Being Kind to Your Kidneys (Part 1)

When was the last time you thought about your kidneys? Was it when you had a kidney test (a microalbumin test, to be exact) at your doctor’s office? Many of us don’t give much thought to these two bean-shaped organs, but if you have diabetes, you may be worried about developing diabetic kidney disease. But as with other complications of diabetes[1], you can take steps to lower your risk of having kidney problems[2].


What do they do, anyway?
Let’s face it — the kidneys are not the most glamorous or exciting of organs. But they’re essential. And they do more than just excrete waste products. First, you might be interested in knowing that each of your kidneys is the size of a fist. They’re located near the middle of your back, just underneath your rib cage. Here’s the run-down of the role that the kidneys play in our health:

• They remove waste products from the blood. Your kidneys filter about 200 quarts of blood every day, removing 2 quarts of waste products that come from food and the breakdown of tissues, as well as water. These 2 quarts are in the form of urine, which is stored in the bladder.

• They filter out and retain substances that the body needs, such as sodium, phosphorous, and potassium.

• They help to balance the body’s fluids.

• They help regulate blood pressure by releasing a hormone called renin.

• They release a hormone called erythropoietin that triggers bone marrow to make red blood cells.

• They produce calcitriol, the active form of vitamin D.

• They help to remove drugs from the body.

Pretty impressive, when you stop and think about it. And you can understand why keeping your kidneys healthy is vital: We can’t survive without these organs.

How does diabetes play a role in kidney health?
Not everyone with diabetes will get kidney disease (sometimes called “diabetic nephropathy”). However, according to the CDC, more than 35% of adults with diabetes have chronic kidney disease.

Diabetes is likely to wreak havoc when blood glucose and A1C levels remain high for extended periods of time. High blood glucose levels can damage the blood vessels anywhere in the body, including those in the kidneys. When they’re damaged, the kidneys can’t do their job properly, and in particular, it means that they can’t filter out waste products from your blood all that well. Having uncontrolled high blood pressure is another major risk factor for diabetic kidney disease.

High blood glucose levels can also cause nerve damage. Nerves help to control the emptying of your bladder, and if they’re damaged, you can have difficulty doing so. Retaining urine in the bladder can lead to a bladder and/or kidney infection due to overgrowth of bacteria.

So here are some of the consequences of diabetic kidney disease:

• High blood glucose levels cause the kidneys to filter too much blood, which puts a strain on the filtering units of the kidneys (called the nephrons). As a result, the nephrons can start to leak and spill protein into the urine. This is called microalbuminuria. Microalbuminuria is an early sign of possible kidney problems, and a microalbumin test is one of those crucial tests that you should make sure you have done at least once a year.

• You may start to gain weight from fluid retention. You might notice this in your ankles, for example.

• You might urinate more frequently than usual.

• You may develop high blood pressure.

Later stages of kidney damage (called chronic kidney disease or chronic renal failure) can lead to more noticeable symptoms, including:

• High levels of BUN and creatinine in the blood (these are lab tests that indicate kidney function)

• Nausea and vomiting

• Itching

• Muscle cramps

• Anemia

• Weakness

• Loss of appetite

Also, people with chronic kidney disease tend to need less insulin and diabetes pills. The kidneys normally break down medications, but if they’re not working as they should, these medications stay more “active” in the body. Low blood glucose levels may occur, as a result.

Kidney failure may eventually occur. This is called end-stage renal failure. At this point, the kidneys are no longer able to function to sustain health (this occurs when the kidneys are working at only 10% or 15% capacity). In order to survive, the person must go on dialysis or have a kidney transplant.

It’s hard and scary to read about kidney failure. But know that there are things that you can do to greatly reduce your chances of having kidney problems, so stay hopeful! We’ll go over these next week.

  1. complications of diabetes:
  2. kidney problems:

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Amy Campbell: Amy Campbell is the author of Staying Healthy with Diabetes: Nutrition and Meal Planning and a frequent contributor to Diabetes Self-Management and Diabetes & You. She has co-authored several books, including the The Joslin Guide to Diabetes and the American Diabetes Association’s 16 Myths of a “Diabetic Diet,” for which she received a Will Solimene Award of Excellence in Medical Communication and a National Health Information Award in 2000. Amy also developed menus for Fit Not Fat at Forty Plus and co-authored Eat Carbs, Lose Weight with fitness expert Denise Austin. Amy earned a bachelor’s degree in nutrition from Simmons College and a master’s degree in nutrition education from Boston University. In addition to being a Registered Dietitian, she is a Certified Diabetes Educator and a member of the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators. Amy was formerly a Diabetes and Nutrition Educator at Joslin Diabetes Center, where she was responsible for the development, implementation, and evaluation of disease management programs, including clinical guideline and educational material development, and the development, testing, and implementation of disease management applications. She is currently the Director of Clinical Education Content Development and Training at Good Measures. Amy has developed and conducted training sessions for various disease and case management programs and is a frequent presenter at disease management events.

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