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Health Corners
Nephropathy

Unchecked high blood sugar levels over a period of many years can lead to the slow deterioration of kidney functions.

Five stages of kidney damage:

The process that leads to complete kidney failure (End Stage Renal Disease) has been identified to have five stages:

Stage I: The flow of blood through the kidneys increases if the blood sugar level is high. This leads to the overworking of kidneys. This is called hyper filtration. Many diabetics remain in this stage of nephropathy for years.

Stage II: The filters in the kidney begin to let some protein (albumin) leak into urine. This is called microalbuminuria. Initially this may happen on and off. But when the leak gets to a measure of 200 micrograms of albumin per minute, it means that the damage has reached its second stage and the rate indicates the tendency to increase.

Stage III: When the microalbuminuria count crosses 200mg/minute mark the patient has reached stage III. This is also called “clinical albuminuria”. The problem shows up in routine urine tests.

If the patient also has or develops blood pressure, it makes things worse. The ability of the kidneys to filter waste is reduced further. The creatinine and urea nitrogen levels in the blood shoot up.

Stage IV The problem gets pretty serious here. Proteins leak out in large amounts. The kidney’s filtration rate drops much below normal. The creatinine and urea nitrogen levels in the blood shoot up further. Almost always high blood pressure occurs.

Stage V: This is the final stage and here the kidneys barely function. It takes about 20 years for IDDM patients to reach this stage from stage I. But if they also have high blood pressure this can happen twice as fast.

Treatment

Dialysis and Transplantation

When the function of the kidneys has reached stage five, only two options are available - dialysis or kidney transplant.

Dialysis: The process by which, when kidneys fail, blood is purified by a machine is called dialysis. A tube connecting to an artificial kidney machine is inserted into an artery. The blood flows into the machine and is purified by an osmotic process. The purified blood is passed back into the body. Dialysis for diabetics with kidney failure works well for a time. But if there are problems in the other parts of the body such as the heart or nerves, it increases morbidity and mortality.

Transplant:Till recently diabetics were not considered for kidney transplants because increased blood glucose levels would lead to complications and survival rates were poor.

Today however, the prospects have improved as better control of diabetes is possible and rates of survival after transplants have improved.

Slowing down the pace of deterioration

The following steps help in the process of slowing down the progress of kidney disease in diabetics:

  • Blood glucose control is most essential.
  • Monitoring through both blood tests (for creatinine) and urine tests (for micro albumin and proteins).
  • Controlling Hypertension by medication.
  • Low protein diets are advised if a diabetic also has kidney disease.

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