DKD
There are certain risk factors that increase a person’s chances of developing DKD:
– Type 1 or Type 2 Diabetes: Having diabetes, especially if it is not well controlled, is the biggest risk factor. The longer a person has diabetes, the higher their risk.
– Poor Blood Sugar Control: Consistently high blood sugar levels over many years can damage small blood vessels in the kidneys over time. Good control of blood sugar, blood pressure, and cholesterol is important for kidney health.
– High Blood Pressure: High blood pressure from any cause increases pressure in the kidneys and accelerates their decline in function. Getting blood pressure under control is an important part of treatment.
– Family History: Genetics can play a role. People whose family members have a history of DKD may be at slightly higher risk themselves.
– Smoking: Smoking cigarettes or exposure to secondhand smoke is linked to worse outcomes of kidney disease in people with diabetes.
– Race: DKD affects African Americans, Hispanic/Latino Americans, Asian Americans, Pacific Islanders, and Indigenous peoples at higher rates than white Americans.
Stages and Progression of DKD
Diabetic kidney disease is a progressive condition that tends to get worse over many years. Doctors usually measure its severity based on glomerular filtration rate (GFR), which is a test that measures how well the kidneys are filtering waste from the blood.
There are five main stages of chronic kidney disease associated with diabetes:
– Stage 1: GFR is normal (90 or higher) but signs of kidney damage are present, such as protein in the urine.
– Stage 2: Mild reduction in GFR (60-89). Protein or red blood cells may be detected in urine samples.
– Stage 3: Moderate reduction in GFR (30-59). Further decline in kidney function begins to impact daily life.
– Stage 4: Severe reduction in GFR (15-29). Major lifestyle and dietary changes are needed.
– Stage 5: Kidney failure requiring dialysis or transplant (less than 15). Without dialysis or transplant, toxins accumulate and fluid overloads occur.
Most patients first experience stage 1 or 2 and may show no symptoms for many years. But if blood sugar, blood pressure, and other risk factors remain poorly controlled, kidney function can continue declining into later stages with more severe complications.
Symptoms of DKD
In early stages, DKD often has no obvious symptoms. But as it progresses, the following symptoms may develop:
– Fatigue and loss of energy.
– Swelling (edema) of feet, ankles, legs, hands.
– Shortness of breath.
– Nausea and poor appetite.
– Sleep problems.
– Changes in how often you need to urinate.
– Difficulty concentrating.
– Itchy skin.
– Muscle cramps.
– Chest pain (in severe cases)
The symptoms tend to mimic many other illnesses, so regular checkups with blood and urine tests are important to catch any worsening of kidney function early. Finding symptoms early allows treatment changes to help slow progression.
Treatment and Management of DKD
There is no cure for DKD, but treatment focuses on controlling risk factors to preserve kidney function as long as possible and delay complications:
– Blood sugar control with oral drugs, insulin, nutrition therapy, etc. Target HbA1C level is usually 7% or lower.
– Blood pressure control with antihypertensive medications. Targets are less than 130/80 mm Hg.
– Cholesterol management as needed.
– Lifestyle modifications like healthy diet, weight control, physical activity, smoking cessation.
– Medications that block the renin-angiotensin system (ACE inhibitors, ARBs) are standard. They protect kidneys as well as blood pressure.
– Close monitoring of kidney function with regular medical checks and lab tests.
– Treatment of complications as they develop like anemia or bone disease.
– Dialysis or transplant planning if kidney function drops very low. These treatments replace some kidney functions to sustain life.
In Summary, following the treatment plan closely and working with a nephrologist (kidney specialist) can maximize years of good kidney health for a diabetic. Regular checkups help catch problems early, when treatment changes have higher chances of success. Comprehensive care is the best defense against diabetic kidney disease progression.
